二甲基甲酰胺对作业人群的健康影响及体检周期的探讨

发布时间：2018-06-11 11:55

本文选题：二甲基甲酰胺 + 健康监护　；参考：《苏州大学》2013年硕士论文

【摘要】：目的研究探讨二甲基甲酰作业人群肝肾功能损害情况及相关指标异常、甚至出现肝功能衰竭至死的原因，了解二甲基甲酰作业人群相关疾病的发生发展规律，探讨二甲基甲酰胺作业人群的体检周期，探索二甲基甲酰胺中毒敏感指标，，为制定职业健康监护方案提供客观依据。方法选定一家皮革生产企业DMF作业岗位工人作为研究对象，同时以该公司后勤等非接触DMF作业人员为参照，收集2008-2012年接触与非接触人群的健康监护结果，全面系统地分析DMF对健康状况的影响，了解DMF浓度与相关指标异常的关系，确定早期DMF中毒时的敏感指标。再针对二甲基甲酰胺急性中毒频发的特点，对该公司新录用的DMF作业人员除进行法定的岗前体检外，进行上岗后一周、两周、一个月、三个月、六个月的健康检查，检查项目为全面分析后而制定的谷丙转氨酶（ALT）、谷草转氨酶（AST）、γ谷氨酰转肽酶（γ-GT）等敏感生化指标以及血常规、尿常规等指标，计算异常率，为制定体检周期提出建议。用SPSS12.0统计软件包对结果进行统计分析。结果1.上岗后检查人员510人，共计有124人主诉有消化系统症状，其中恶心86例（16.86%）、食欲下降35例（6.86%）、腹胀27例（8.63%）、腹痛30人（5.88%）；其次是呼吸系统和神经系统症状，其中主诉咳嗽咽痛者9例（1.76%），失眠多梦者6例（1.18%），此外有15人主诉皮肤瘙痒者15例（2.94%）。除2人发现手臂部皮肤皮疹外，其余人员均未见明显阳性体征。 2.上岗后各个时期肝功能检查情况详见表12。从表中可以看出，上岗后一周肝功能异常人数达43人，异常率达8.43%，上岗后两周肝功能异常总人数达76人，异常率为14.90%，上岗后一个月肝功能异常总人数为92人，异常率为18.04%。上岗后三个月肝功能异常人数为112人，异常率为21.96%，上岗后六个月肝功能异常总人数达118人，总异常率为23.14%。 3.上岗后血常规、尿常规、肾功能检查情况与上岗前相比，差异无统计学意义。结论1.二甲基甲酰胺作业人员上岗一周后即可出现明显的肝功能异常，且部分人员肝功能异常出现早于消化道症状出现之前，因此早期筛查有助于发现职业敏感人群。 2.二甲基甲酰胺急性中毒人员肝功能指标改变与空气中二甲基甲酰胺浓度有明显的剂量-反应关系，采取针对性的控制措施降低车间空气中DMF浓度，是最直接有效的方法。 3.二甲基甲酰胺职业健康监护方案有待进一步完善，制定合理的敏感指标及适当的体检周期有助于早期发现职业损害人群，对保障劳动者的健康有积极意义。
[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), 纬 -glutamyl transpeptidase (纬 -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.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R135

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