本文關鍵詞： 錫冶煉工人 接塵工齡 塵肺 錫塵 肺纖維化　出處：《廣西醫(yī)科大學》2012年碩士論文　論文類型：學位論文

【摘要】：目的：了解錫冶煉工人塵肺病的發(fā)病情況,并分析其與工人接塵工齡之間的相關關系；探討錫冶煉生產(chǎn)性粉塵對肺組織的損傷及其程度,推測接塵工人引起塵肺病的可能性。 方法：(1)采用橫斷面調(diào)查研究方法,收集廣西某冶煉廠錫冶煉車間所有在崗的冶煉工人2010年的體格檢查資料,以及其中的塵肺病患者的全部診斷資料。運用現(xiàn)時壽命表法計算患者工齡累積發(fā)病概率和工人塵肺病累積患病率,應用SPSS16.0統(tǒng)計軟件進行接塵工齡與工人累積患病率的相關回歸分析。 (2)收集廣西某冶煉廠錫冶煉車間粗煉車間和精煉車間的呼吸帶高度自然沉降的生產(chǎn)性粉塵,篩選粒度5μ m的呼吸性粉塵,并測定其分散度及游離二氧化硅含量,生理鹽水配制成50mg/ml的濃度進行實驗。選擇SPF級SD大鼠,隨機分成粗煉車間錫冶煉粉塵組、精煉車間錫冶煉粉塵組及標準石英粉塵陽性對照組和生理鹽水陰性對照組,以1ml/只的劑量通過非暴露式氣管內(nèi)染塵方法對大鼠進行染塵,觀察第30天和第90天的肺組織病理切片,并測量大鼠體重及全肺濕重,計算肺臟器系數(shù),應用SPSS16.0統(tǒng)計軟件分析各組間肺臟器系數(shù)的差異。 結果：(1)一般情況及塵肺病發(fā)病情況：錫冶煉車間共385名冶煉工人,其中男性354人,女性31人,年齡在19-56歲；總工齡在0.17-38.00年,平均總工齡16.51年；接塵工齡0.17-36.00年,平均接塵工齡15.62年。385名錫冶煉工中有9例確診為塵肺病患者,均為男性,檢出率為2.34%,患者確診為塵肺病時的年齡在34～55(39.0±5.1)歲,接塵工齡9-18(15.6±3.1)年。 (2)患者工齡累積發(fā)病率：該廠錫冶煉工人塵肺病患者發(fā)病的接塵工齡在9-18年,發(fā)病率隨著接塵工齡的增加逐漸升高,接塵工齡在13-18年發(fā)病率迅速升高。 (3)塵肺病累積患病率及其與接塵工齡的相關分析：錫冶煉生產(chǎn)工人中塵肺病的患病人數(shù)集中在接塵工齡9-23年間,接塵工齡與塵肺病累積患病率之間呈高度正相關[相關系數(shù)(r)=0.933,P0.05],回歸方程為y=O.003x-0.012。 (4)錫冶煉車間生產(chǎn)性粉塵游離二氧化硅含量：粗煉車間粉塵游離氧化硅含最為53.19%,精煉車間粉塵為44.25%：經(jīng)篩選后兩車間粉塵粒度5μ m的塵粒所占百分數(shù)均在90%以上。 (5)大鼠肺臟器系數(shù)比較：染塵后第30天,粗煉車間粉塵組與陰性對照組和陽性對照組之間的差異均有統(tǒng)計學意義(p0.05),精煉車間粉塵組與陰性對照組之間的差異有統(tǒng)計學意義(p0.05),而與陽性對照組之間的差異無統(tǒng)計學意義(p0.05)；第90天,粗煉車間粉塵組與陰性對照組之間的差異無統(tǒng)計學意義(p0.05),而與陽性對照組之間的差異有統(tǒng)計學意義(p0.05),精煉車間粉塵組與陰性對照組和陽性對照組之間的差異均有統(tǒng)計學意義(p0.05)。 (6)肺組織病理觀察：肉眼觀察,30天時,粗煉組兩肺組織呈淡紅色,表面可見散在針頭大小的中心為暗黑色、周圍灰白色斑點,精煉組可見散在中心為灰黑色、周圍灰白色斑點,形狀不規(guī)則；90天時,粗煉組部分大鼠肺組織呈灰白色實變狀,表面可見散在灰白色斑點,質(zhì)地較韌,精煉組部分大鼠肺組織表面呈灰黑色實變狀,尚有灰白色斑點。 鏡下觀察,兩組均可見散在粉塵顆粒沉著和塵灶形成,多位于細支氣管、終末支氣管、肺泡管周圍,塵灶內(nèi)可見巨噬細胞、纖維母細胞、中性粒細胞和淋巴細胞反應,均發(fā)生炎癥反應,第90天時,粗煉組可見有塵-炎性肉芽腫形成。 結論：(1)錫冶煉工人接塵工齡與塵肺病累積患病率之間關系密切,在該廠現(xiàn)有勞動條件下,若想把塵肺病的患病率控制在1%左右,工人的接塵工齡期限以不超過7年為宜。 (2)錫冶煉粗煉車間和精煉車間生產(chǎn)性粉塵致染塵動物第30天和第90天的肺組織病理變化表現(xiàn)為炎癥反應、粉塵顆粒沉著和塵灶形成,塵灶內(nèi)可見少量巨噬細胞、淋巴細胞增生,粗煉車間粉塵還可見塵炎性肉芽腫形成,塵肺早期病變形成,但由于觀察時間較短,尚需觀察更長時間或做進一步深入研究。
[Abstract]:Objective: to understand the incidence of pneumoconiosis in tin smelting workers, and analyze the relationship between them and the workers' age of dust exposure, explore the damage and degree of tin smelting dust on lung tissue, and predict the possibility of pneumoconiosis caused by dust workers.
Methods: (1) using the method of cross-sectional study, physical examination data collected in Guangxi smelter tin smelting workshop all in smelting workers in 2010, and the patients with pneumoconiosis diagnosis. All the data using current life table method with seniority cumulative incidence and workers pneumoconiosis cumulative prevalence rate, using SPSS16.0 statistical software by regression analysis of the dust exposed workers with cumulative prevalence.
(2) the collection of Guangxi smelter smelting workshop tin smelting workshop and refining plant breathing zone height natural sedimentation dust production, screening of particle size of 5 mu m respirable dust, and determination of the dispersion and free silica content, physiological saline into the experiment. The concentration of 50mg/ml SPF SD rats and randomly divided into smelting workshop of tin smelting dust group, refining workshop tin smelting dust standard quartz dust group and positive control group and saline control group, with only 1ml/ dose by non exposed endotracheal dust method on rats exposed to dust, observation of lung tissue pathological sections of thirtieth days and ninetieth days. And measure the body weight of rats and the whole lung wet weight, lung coefficient calculation, analysis of differences in lung coefficient between groups using SPSS16.0 statistical software.
Results: (1) the general situation and the incidence of pneumoconiosis: tin smelting workshop a total of 385 smelting workers, including 354 males and 31 females, aged 19-56; the total length of service in 0.17-38.00 years, the average total length of 16.51 years; the dust exposed 0.17-36.00 years, the average exposure time of 15.62 years.385 tin smelting in 9 cases of pneumoconiosis patients were male, the detection rate was 2.34%, the patients diagnosed with pneumoconiosis disease at the age of 34~55 (39 + 5.1) years of age, exposure time 9-18 (15.6 + 3.1) years.
(2) the cumulative incidence of patient age: the age of dust exposed workers in tin smelter workers is 9-18 Years, the incidence rate increases with the increase of dust exposure age, and the incidence of dust exposure increases rapidly in 13-18 years.
(3) the cumulative pneumoconiosis and dust exposed correlation analysis: prevalence of tin smelting production workers pneumoconiosis prevalence in the dust exposed 9-23 years, showed a highly positive correlation [correlation coefficient between the exposure time and the cumulative incidence of pneumoconiosis (R) =0.933, P0.05], the regression equation was y=O.003x-0.012.
(4) the content of productive dust and free silica in tin smelting workshop: the dust in the refining workshop is 53.19% and the dust in the refining workshop is 44.25%. After screening, the percentage of dust particles 5 mu m in two workshops is above 90%.
(5) the rat lung coefficient: thirtieth days after exposure to dust, smelting workshop dust group and the differences between the negative control group and positive control group were statistically significant (P0.05), the difference between refining workshop dust group and the negative control group was statistically significant (P0.05), while there was no significant difference between the positive control group (P0.05); the ninetieth day, there was no significant difference between the smelting workshop dust group and negative control group (P0.05), and the difference was statistically significant between the positive control group (P0.05), refining workshop dust group and the negative control group and positive control group differences were statistically significant (P0.05).
(6) the pathological observation of lung tissue: the naked eye, 30 days, two refined group lung tissue was light red, the surface scattered in needle size centered around the dark black, gray white spots, refining group scattered in the center for the surrounding gray black, white spots, irregular shape; 90 days. The lung tissue of rats with refined group showed gray real shape, surface scattered grayish white spots, texture and tough, refining part of rat lung tissue surface grayish black real shape, there are still gray spots.
Under the microscope, the two groups were scattered in the dust particles and dust deposition foci located in the bronchioles, terminal bronchioles, alveolar ducts around dust foci could be seen in the macrophages, fibroblasts, neutrophils and lymphocytes, were inflammation, ninetieth days, smelting dust - visible group inflammatory granuloma formation.
Conclusion: (1) there is a close relationship between the duration of dust exposure and the cumulative incidence of pneumoconiosis in tin smelters. Under the existing working conditions of the factory, if we want to control the prevalence of pneumoconiosis at about 1%, the workers' duration of dust exposure is no more than 7 years.
(2) tin smelting smelting workshop and refining workshop production of dust caused by dyeing changes and ninetieth days of lung tissue showed inflammation of thirtieth animal dust, dust and dust granules in foci within a small amount of dust focal macrophage, lymphocyte proliferation, smelting workshop dust dust visible inflammatory granuloma, pneumoconiosis the early lesion formation, but due to the shorter observation time, still need to observe the longer time or do further research.

【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R135.2

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