【作者】 陈立新；

【导师】 汤建国；

【作者基本信息】 浙江大学 ， 临床医学， 2010， 硕士

【摘要】 背景和目的：建德市存在一定数量的电镀企业,它们规模小,工艺落后和防护措施滞后。工人流动性大,大多工人为外籍人员,文化水平低下,防护意识淡薄。常导致严重的鼻部损害。因此,此次调查首先在于摸清本市电镀作业工人铬污染状况,为下一步采取治理措施提供必要的准备。其次,作业场所空气采样测定铬含量不能准确反映个体所受的铬污染,而目前厂方和监测机构又不具备购置个体采样器的意愿与资金。故拟采用鼻灌洗方法采集鼻腔灌洗液测定其中的铬含量从而反映个体所受的铬污染状况。最后,随着六价铬化合物健康危害被广泛认识,人们更加关注接触低浓度铬盐劳动者健康危险的评价。故而测定红细胞铬含量以反映低剂量六价铬近期接触的情况。对象与方法：对建德市二个电镀企业的36名铬接触工人进行调查。采取作业现场铬浓度监测：铬作业2小时后于工人呼吸带高度用79-4型粉尘采样仪,双层滤膜阻留采集样本150L。样品用二苯碳酰二肼电比色法定量测定；流行病学调查：通过设计表格,进行问卷调查,内容包括：姓名、性别、年龄、工龄、学历、职业接触史、烟酒史、个人防护如戴口罩、手套等。生产企业劳动卫生学调查：包括生产工艺流程,防护措施等；个人职业卫生与防护意识：如个人防护用品使用、挖鼻习惯等；铬接触者的体格检查和鼻铬污染量的测定：后者可采用鼻腔灌洗方法收集灌洗液进行测定；采用PPD、血清梅毒抗体、鼻窦CT、鼻内镜下鼻组织活检：以排除可能引起的鼻中隔损伤的其他疾病；红细胞铬含量：反映低剂量六价铬近期接触的情况。结果：1,作业场所铬浓度短时间浓度范围和时间加权浓度均符合国家标准2,工人以外地人员为主,学历低(初中及以下者占88.9%),防护意识差(94.4%不戴口罩)3,36名被调查者中发现鼻中隔糜烂11人,占30.5%；鼻中隔溃疡5人,占13.9%；鼻中隔穿孔3人,占8.3%。PPD、梅毒抗体均为阴性,鼻中隔穿孔3人经活组织检查排除特异性感染和其他病变。4,鼻腔灌洗液中铬含量接触组与对照组相比,具有统计学差异,(P<0.05)。5,铬接触工人红细胞铬含量(平均5.16μg)明显高于正常值(0.5μg)。结论：1,铬接触工人鼻中隔病变较为严重。2,鼻腔灌洗法可能成为个体采样器的替代方法。3,红细胞铬含量可以反映低剂量六价铬近期接触情况。更多还原

【Abstract】 Background and objective:there are a lot of electroplate corporations in Jian de city, which are of small size, outdated equipments and poor safeguards. The platers (most of them are Migrant workers) are always on moving, they are poor educated and don’t pay attention to the importance of safeguard so that their nasal cavity been damaged during working. The purpose of this research is to understand the pollution of the chrome of the platers in Jian de city and look for the way how to deal with the problem. Secondly, the pollution of the chrome can not be reflected by the total Chromium which measured from the air of the workplace. We take the way of monitoring the total chromium by collecting nasal lavage. Finally, if the harm of Hexavalent chromium compounds is widely accepted by human being, it would be emphasized that the importance of revaluing the health risks of the workers who contact with low concentrations of chromium salts.Materials and methods:The investigated workers contained 36 workers who contacting with chrome in two galvanization enterprise of Jiande. Monitoring the concentration of the chrome in the workplace:we used 79-4 dust sampling meter to monitor the breaths of the workers after Chromium work for 2 hours, with double-decked filter diaphragm detention gathering sample 150L. The samples were quantitatively determinated with the benzoin carbonyl two jing electricity color method. Epidemiology investigation:by designing the form of questionnaire survey which including name, sex, age, seniority, and academy degree; history of occupational exposure, history of tobacco and alcohol, individual safeguard such as wearing the respirator, the glove and so on. Production enterprise work hygiene investigation, including technique of production flow, safeguard measure and so on. Individual occupational hygiene and safeguard consciousness:for example, using personal protective articles, the custom of digging the nose and so on. Physical examination of Chromium contactors and nasal chromium level of contamination measure:the later may be collected from nasal lavage. PPD, Syphilis antibodies in serum, nasal sinus CT, Nasal biopsy were used to exclude the possibile diseases which may cause the injury of nasal septum. Red blood cell chromium content was checked to reflect the low dose six price chromium which contacted recently.Results:1 The chromium concentration and time of work place conformed to meet the national standards2 Most of the workers are mirgant, low educated (junior middle school and below account for 88.9%), their safegurard consciousnes was poor (94.4%do not wear respirator)3 Erosion of nasal septum(11),nasal septum ulcer (5) and nasal septum perforation(3) were found, PPD, Syphilis serologyly were negative, the 3 people who suffer from nasal septum perforation underwent the nasal biopsy to exclude the specificity infection and other pathological changes.4 Comparing the total chromium of nasal lavage of the chromium contact group with the control group, it was significnt difference, P<0.055. RBC chromium content(5.16μg) of the chromium contact group was obviously higher than the normal(0.5μg).Conclusion:1 Chromium-contacted worker had more serious disease of nose2 Nasal lavage may be replace the individual sampling3 Red blood cell chromium content may reflect that the low-dose hexavalent chromium recently更多还原