深圳市申请职业病诊断307例分析

Occupational disease diagnosis for 307 cases in Shenzhen

目的了解职业病诊断组织材料、诊断结局和可能的影响因素,为开展职业病诊断工作提供参考。方法回顾性分析深圳市级职业病诊断机构2016年完成职业病诊断流程的307例诊断病例资料。结果病例来源属于疑似职业病病例的256例,占83.39%,未定为疑似职业病的51例,占16.61%;由用人单位主导提请职业病诊断的250例,占81.43%,劳动者个人要求职业病诊断的57例,占18.57%;按要求一次性提交齐全资料125例,另182例均书面发出补充职业病诊断材料通知书;职业病诊断耗费时间中位数31 d。职业病诊断以职业性噪声聋为主,其次为化学中毒、尘肺病,分别有195、37、29例。确诊为职业病163例,占53.09%,不能诊断为职业病144例,占46.91%。职业性肿瘤的确诊率最低,占提请诊断例数的三分之一,其次是职业性皮肤病和职业性噪声聋,均未超过50.00%。不能诊断为职业病的主要原因:噪声聋类病例为较好耳听阈加权值<26 dB,客观听力结果不支持纯音测听结果,连续噪声作业工龄<3年;苯中毒类病例为无明确的苯接触史;尘肺病类为胸片影像学改变与粉尘接触史不相符。申请市级职业病鉴定51例,占16.61%,鉴定结果与诊断结论不一致12例。结论应控制职业健康检查质量,严格把握发出疑似职业病报告卡的条件,及重视客观听力检查的作用,以提高职业病诊断确诊率。职业病诊断应明确职业病诊断的依据,可减少申请职业病鉴定病例。职业病诊断工作总体顺利开展,可通过品管方法完善职业病诊断流程,提高当事人诊断体验。

Objective To investigate organizing materials, diagnosis results and possible influencing factors ofoccupational disease diagnosis, and to provide reference for better diagnosis of occupational diseases. Methods Aretrospective analysis of 307 cases of occupational disease diagnosis records completed by a municipal occupational diseasediagnosis institution in 2016 was conducted. Results A total of 256 cases(83.39%) came from suspected occupationaldiseases, and the other 51 cases(16.61%) applied for diagnosis of occupational disease were not identified as suspected;250cases(81.43%) were applied for diagnosis of occupational disease by employers and the other 57 cases(18.57%) by workers;125 cases were submitted by materials completely at one time as required, and the other 182 cases were mailed with notice tothe employers to supplement the required information. The median time spent on occupational disease diagnosis was 31 d. Thediagnosed cases were dominated by occupational noise-induced deafness, followed by chemical poisoning and pneumoconiosis,with 195, 37, and 29 cases, respectively. And 163 cases(53.09%) were diagnosed as occupational diseases, and the other 144cases(46.91%) were not. The diagnosis rate of occupational tumors was the lowest, accounting for one-third, followed byoccupational skin diseases and occupational noise-induced deafness, all of which did not exceed 50.00%. The main causes offailure to be diagnosed as occupational diseasesare as follows:cases applying for noise-induced deafness that the monauralthreshold of weighted value(MTWV) of the good ear is lower than 26 d B, and the objective hearing results do not support theresults of pure tone audiometry, and continuous noise operation working age <3 years;cases applying for benzene poisoninghave no clear evidence of occupational benzene exposure;chest radiographic changes is not consistent with the dust contactoccupational history to the cases of pneumoconiosis category. And 51 out of 307 cases had applied for municipal occupationaldisease appraise(16.61%), and there were 12 cases that the appraise results were inconsistent with the diagnosis conclusions.Conclusion The goal is to improve the diagnosis rate of occupational diseases, we should control quality of occupationalhealth examination and control conditions for issuing suspected occupational disease report cards, and emphasize the role ofobjective hearing examination. We should clarify the basis for diagnosis of occupational diseases to reduce the number of caseswho apply for occupational disease appraise. The diagnosis of occupational diseases has been carried out smoothly. We shouldimprove the diagnostic process by quality control to enhance the diagnostic experience of the parties concerned.