《职业性刺激性化学物致慢性阻塞性肺疾病的诊断》标准的德尔菲法专家调研

Delphy expert survey on diagnosis of chronic obstructive pulmonary disease caused by occupational irritant chemicals

目的探讨GBZ／T237-2011版《职业性刺激性化学物致慢性阻塞性肺疾病的诊断》标准指标体系在应用中遇到的问题，为新标准修订提供参考。方法采用德尔菲（Delphi）专家调研法，对《职业性刺激性化学物致慢性阻塞性肺疾病的诊断》的6个一级指标（适用范围、诊断原则、诊断指标、处理原则、诊断分级、附录A）及其相应的若干个二级指标的合理性咨询专家意见。结果第一轮德尔菲法结果：适用范围中关于标准适用范围的问题，诊断指标中关于长期职业史问题、吸烟史问题、临床诊断指标问题的合理性均数小于7，变异系数大于0．25，表明专家对原标准中适用范围提出异议；诊断指标中长期职业史问题、吸烟问题过于苛刻给临床诊断带来了困难。第二轮德尔菲法结果：适用范围中扩大职业性刺激性气体范围均数为7，变异系数为0．24，表明专家意见集中，认为可以扩大适用范围；诊断指标中无明确吸烟史、3年工龄均数分别为1．78、3．43（小于7），表明专家意见一致，认为这两个诊断指标不利于职业病临床医师的实践工作，可以考虑去除此类诊断指标；诊断指标中综合考虑吸烟史、吸烟量以包．年衡量、均数分别为7．6l、7．61（大于7），变异系数小于0．25，表明专家意见集中，一致认为可以考虑把这类指标纳入诊断指标体系。结论《职业性刺激性化学物致慢性阻塞性肺疾病的诊断》在实施过程中应采取的改进措施是扩大职业性刺激性气体范围，吸烟问题可以结合临床综合考虑，职业接触史可考虑适当缩减。

Objective o explore the problems encountered in the application of GBZ/T 237-2011 edition of ＂Diagnosis of Chronic Obstructive Pulmonary Disease Caused by Occupational Stimulating Chemicals＂, and to provide reference for the revision of the new standard. Methods Delphi expert survey method was used to consult experts on the reasonableness of six primary indicators （scope of application, diagnostic principles, diagnostic indicators, treatment principles, diagnostic grading, appendix A） and their corresponding secondary indicators in the Diagnosis of Chronic Obstructive Pulmonary Disease （COPD） caused by Occupational Stimulant Chemicals. Results The results of the first round of Delphi method showed that the reasonable mean of the diagnostic criteria about long-term occ, upational history, smoking history and clinical diagnostic criteria was less than 7, and the coefficient of variation was greater than 0.25, indicating that the experts disagreed with the scope of application of the original criteria ; the average of smoking history and 3-year working age were 1.78 and 3.43 （less than 7） respectively, which indicated that the experts agreed that the two diagnostic indexes were not conducive to the practical work of oecupational disease clinicians;among the diagnostic indicators, smoking history and smoking volume were taken into account in a comprehensive way, and the average values were 7.61 and 7.61 （greater than 7）, respectively, the coefficient of variation was less than 0.25, indicating that the experts had concentrated their opinions and agreed that such indicators could be considered into the diagnostic index system.Conclusion ＂Diagnosis of Chronic Obstructive Puhnonary Disease Caused by Occupational Stimulating Chemicals＂ should be improved by expanding the scope of occupational irritant gases. Smoking problems can be considered in combination with clinical practice, and occupational exposure history can be considered to reduce appropriately.