经口摄入致群发性职业性慢性铅中毒事故特征分析

Characteristics of an incident of occupational chronic lead poisoning by oral intake

目的调查分析一起群发性职业性慢性铅中毒事故特征。方法运用工作场所现场调查、空气监测、员工职业健康检查等职业流行病学调查方法和临床资料分析,阐明2017年东莞市某电子厂一起群发性职业性慢性铅中毒事故致病途径和发病特征。结果该公司玻壳车间员工共计87人,血铅检出浓度范围为103.15~755.70μg/L,中位数为364.0μg/L。超过诊断值水平(>600μg/L)4例,超过生物接触限值水平(400~600μg/L)24例,共计5例诊断为职业性慢性铅中毒;工作场所空气中铅烟(尘)接触水平为<0.001~0.022 mg/m^3。其余车间408名员工(对照)血铅检出浓度范围为26.91~184.23μg/L,中位数为53.82μg/L;工作场所空气中铅烟(尘)接触水平为<0.001 mg/m^3。玻壳车间员工血铅水平显著高于其余车间(P<0.01),玻壳车间不同岗位、工龄员工血铅水平上差异有统计学意义(P<0.05、P<0.01);而在不同性别员工血铅水平差异无统计学意义(P>0.05)。玻壳车间员工该种作业和接触方式下血铅水平逐年升高,接触9年后基本维持在生物接触限值水平。结论玻壳车间员工为涉铅作业,是一起工作场所空气中铅浓度低于接触限值,经口摄入致群发性职业性铅中毒,主要为用人单位个人卫生管理缺失,经消化道摄入导致群发性职业性慢性铅中毒事故。

Objective To investigate and analyze the characteristics of an incident of occupational chronic lead poisoning.Methods The pathogenetic pathways and characteristics of an incident of occupational chronic lead poisoning in an electronics factory in Dongguan City in 2017 were elucidated by occupational epidemiological investigation methods and clinical data analysis,such as field investigation,air monitoring and occupational health examination. Results The range of blood lead concentration of all 87 workers in the glass-bulb workshop of the factory was 103. 15-755. 70 μg/L,with the median concentration being364.0 μg/L. The blood lead concentration of 4 cases exceeded the diagnostic value（〉 600 μg/L）. The blood lead concentration of24 cases exceeded the biological contact limit of lead（ 400-600 μg/L）. A total of 5 cases were diagnosed as occupational chronic lead poisoning. The contact concentration of lead fume/dust in the air of the glass-bulb workshop was 0.001-0.022 mg/m^3. The range of blood lead concentration of 408 workers（ serving as the controls） in other workshops was 26.91-184.23 μg/L,with the median concentration being 53. 82 μg/L. The contact concentration of lead fume/dust in the air of other workshops was〈0.001 mg/m^3. The blood lead level was significantly hig her in workers of the glass-bulb workshop than in those of other workshops（ P〈0.01）. The blood lead level showed statistically significant differences among workers with different posts and working years in the glass-bulb workshop（ P〈0.05,P〈0.01）,but no statistically significant difference was found between male and female workers（ P〉0.05）. The blood lead level of workers with above-mentioned operation and occupational exposure setting in the glass-bulb workshop increased year by year,and their blood lead level was basically maintained at the level of biological contact limit after 9 years of exposure. Conclusions The workers in the glass-bulb workshop were exposed to lead,but the concentration of occupational lead exposure in the air of the workplace was below the limit. The results reveal that it is an incident of occupational chronic lead poisoning induced by oral intake,and the main reason for the incident is insufficient management of personal hygiene in the factory.