《职业性刺激性化学物致慢性阻塞性肺疾病的诊断》标准应用的德尔菲法评价

Evaluation of the standard application of Delphi in the diagnosis of chronic obstructive pulmonary disease caused by occupational irritant chemicals

目的探讨GBZ237—2011《职业性刺激性化学物致慢性阻塞性肺疾病的诊断》标准（以下简称《标准》）在应用中遇到的问题，减少职业性慢阻肺患者的漏诊人数，为新标准修订提供参考。方法采用德尔菲（Delphi）专家调研法，征求专家意见，内容包括3个一级指标：内涵评估、实施评估、可操作性评估及若干个二级指标。经过资深专家论证，分析《标准》评价的指标体系在实际工作中的应用情况。结果通过德尔菲专家调查法，发现专家评价中对标准中3个一级指标均数大于7、变异系数小于0．25，专家在内涵评估、实施评估意见上一致，但损伤性评估中职业接触史、岗前无呼吸系统损害症状、吸烟史、早期发病症状与职业环境有关二级指标均数小于7、变异系数大于0．25，专家意见不一致。专家们根据临床经验，认为应该扩大职业性刺激性气体范围，并且诊断过程中对吸烟问题、工龄确定、职业接触史等问题的操作性提出异议。结论自2011年颁布实施《标准》以来，在实施过程中出现了标准范围局限性、干扰因素排除困难、工龄限制等问题，这些问题使得很多长期接触刺激性气体的职业人群患有“职业性慢性呼吸系统疾病”而得不到明确诊断。

Objective To investigate the problems encountered in the application of the standard （hereinafter referred to as standard） for the diagnosis of chronic obstructive pulmonary disease caused by occupational irritant chemicals, to provide reference for the revision of the new standard, to reduce the number of missed patients in occupational COPD, and to get rid of the working environment of those who suffer from chronic respiratory diseases due to long-term exposure to poisons., slowing the progression of the disease. Methods Using Delphi （Delphi） Expert research method, after the senior experts to demonstrate, to understand the GBZ 237-2011 ＂occupational irritant chemicals to the diagnosis of chronic obstructive pulmonary disease＂ standard evaluation of the system encountered problems, to seek expert advice, The problems encountered during the clinical implementation of the standards promulgated in 2011 are presented. Results Through the Delphi Expert investigation method, it is found that experts agree on the content evaluation and implementation evaluation in the standard, but the operational evaluation of the standard is disputed. According to the clinical experience, the experts believe that the range of occupational irritant gases should be expanded, and the operation of the problem of smoking, seniority determination and occupational contact history should be challenged during the diagnosis. Conclusions Since the promulgation in 2011 of the criteria for the diagnosis of chronic obstructive pulmonary disease caused by occupational stimulant chemicals, there have been some problems in the implementation process, which have caused many occupationally exposed to irritating gases to suffer from ＂occupational chronic respiratory Diseases＂ without a definitive diagnosis.