GB 4865-1985 Occupational chronic allyl chloride poisoning diagnostic criteria and treatment principles
Some standard content:
National Standard of the People's Republic of China
Occupational chronic allyl chloride poisoning
Diagnostic criteria and principles of management ofoccupational chronic allyl chloride poisoningUDC616-057:613
. 632 : 678.743
CB 4865--85
Chronic allyl chloride poisoning is a disease characterized by peripheral nerve damage caused by close contact with chloroene (alkenyl chloride) in industrial production. Its clinical manifestations include varying degrees of distal limb sensation, movement or tendon reflex disorders, and neuro-electromyography can show neurogenic damage.
1 Diagnostic principles
According to the occupational history of long-term close contact with allyl chloride and clinical symptoms, signs and neuroelectromyographic changes mainly characterized by multiple peripheral nerve damage, combined with on-site hygiene investigation and air allyl chloride concentration measurement data, after excluding peripheral neuropathy caused by other causes, it can be diagnosed as chronic allyl chloride poisoning
2 Diagnosis and classification standards
2.1 Observation subjects
Those with any of the following can be listed as observation subjects. 2.1.1 Those with symptoms such as heaviness and weakness in both legs, numbness, soreness, cramping, and coldness in the distal limbs, or suspected neurogenic damage on the nerve electromyogram, but no signs of peripheral nerve damage. 2.1.2 Those with only suspected neurogenic damage on the nerve electromyogram but no typical symptoms and signs of peripheral nerve damage. 2.2 Mild poisoning
In addition to the above symptoms, those with any of the following can be diagnosed as mild poisoning. 2.2.1 Symmetrical pain, touch, and tuning fork vibration disorders in a sock-like distribution, with weakened Achilles tendon reflexes. 2.2.2 The signs are mild or not obvious, but the neuro-electromyography shows definite neurogenic damage. 2.3 Severe poisoning. Patients with any three of the following four manifestations can be diagnosed as severe poisoning. 2.3.1 Weakened limb muscle strength (muscle strength 3 degrees or less), or distal limb muscle atrophy. 2.3.2 Pain, touch, and tuning fork movement disorders in the limbs, most of which are symmetrically distributed in a sock-like distribution, reaching the elbows or knees. 2.3.3 Achilles tendon reflex disappears.
2.3.4 Neurogenic damage is found in electromyography, and there are many spontaneous neural potentials. 9 Treatment principles
It can be treated with B vitamins, energy single compound or Chinese medicine with blood circulation and collateral activating effect, supplemented by physical therapy, physiotherapy, acupuncture therapy and symptomatic treatment.
4 Labor capacity assessment
4.1 Observation subjects
Generally, they are not transferred from chloropropylene operation, and they should be reexamined every six months, and neuro-electromyography examination should be performed as much as possible to allow dynamic observation. Ministry of Health of the People's Republic of China issued on January 14, 1985 and implemented on August 1, 1985
4.2 Chronic allyl chloride poisoning
GB4865-85
Those diagnosed with mild chronic allyl chloride poisoning should be transferred from chloropropylene operation. Those with severe chronic allyl chloride poisoning should no longer engage in chloropropylene and other operations that are harmful to the nervous system.
,3 Patients diagnosed with chronic allyl chloride poisoning should be reexamined regularly. After a short period of treatment, patients with mild poisoning can engage in other light work. For patients with severe poisoning, rest and work arrangements will be made according to the examination results. 5 Requirements for health examinations
5.1 Workers engaged in chloropropylene operations should undergo a physical examination before employment, including detailed internal medicine and neurology examinations, liver function, urine routine, urine sugar or other kidney function tests.
5.2 Workers engaged in chloropropylene operations should undergo a physical examination once a year. In addition to the same examination items as the pre-employment physical examination, a neuro-electromyogram should also be examined when conditions permit.
6 Occupational contraindications
6.1 Various organic diseases of the central and peripheral nervous systems. 6.2 Liver and kidney diseases.
6.3 Endocrine diseases: diabetes, hypothyroidism. 6.4 Connective tissue diseases.
A.1 Electromyography examination method
A.1.1 Preparation before examination
GB 4865-85
Appendix A
Neuro-electromyography examination method and the judgment standard of neurogenic damage
(Supplement)
First, explain the examination requirements and precautions to the examinee clearly, so that he can avoid mental tension and strive for the cooperation of the examinee. A.1.1.2 The examinee takes a suitable posture so that the muscles are supported and stable, and can relax naturally and do various exercises as required. A,1.1.3 The ground electrode is placed on the same limb as the muscle to be examined. A.1.1.4 Disinfect the local skin with 2.5% iodine and 75% alcohol. A.1.2 Inspection procedures
A.1.2.1 Myoelectric activity during insertion: insert the central axis needle electrode (needle core area is 0.45mⅢ) into the muscle belly quickly, scan at a speed of 50-100ms/cm, and a sensitivity of 100μV/cm, and observe the characteristics of the activity during the insertion of the needle electrode and whether there is myotonia, myotonia-like discharge or prolonged electrical activity during insertion.
A.1.2.2 Myoelectric activity during muscle relaxation
Scan at a speed of 5-10ms/cm, and a sensitivity of 1μV/m, and observe whether there are fibrillation potentials, positive phase potentials, and bundle potentials A.1.2.3 Myoelectric activity during small contraction (light contraction): The conditions are the same as A.1.2.2. Measure the average duration and average positive potential of 20 action potentials, and the percentage of multiphase potentials. To determine the average duration of the motor unit, the needle electrode can be moved to the subcutaneous area and changed in the clockwise direction. If necessary, different positions should be selected for the same muscle for inspection. To avoid errors, each wave must appear 2 to 3 times at the same time before it can be counted. The duration is from the initial deflection of the baseline to the final deflection back to the baseline. The phase of the motor unit is based on the peak crossing the baseline.
A.1.2.4 Myoelectric activity during strong contraction: The scanning speed is 50~100ms/cm, and the sensitivity is 500uV/cm~1mV/cm. When the subject contracts the tested muscle with maximum force, observe whether it is the upper disturbance phase, mixed phase or simple phase, and measure its peak amplitude. A,2 Nerve conduction velocity
The skin moisture of the examinee should be kept above 30℃. The examined part should be cleaned with alcohol to remove grease. The surface electrode should be correctly placed on the nerve. The skin should not be pushed. When giving electrical stimulation, attention should be paid to safety. The ground electrode should be placed between the stimulation point and the recording point. A,2.1 Motor nerve conduction velocity
A.2.1.1 Electrode placement
Except for the needle electrode when examining the posterior tibial nerve, the surface electrode is used as the stimulation electrode. Except for the surface electrode when examining the common peroneal nerve, the concentric axis pin electrode is used as the recording electrode. The electrode placement sites of the main examined nerves are as follows: Ulnar nerve: proximal stimulation The proximal stimulation point is placed between the medial superior sphenoid bone and the ulnar fossa, the distal stimulation point is at the ulnar edge of the wrist crease, and the recording electrode is placed on the abductor digiti minimi muscle of the hand.
Median nerve: The proximal stimulation point is placed on the medial superior sphenoid bone, the distal stimulation point is at the midpoint of the wrist crease, and the recording electrode is placed on the short abductor digiti minimi nerve of the hand: The proximal stimulation point is placed at the small center of the run fossa (Weizhong point), the distal stimulation point is at the posterior part of the medial malleolus, and the recording electrode is placed at the posterior part of the malleolus. For the posterior tibial nerve, insert the positive and negative electrodes of the stimulating electrode into the subcutaneous tissue at the midpoint of the line connecting the medial malleolus and the heel, 1 cm apart, and move the negative electrode needle tip forward and upward to approach the posterior tibial nerve until the stimulation is less than 1 cm to induce evoked potentials. An irrelevant electrode is inserted into the subcutaneous tissue nearby , 2cⅡ apart. The recording electrode is placed on the extensor digitorum.
Common peroneal nerve: The proximal stimulation point is placed below the labrum, the distal stimulation point is at the ankle dorsum, and the recording electrode is placed on the extensor digitorum brevis.
GB4865—85
A,2.1.2 Give a single pulse square wave stimulation, 1~1.5 pulse/s, square wave duration 0.1~0.2㎡5, the intensity must reach super-strong stimulation (that is, after increasing the stimulation, the evoked potential no longer increases), and then increase the intensity by 30%A.2.1.3 Measure the time (s) from the stimulation artifact to the beginning of the evoked potential waveform, called the latency, and measure the proximal stimulation respectively. The difference between the latency of the proximal and distal stimulation points is the conduction time (ms) between the two points of the nerve. A.2.1.4 Use a steel ruler or a kennel to accurately measure the distance between the proximal and distal stimulation points, which is the length (cm) between the two points of the nerve segment.
The conduction velocity between the two points of the nerve segment can be calculated using the following formula. Conduction velocity (m/s) = conduction time (ms) distance (em)
The distal nerve conduction velocity often lacks diagnostic value, so it is not calculated using the above formula and is generally expressed as the distal motor latency. A,2.2 Sensory nerve conduction velocity
A,2.2.1. Except for the surface electrode used for the examination of the enteric nerve, all stimulating electrodes are ring electrodes, which are wrapped around the fingers or feet, with the negative electrode placed on the proximal knuckle and the positive electrode placed on the posterior knuckle. The electrodes are at least 1 cm apart. The electrode placement sites are as follows: ulnar nerve: index finger.
ulnar nerve: little finger.
sural nerve: posterior and inferior to the external tibial nerve
tibial nerve: talus.
recording electrodes are surface electrodes, except for the needle electrode used for the examination of the posterior tibial nerve. The placement site, whether distal or proximal, should be placed at the site where the highest evoked potential is elicited when measuring the motor nerve conduction velocity. When examining the enteric nerve, the recording electrode is placed on the posterior side of the calf 14 cm away from the stimulating electrode.
Use single pulse square wave electrical stimulation, 1-1.5 times/s, 0.1-0.2ms each time, increase the stimulation intensity until the subject feels obvious numbness in the fingers or toes (the stimulation amount of the constant current stimulator is generally 30-40mA, and the maximum does not exceed 50mA). A.2.2.3 A cumulative meter is required, and the number of cumulative times can be determined according to the clarity of the graph. The height from the peak to the beep of the evoked potential is the amplitude (voltage). A.2.2.4
A,2.2.5 The method for determining the latency, the distance between the stimulating electrode and the recording electrode, and the calculation formula for the nerve conduction velocity are the same as A.2.1.4.
A,3 Normal values of neuro-electromyography
Strictly speaking, each laboratory should have its own normal values. At present, the country has not established its own normal value unit, and the normal values listed in Table 1-3 can be referred to, but the inspection method should be consistent. A.3.1 Normal value of electromyogram
A.3.1.1 Activity: The duration of the discharge at the needle pole does not exceed 25. A,3.1.2 Spontaneous potentials (fibrillary waves, positive sharp waves) generally do not appear at rest. About 4.3% to 10% of normal muscles can show white potentials at one location.
A,3.1.3 Average duration of motor units: The normal value of the average duration of 20 motor units is shown in Table A1. Multiphasic potential fraction: The phase of the motor unit is more than 5 phases. The multiphasic potential of general muscles does not exceed 20%, and the multiphasic potential of deltoid muscle and anterior tibialis muscle does not exceed 25%. A.8.1.5 Interference phases are present during strong contraction.
A.3.1.6 There are many factors that affect the voltage of motor units, which can be judged according to the normal values of each experimental unit. A,3.2 Normal values of motor nerve conduction velocity are shown in Table A2. Normal values of sensory nerve conduction velocity are shown in Table A3. A.3.31
Criteria for judging neurogenic damage
A.4.1 Electromyography
GB 4865--85
A.4.1.1 Gate potentials (fiber frontal waves, positive sharp waves) appear in 3 parts of fast muscles. A.4.1.2 The average duration of 20 motor units during small contractions is more than 20% longer than the normal value of the corresponding age group. A, 4.1.3 The fraction of multiphasic potentials increases during small force contractions, exceeding 20% of the 20 motor units of general muscles, and exceeding 25% of the deltoid and tibialis anterior muscles.
A.4.1.4 Mixed phase or simple phase during strong contractions. One of the first two of the above four items must be present, and the other full items must be referred to before it can be determined as neurogenic damage. A.4,2 Nerve conduction velocity
A, 4.2.1 Slowed sensory nerve conduction velocity (more than the normal mean - 2 standard deviations). A.4.2.2wwW.bzxz.Net
Slowed motor nerve conduction velocity (more than the normal mean - 2 standard deviations) or prolonged distal motor latency (more than the normal mean + 2 standard deviations).
Decreased sensory potential amplitude (more than the normal mean - 2 standard deviations). A.4.2.3
Evoked motor potential amplitude significantly decreased (less than 1mV) or waveform significantly complex (more than 4 phases). A.4.2,4
One of the first two of the above four items is present, and the other two items are referred to and other technical reasons are excluded before it can be determined as neurogenic damage. Table A1
"Age
[11.210.0
11.5 10.9
11.f 11.7
20 motor units average duration normal value
triceps,
digitorum medius
span finger flexor
interdigital muscle
"little finger flexor
entire anterior muscle
(2] [132] (1362](1362 (1
10.2 10.3
10.4 10.5
10-3 11.6
10.7 11.9
12.2 12.1
12.3 12.3
12.7 13.1
13.0 13.4
13.4 13.8
13.9 11.3
14.2 14.7
Braunchy toe
Note+Table columns. Band values 1JL.udin HP,Electromyography in Practi:，Georg Thime Verlag, Stugart,1980和［2学杂64（）r91，1984。 Via
Anteric nerve
Non-total bell meridian
Tibial meridian
Posterior erector nerve
30~ 64
30~ 64
20 ~55
Let: Data source
Nerve number
Xuan (surface)
Body (surface)
South "table)
Wrist (surface)
(surface)
Ankle (surface)
Ankle (surface)
Bone (surface)
Body (decline)
Heel (needle plate)
Lang (surface)
Elbow (surface)
Motor nerve conduction velocity
Motor nerve conduction velocity (/5)
Recording electrode
Mean value soil acceptance standard difference
Thumb short extension needle pole)| |tt||abductor digiti minimi (needle pole)
fossa (surface)
Kang'ouli [surface]
Tengzuili (surface)
Cancer outside (surface)
Pinli outside (surface)
Tengshuai outside (skin surface)
Orbital fossa (surface)
Extensor digitorum brevis ...needle pole)
61.7±1.1
60-28 + 5.27 | | tt | 73.3 | | tt | ±u.61
2.9±0.54
37.5~8393
14.53±0.70
3.3±1.03
4.82±0.95
3a ℃ and above
30℃ and above E
30 and above
30 and above
30℃ and above
3.1-5.a30 and above
［1］1研充13（4）：1，[984。 ［2］Chinese Medical Journal 57(6):374，1977。 ［3］Chinese Journal of Neuropsychiatry 15（2）：78, 1982. Table convex number oxygen except the source (which is the geometric mean, the rest are arithmetic means. Data
positive nerve
cunxiang meridian
tiaojiang nerve
tibial nerve
age number of stimulation electrodes
30 ~64
Recording electrodes
Index finger ring wrist (surface)
Thumb (ring head (needle pole, below the branch) Little finger (ring wrist (surface)
Outer finger (wheat flour)
Toe (ring inner finger (needle pole)
Toe (surface)
Sensory nerve conduction velocity
Sensory nerve conduction
Velocity (m/s)
Mean+
Standard deviation
Distal sensory electrical activity
Amplitude (uV)
Latency (ms)
(from the onset of the wave)
Mean±
Standard deviation
65.5 ±1.1 54.4~78.82.0 Upper 1.155.6-7.95
Time part (surface)
166.4=1.2
[Posterior side of waist (surface) 58.9=1.1
Upper 14cm
42.5±1.3
Buttocks and toes (ring inner heel (needle pole, subcutaneous)
50.3~87.72. U ± 1.1
48.3~71.82.3 ±1.1
26-2-68.8
Note: Data source——
【1】Niu Yan Xue Research 13 (4): 1; 19. [2] Chinese Journal of Neuroscience 152: 78, 1982. The values in [1] are geometric means, and [2] are arithmetic means. Fan
(peak to peak)
mean=
Standard deviation
12.1±1.5
16.6±9,33
12.7±1.5
1.95~2.90
6.4 ±2.0
2.4 ±2.1
30℃ or above
30℃ or above
30℃ or above
30 yuan or above
30℃ or above
30c or above:
GB4865—85
GB4865-85
Appendix B
Muscle strength grading standard
Supplement)
Muscle strength refers to the muscle contraction force exerted during active movement. To judge the degree of limb paralysis, Changchuan's muscle strength grading standard is as follows: 0 degree, complete muscle paralysis, no contraction
1 degree: slight muscle contraction can be seen or touched, but it cannot cause movement of limbs or joints. 2 degree: Muscles can move when not affected by force, but cannot resist gravity. 3 degree: Can still complete its movement in the direction opposite to gravity, but cannot withstand external resistance. 4 degree: Can resist a certain resistance, but lower than normal people. 5 degree: normal muscle strength.
C, 1 Scope of application of this standard
GB4865-85
Instructions for correct use of the standard
(reference number)
This standard applies to those who are poisoned by the production of chlorobenzene and long-term exposure to chlorobenzene in the production of epoxychlorobenzene, chlorobenzene sulfonic acid, dimethoate or batan.
C.2 The measurement data of the concentration of allyl chloride in the workshop air are of reference significance for diagnosis. C.3 The main clinical manifestation of this disease is multiple peripheral neuropathy. When the nerve-electromyography examination is performed without adequate conditions, the diagnostic significance of a single abnormal sign is difficult to determine. The diagnosis can only be made when there are symptoms such as heaviness and weakness in both legs, soreness, tingling and pain in the limbs, and accompanied by a constant peripheral pain, touch or sound and vibration sense disorder and weakened heel reflex on one or both sides. The sensory test should be repeated many times, and the Achilles tendon reflex test should be performed in the kneeling position. C.4 Neuro-electromyography examination is of great significance for the early diagnosis of this disease. In chronic allyl chloride poisoning, the main focus should be on the damage to the peripheral nerves, and the electromyography of the distal muscles of the limbs should be examined, such as the abductor pollicis and the abductor digiti minimi. Because it is difficult to get the cooperation of the examinee in the examination of small muscles of the foot, the anterior tibialis or posterior tibialis is selected for the examination of the lower limbs. When measuring the nerve conduction velocity, the median nerve and ulnar nerve are generally used, and the common tibial nerve and posterior tibial nerve are used in the lower limbs. The judgment should be made according to the operation methods in Appendix A.1 and A.2, with reference to the normal assessment and judgment criteria of neurogenic damage. C.5 Peripheral neuropathy can be caused by other diseases, such as diabetes, nutritional deficiency, compression injury, drug and other industrial poisoning and hereditary diseases, infectious diseases or connective tissue diseases, so it should be excluded from occupational history, medical history, physical examination and laboratory examination. Additional remarks:
This standard was proposed by the Occupational Disease Diagnosis Standard Subcommittee of the National Health Standard Technical Committee. This standard was drafted by the Health Research Institute of the China Preventive Medicine Center and the Institute of Occupational Disease Prevention and Control of Labor and Health of Shandong Province. The Ministry of Health entrusted the China Preventive Medicine Center to be responsible for the interpretation of this standard.5. Peripheral neuropathy may be caused by other diseases, such as diabetes, nutritional deficiency, compression injury, drug and other poisoning, hereditary diseases, infectious diseases or connective tissue diseases, etc., so it should be excluded from occupational history, medical history, physical examination and laboratory examination. Additional remarks:
This standard was proposed by the Occupational Disease Diagnosis Standard Subcommittee of the National Health Standard Technical Committee. This standard was drafted by the Health Research Institute of the China Preventive Medicine Center and the Institute of Occupational Disease Prevention and Control of Labor and Health of Shandong Province. The Ministry of Health entrusted the China Preventive Medicine Center to be responsible for the interpretation of this standard.5. Peripheral neuropathy may be caused by other diseases, such as diabetes, nutritional deficiency, compression injury, drug and other poisoning, hereditary diseases, infectious diseases or connective tissue diseases, so it should be excluded from occupational history, medical history, physical examination and laboratory examination. Additional remarks:
This standard was proposed by the Occupational Disease Diagnosis Standard Subcommittee of the National Health Standard Technical Committee. This standard was drafted by the Health Research Institute of the China Preventive Medicine Center and the Institute of Occupational Disease Prevention and Control of Labor and Health of Shandong Province. The Ministry of Health entrusted the China Preventive Medicine Center to be responsible for the interpretation of this standard.
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