本文選題：二甲基甲酰胺 + 健康監(jiān)護(hù)�。� 參考：《蘇州大學(xué)》2013年碩士論文

【摘要】：目的研究探討二甲基甲酰作業(yè)人群肝腎功能損害情況及相關(guān)指標(biāo)異常、甚至出現(xiàn)肝功能衰竭至死的原因，了解二甲基甲酰作業(yè)人群相關(guān)疾病的發(fā)生發(fā)展規(guī)律，探討二甲基甲酰胺作業(yè)人群的體檢周期，探索二甲基甲酰胺中毒敏感指標(biāo)，，為制定職業(yè)健康監(jiān)護(hù)方案提供客觀依據(jù)。 方法選定一家皮革生產(chǎn)企業(yè)DMF作業(yè)崗位工人作為研究對象，同時以該公司后勤等非接觸DMF作業(yè)人員為參照，收集2008-2012年接觸與非接觸人群的健康監(jiān)護(hù)結(jié)果，全面系統(tǒng)地分析DMF對健康狀況的影響，了解DMF濃度與相關(guān)指標(biāo)異常的關(guān)系，確定早期DMF中毒時的敏感指標(biāo)。再針對二甲基甲酰胺急性中毒頻發(fā)的特點(diǎn)，對該公司新錄用的DMF作業(yè)人員除進(jìn)行法定的崗前體檢外，進(jìn)行上崗后一周、兩周、一個月、三個月、六個月的健康檢查，檢查項目為全面分析后而制定的谷丙轉(zhuǎn)氨酶（ALT）、谷草轉(zhuǎn)氨酶（AST）、γ谷氨酰轉(zhuǎn)肽酶（γ-GT）等敏感生化指標(biāo)以及血常規(guī)、尿常規(guī)等指標(biāo)，計算異常率，為制定體檢周期提出建議。用SPSS12.0統(tǒng)計軟件包對結(jié)果進(jìn)行統(tǒng)計分析。 結(jié)果1.上崗后檢查人員510人，共計有124人主訴有消化系統(tǒng)癥狀，其中惡心86例（16.86%）、食欲下降35例（6.86%）、腹脹27例（8.63%）、腹痛30人（5.88%）；其次是呼吸系統(tǒng)和神經(jīng)系統(tǒng)癥狀，其中主訴咳嗽咽痛者9例（1.76%），失眠多夢者6例（1.18%），此外有15人主訴皮膚瘙癢者15例（2.94%）。除2人發(fā)現(xiàn)手臂部皮膚皮疹外，其余人員均未見明顯陽性體征。 2.上崗后各個時期肝功能檢查情況詳見表12。從表中可以看出，上崗后一周肝功能異常人數(shù)達(dá)43人，異常率達(dá)8.43%，上崗后兩周肝功能異常總?cè)藬?shù)達(dá)76人，異常率為14.90%，上崗后一個月肝功能異�？�?cè)藬?shù)為92人，異常率為18.04%。上崗后三個月肝功能異常人數(shù)為112人，異常率為21.96%，上崗后六個月肝功能異常總?cè)藬?shù)達(dá)118人，總異常率為23.14%。 3.上崗后血常規(guī)、尿常規(guī)、腎功能檢查情況與上崗前相比，差異無統(tǒng)計學(xué)意義。 結(jié)論1.二甲基甲酰胺作業(yè)人員上崗一周后即可出現(xiàn)明顯的肝功能異常，且部分人員肝功能異常出現(xiàn)早于消化道癥狀出現(xiàn)之前，因此早期篩查有助于發(fā)現(xiàn)職業(yè)敏感人群。 2.二甲基甲酰胺急性中毒人員肝功能指標(biāo)改變與空氣中二甲基甲酰胺濃度有明顯的劑量-反應(yīng)關(guān)系，采取針對性的控制措施降低車間空氣中DMF濃度，是最直接有效的方法。 3.二甲基甲酰胺職業(yè)健康監(jiān)護(hù)方案有待進(jìn)一步完善，制定合理的敏感指標(biāo)及適當(dāng)?shù)捏w檢周期有助于早期發(fā)現(xiàn)職業(yè)損害人群，對保障勞動者的健康有積極意義。
[Abstract]:Objective to study the damage of liver and kidney function and the abnormality of related indexes in the population exposed to dimethylformyl, even the causes of liver failure to death, and to understand the regularity of occurrence and development of related diseases in the population exposed to dimethylformyl. To explore the physical examination period of workers exposed to dimethylformamide, to explore the sensitive index of dimethylformamide poisoning, and to provide an objective basis for the establishment of occupational health monitoring scheme. Methods the DMF workers in a leather production enterprise were selected as the research objects. At the same time, the health monitoring results of non-contact DMF workers such as logistics were collected from 2008 to 2012, and the effects of DMF on health status were analyzed systematically, and the relationship between DMF concentration and abnormal related indexes was understood. To determine the sensitive indexes of early DMF poisoning. In view of the frequent incidence of acute dimethylformamide poisoning, the newly hired DMF workers in the company were given a health check one week, two weeks, one month, three months and six months after taking up the post, in addition to the statutory pre-job physical examination. The sensitive biochemical indexes such as alanine aminotransferase (alt), aspartate aminotransferase (alt), 緯 -glutamyl transpeptidase (緯 -GT), blood routine examination, urine routine, etc. The results were analyzed by SPSS 12.0 software package. There were 510 postmortem examiners, 124 of whom complained of digestive system symptoms, including 86 cases of nausea (16.86%), 35 cases of loss of appetite (6.86%), 27 cases of abdominal distension (8.63%), and 30 cases of abdominal pain (5.88%), followed by symptoms of respiratory system and nervous system. Among them, there were 9 cases with cough and pharynx, 6 cases with insomnia and dream, 15 cases with skin itching and 15 cases with skin pruritus. Except for 2 people who found skin rash in the arm, no obvious positive signs were found in the others. 2. 2. The liver function examination of each period after going on duty is detailed in Table 12. It can be seen from the table that the number of abnormal liver function is 43 and the abnormal rate is 8.43. The total number of abnormal liver function is 76 in two weeks, the abnormal rate is 14.90, and the total number of abnormal liver function is 92 in one month after taking up the post, the abnormal rate is 18.04. The number of patients with abnormal liver function was 112 and the abnormal rate was 21.96. the total number of patients with abnormal liver function was 118 and the total abnormal rate was 23.14.3. There was no significant difference in blood routine, urine routine and renal function between post and post. Conclusion 1.Conclusion 1. Dimethylformamide workers can have obvious liver dysfunction after one week, and some of them have abnormal liver function earlier than before digestive tract symptoms, so early screening can help to find occupational sensitive population. 2. There was a significant dose-response relationship between the change of liver function index and the concentration of dimethylformamide in the air. It is the most direct and effective method to reduce the DMF concentration in the air of the workshop by taking targeted control measures. 3. The dimethylformamide occupational health monitoring scheme needs to be further improved. The establishment of reasonable sensitive indicators and proper physical examination cycle is helpful for early detection of occupational injury population and has positive significance for the protection of workers' health.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R135

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