677名接触无机氟工人职业健康检查结果分析

Analysis on results of occupational health examination in 677 workers exposed to inorganic fluorine

目的分析氟及其无机化合物对作业工人的健康危害,为氟作业工人的防护及职业病诊断标准的修订提供技术支持。方法2019年1月,采用整群抽样方法,选择湖南省某氟化学公司接触氟工人677人作为调查对象,进行职业健康检查,并对疑似职业中毒人员行职业病诊断,根据诊断结果分为中毒组和非中毒组,采用t检验、Pearsonχ^(2)检验进行统计学分析。结果共诊断73名职业性慢性氟及其无机化合物中毒,93.15%(68/73)多发骨骼病变,病变好发部位以胫腓骨上段为主,胫骨、腓骨及尺桡骨病变有35.00%(21/60)、50.00%(18/36)和58.82%(10/17),仅在单侧出现。其他异常结果检出率主要为牙结石(60.71%,411/677)、脂肪肝(48.89%,331/677)、心电图异常(44.17%,299/677)、骨量减少(33.53%,227/677)、谷丙转氨酶(ALT)升高(13.15%,89/677)。与非中毒组比较,中毒组工人的年龄、接触氟工龄和脂肪肝检出率更高,差异均有统计学意义(P<0.01)。结论无机氟所致长骨骨质改变部分仅发生在单侧,因此职业健康检查的基本摄片部位应包括双侧长骨,以免漏诊;单发轻微的骨膜骨化诊断职业中毒难以把握,建议标准修订时对其程度做出明确规定。

Objective To analyze the health hazards of fluorine and its inorganic compounds to workers exposed to fluorine,and to provide technical support for the protection of workers exposed to fluorine and the revision of occupational disease diagnostic standards.Methods In January 2019,677 workers exposed to fluorine in a fluorine chemical company in Hunan Province were selected by cluster sampling,and occupational health examination was conducted.The suspected occupational poisoning workers were diagnosed as occupational diseases,which were divided into poisoning group and non-poisoning group.T test and Pearsonχ^(2) test were used for statistical analysis.Results A total of 73 occupational chronic fluorosis patients were diagnosed.93.15%(68/73)of the skeletal lesions were multiple,and the most frequent sites were the upper tibia and fibula.35.00%(21/60),50.00%(18/36)and 58.82%(10/17)of the tibia,fibula,ulna and radius had periosteal changes only on one side.Other abnormal results were mainly dental calculus(60.71%,411/677),fatty liver(48.89%,331/677),abnormal electrocardiogram(44.17%,299/677),decreased bone mass(33.53%,227/677)and increased ALT(13.15%,89/677).Compared with non-poisoning group,the age,length of service exposed to fluoride and fatty liver detection rate of poisoning group were higher,and the differences were statistically significant(P<0.01).Conclusion The changes of long bone caused by inorganic fluoride only occur in one side,so the basic location of occupational health examination should include bilateral long bone to avoid missed diagnosis.It is difficult to diagnose occupational poisoning with single slight periosteal ossification,it is suggested that the standard should be revised to specify the degree.