GB 8782-1988 Occupational decompression sickness diagnostic criteria and treatment principles
Some standard content:
National Standard of the People's Republic of China
Diagnostic criteria and principles of management ofoccupational decompresston sicknessUDC 616-0571616
-07/-08:613
G 8782-88
Decompression sickness is a systemic disease caused by improper decompression after high-pressure work, in which the gas originally dissolved in the body exceeds the supersaturation limit, and bubbles are formed inside and outside the blood vessels and tissues. Acute decompression sickness occurs within a short period of time after decompression or during decompression. It mainly occurs in the femur, humerus and tibia, and the slowly evolving ischemic bone or bone joint damage is decompression osteonecrosis. Diagnostic principles
1. Acute decompression sickness
Clinical manifestations caused by gas secretion in the body within 36 hours after high-pressure work can be diagnosed only after comprehensive analysis and exclusion of similar diseases caused by other reasons.
For difficult cases, diagnostic compression should be performed to confirm the diagnosis. 1.2 Decompression osteonecrosis
There is a history of high-pressure work, and most of them also have a history of acute decompression sickness; X-ray films show bone or osteoarticular necrosis mainly occurring in the humerus, femur and (or) tibia. After comprehensive analysis and exclusion of normal variations such as bone islands and other bone diseases, the diagnosis can be made. 2 Diagnosis and grading and staging standards
2. 1 Acute decompression sickness
2.1.1 Mild
Skin manifestations such as itching, papules, marble-like spots, subcutaneous hemorrhage, edema, etc. 2.1.2 Moderate
Mainly occurs in the large joints of the limbs and nearby muscle and bone joint pain. 2.1.3 Severe
Severe if one of the following conditions occurs:
Nervous system
Confusion, etc.
Difficulty standing or walking, hemiplegia, occlusion, dysphagia, sensory impairment, hearing impairment, vestibular dysfunction, coma, circulatory collapse, shock, etc.
Pain behind the sternum and dyspnea, etc.,
Heart, respiratory system
2.2 Decompression osteonecrosis
Stages according to changes in bone X-rays.
Stage 2.2.11
Local bone density areas, dense patches, stripes and (or) small fecal translucent areas are seen in the femur, humerus and (or) tibia, the latter may have irregular edges or lobes, surrounded by a visual ring. The area of change does not exceed 1/3 of the bone in the upper limb, and does not exceed 1/3 of the femoral head in one limb. Stage 2.2.2J
The area of bone change exceeds 1/3 of the humeral head or femoral head in the upper or lower limb, or large areas of bone marrow calcification appear. 2.2.3I stage
Approved by the Ministry of Health of the People's Republic of China on February 22, 1988, and implemented on September 1, 1988
GB8782-88
The lesion involves the joints, the joint surface is blurred, destroyed, deformed, and snake bones are formed, the joints are irregular or narrowed: the hip or shoulder joints are destroyed and deformed, bone hyperplasia and bone and joint damage, etc. The affected joints have local pain and movement disorders. 3 Treatment principles
3.1 Acute decompression sickness
Compression treatment must be carried out as soon as possible, and comprehensive auxiliary treatment should be given in time according to clinical manifestations. If compression treatment is not carried out in time or correctly at that time and symptoms remain, compression treatment should still be actively carried out. 3.2 Decompression osteonecrosis
According to the specific situation, hyperbaric oxygen compression and other comprehensive therapies can be carried out. 4 Work capacity assessment
4.1 Acute decompression sickness
After the symptoms and signs completely disappear, different periods of rest are given. Rest for 1 to 3 days for mild cases, 3 to 5 days for moderate cases, and at least 7 days for severe cases. After the rest period, the patient must undergo a specialist examination, and only those who pass the examination are allowed to participate in high-pressure operations. Those with recurrent illnesses or serious nervous system lesions will be transferred from the operation.
4.2 Decompression osteonecrosis
4.2.1 Stage 1
Under close medical support, divers can only dive within 10m, and caisson workers and tunnel workers can only participate in high-pressure operations below 203kPa (an additional pressure), and strictly abide by the operating regulations 4.2.2 Stage 2 and Stage 3
Transfer from high-pressure operations. It is prohibited to carry heavy loads or stand for long periods of time, and actively seek medical treatment. 5 Requirements for health examinations
For example, those who work in high-pressure operations must first undergo a comprehensive physical examination as required, including X-ray examinations of the shoulder, knee joints, humerus, tibia, and tibia. Only those who pass the examination can participate in the work. Later A professional physical examination should be conducted once a year and continue until 3 years after stopping high-pressure work.
6 General occupational prohibition certificate
. Organic diseases and obvious functional diseases of the nervous, mental, circulatory, respiratory, urinary, blood, motor, endocrine, and digestive systems.
h. Organic diseases of the eyes, ears, larynx, and vestibular organs. e. Age over 50 years old.
d. Various surgically cured infectious diseases, those prone to fainting, uncured idiocy, allergic constitution, stuttering, obvious skin diseases and extensive skin scars.
Failure of the pressurization test or positive oxygen sensitivity test e.
A.1X X-ray manifestations
A.1.1 Translucent areas
GB 8782—88
Appendix A
X-ray manifestations and differential diagnosis of decompressive osteonecrosis (supplement)
The cystic changes are usually round, oval, lobed or clustered, sometimes irregular. Single or multiple, with a diameter of about 3-20mm. The decay wall generally has a clear sclerotic edge and is 0.51ml thick. There is no bone structure in the decay area, which is more obvious in the body layer film. There may be obvious sclerotic cord bone pattern shadows around the cystic changes. Single or multiple translucent areas can be seen in the necrotic area, with different sizes and shapes, and irregular reverse edges. Some of the translucent areas are larger in range, with a diameter of up to 3~4 cm. A.1.2 Dense patchy shadows
Isolated or scattered, of varying sizes, ranging from a few millimeters to several centimeters, with various shapes, sometimes in the shape of strings or clusters, with not very sharp edges. The density inside the patchy shadow is not uniform, with low density showing disordered or fused bone patterns, and high density white as ivory, so that the bone structure cannot be seen clearly. It can appear in the humerus, femur and tibia.
A.1.3 Dense stripe shadows
The dense stripes can be irregular lines, serpentine, whirlpool, villi, messy or beard-like. The edges are not very sharp, about 2 to 5 mm wide, and up to several centimeters long. Calcification spots of varying sizes and small translucent areas can be mixed between the stripe shadows. This change is different from the direction and distribution of the bone patterns of the surrounding cancellous bone, and is often seen in the humeral head and neck and between the femoral neck and trochanter. A.1.4 Crescent-shaped dense shadow
refers to the crescent-shaped dense shadow on the inner upper edge of the purple joint surface. Its inner upper edge is sharp, and the outer lower edge is clearly demarcated from the normal bone. The edge is irregular, and can be seen as lace-like, or partially blurred, and gradually migrates into the normal bone. It is most common in the humerus, and a few in the femoral head. It can account for 1/6 to 1/2 of the area of the humeral head or femoral head. Sometimes there is a transparent area in the lesion. A.1.5 Medullary cavity calcification
is common in the middle and lower parts of the femur and the upper part of the tibia, and can also be seen in the upper and middle parts of the humerus. It manifests as an irregular calcification shadow with sharp strips and spots and patches in the medullary cavity. The shadow density is lighter in the early stage, and it is spotted or short strips (it is easier to find femoral and tibial lesions in the early stage by taking lateral films). Later, the degree of calcification gradually increases, and the range can also be gradually expanded. The maximum long diameter can reach 20cm, the transverse diameter can reach about 4cm, and the shape is very irregular. There may be a calcified ring around the partially calcified medullary cavity, and there are irregular translucent areas inside. A.1.6 Articular surface destruction and joint damage
In the early stage, the edge of the articular surface of the femoral head or humeral head is slightly blurred and deformed, followed by the cracking of the articular surface, and a linear translucent band appears in the bone cortex, which is connected to the bone necrosis area under the articular surface. As the destruction continues to progress, in addition to the formation of dead bone, part of the force point of the articular surface collapses, and the range can gradually expand, causing the femoral head or humeral head to be irregularly deformed. At the same time, the hip joint or shoulder joint also appears to be damaged and deformed accordingly. A.2 Differential diagnosis Www.bzxZ.net
In X-ray differential diagnosis, attention should be paid to the following items. A. 2.1 Bone spider
The calcified spots left behind by the partial renal variation during the ossification process are generally round, circular or irregular in shape, with a diameter ranging from 3 to 1 cm. The edge of the bone is sharp, sometimes with thorn-like protrusions, and is surrounded by cancellous bone structures. It is often found in the cancellous bones at both ends of the femur and tibia. A, 2. 2 Cartilage island
is the soft renal tissue left over from the localized ossification disorder during the ossification of long bones or flat bones. It is often seen in the femoral neck, with clear boundaries, usually single, and a diameter of 4 to 10 cm. Most of them are round translucent shadows, and adjacent overlapping or crossing bone lines can be seen. A.2.3 Chronic cystic degeneration of the humerus
GB 878288
is a cystic bone fibrosis area near the greater tuberosity on the outside of the humeral head of a normal person, often occurring bilaterally. Its inner edge is a clear part of the humeral head with rich trabeculae, with a convex arc shape, the upper end of which is connected to the remains of the healed part of the bone calcium, and the outer edge is the shadow of the greater tuberosity. The upper edge is generally unclear and gradually migrates into the cancellous bone of the humeral head: the outer end of the lower edge often forms a point angle with the shadow of the greater tuberosity. Sometimes several round translucent areas with a diameter of about 5 mm can be seen in the middle of the humeral head, with clear edges. A.2.4 Long bone marrow calcification
Can be seen in rare diseases such as hyperphosphataseemia, and it is not difficult to identify after comprehensive analysis. A.2.5 Hip osteoarthritis
Can be seen in adult femoral head avascular necrosis and degenerative osteoarthritis caused by various reasons. B. 1 Requirements and quality assessment of radiographs
GB 87B2—88
Appendix
Notes on X-ray examination
(Supplement)
B. 1.1 The shoulder, hip and knee joints on both sides should be irradiated separately. The glenoid cavity of the shoulder joint should be separated from the humeral head. The radiograph should include the joint and its adjacent bone shaft, and generally include 1/3 of the buttocks. The radiograph quality should be clear, with good contrast, clear bone staining, no artifacts, and no abrasions. B. 1. 2 Radiograph quality assessment standards
Excellent: the photo fully meets the quality requirements of bone films. Good: does not fully meet the quality standard requirements, but does not affect the diagnosis. Poor: has technical defects, but can still be used for diagnosis. Waste: cannot be used for diagnosis.
B. 2 Radiographing technology
When taking radiographs, refer to previous bone films to determine the exposure site and conditions. Take anteroposterior films, and take lateral films or body films if necessary. Before taking the film, the examinee must be trained in color and fully cooperate, and then the exposure is carried out. When projecting the lower limbs, the reproductive organs must be protected by a lead plate. The distance between the target and the film is 80 to 90 cm, and the exposure is expressed in milliampere-seconds. Adjust the exposure value according to the contrast of the film. For films with large contrast, increase the kilovolt value and reduce the milliampere-second; for films with small contrast, increase the milliampere-second appropriately. Projection machinery and equipment
X-ray machine uses more than 200mA, fully rectified, rotating anode tube, focal point 1 to 2mm, power greater than 20~~40kW, medium-speed calcium tungstate intensifying screen, and its resolution is not less than 7 line pairs/mm. X-ray film uses blue negative film, medium speed 1~I, contrast greater than 2.5, gray fog less than 0.2, and the power supply voltage must be stable.
B. 4 Dark technology
The developer solution uses the specified formula of the film, and the temperature of the solution is controlled at 18-20. Fixation should be sufficient and washing should be thorough. C.1 Scope of application
GB 8782-88
Instructions for correct use of the standard
(reference)
Various workers in high-pressure environments such as divers, caisson workers, tunnel workers, and medical personnel, scientific and technological personnel in the compression chamber and hyperbaric oxygen chamber, and submarine escape personnel.
c. 2 Common sources of improper pressure
This disease occurs due to improper decompression after high-pressure operations. Improper decompression refers to failure to decompress as required, and even if the decompression is decompressed as required, the disease still occurs due to individual differences, high labor intensity or various environmental factors that cause insufficient relative decompression. ℃. 3 Diagnosis of decompression sickness
Doppler bubble meter can measure the flowing bubbles with larger diameter in the blood flow, but cannot measure the static bubbles that stay in the tissue and cause muscle bone and joint pain and lesions such as atrial fissure, so the instrument has diagnostic reference value for some positive cases. C.4 The section of compression bone necrosis
has a special occupational history and no other medical history that can cause ischemic bone necrosis. X-rays show quite specific bone necrosis, which mainly occurs in the humeral head and the upper, middle and lower segments of the upper femur and the upper tibia, that is, the specific parts of the long bones of the limbs, and can be limited to: a certain part of the iliac radiculitis: in terms of joints, only the shoulder and iliac joints are diseased. There is no I and I stage lesions without articular surface destruction, which do not cause subjective symptoms. Isotopic bone scanning can show bone necrosis lesions at an early stage, but cannot show old lesions that have been calcified or formed cavities, so it is only of diagnostic reference value for some positive cases.
C.5 The division and grading method of the area of the cerebral head and femoral head on X-ray films adopts the self-comparison method. For the cerebral head, a line is drawn between the outermost protrusion of the greater tuberosity and the inner depression. For the femoral head, a line is drawn between the two depressions at the junction of the femoral head and the femoral neck. The area above the line belongs to the humeral head or femoral head. The dorsum of the humerus, femoral kidney and tibia are staged according to the size of the lesion area and the presence or absence of damage to the articular surface. For each patient, the bone joint with the heaviest lesion is used as the regular marker. C.6 Therapeutic principles
Therapeutic principles for acute decompression sickness are formulated according to the working pressure, the time in the high pressure environment, the condition and the response to the treatment pressure. The stay and decompression time under high pressure should not be too short. The treatment plan can be adjusted according to the changes in symptoms and signs. Oxygen can be added in the later stage of decompression to accelerate the discharge of oxygen, except for those caused by decompression. If the patient fails to receive timely recompression treatment after acute decompression sickness, or if the patient fails to receive correct treatment and some symptoms still persist, no matter how long the onset of the disease lasts, as long as there are conditions for recompression treatment, the patient should still actively receive additional treatment to avoid losing the chance of possible cure. C. 7 Physical examination
After high-pressure work, the patient who has not experienced acute decompression sickness and has not undergone decompression according to regulations may still have bubbles in the body; patients with stage I and II decompression osteonecrosis have no subjective symptoms. Therefore, high-pressure workers should undergo a physical examination once a year. If acute decompression sickness has occurred, or there has been long-term pain and activity disorders in the shoulder and spinal cord joints, a physical examination can be performed in advance. Decompression osteonecrosis can only appear on the radiographs 2 years after the diving operation is stopped. Therefore, the period for health examinations for those who are free of high-pressure work is extended to 3 years. If a suspicious lesion is found, it should be checked until it is confirmed. If it is confirmed that there is reductive osteonecrosis, it should be checked every year.
C.8 Occupational contraindications
GB 878288
The physical requirements for high-pressure workers are very high, especially for divers, who have many occupational contraindications. Since the physical requirements for various divers are different, each unit can make appropriate adjustments according to the specific situation. Additional remarks t
This standard was proposed by the Occupational Disease Diagnosis Standard Subcommittee of the National Health Standard Technical Committee. This standard was drafted by Shanghai Yangpu District Central Hospital, Dalian Labor Hygiene Institute, Shanghai Beach Rescue and Salvage Bureau, Navy 401 Hospital, Guangdong Occupational Disease Prevention and Treatment Institute, Qingdao Medical College. This standard was commissioned by the Ministry of Health and the Institute of Labor Hygiene and Occupational Diseases of the Chinese Academy of Preventive Medicine to interpret it.4 Dark technology
The developer uses the specified formula of the film, and the temperature of the liquid is controlled at 18-20. Fixation should be sufficient and washing should be thorough. C.1 Scope of application
GB 8782-88
Instructions for correct use of the standard
(reference)
Various workers in high-pressure environments such as divers, caisson workers, tunnel workers, and medical personnel, scientific and technological personnel in the compression chamber and hyperbaric oxygen chamber, and submarine escape personnel.
c.2 Common sources of improper pressure
This disease occurs due to improper decompression after high-pressure operations. Improper decompression refers to failure to decompress as required, and even if the decompression is decompressed as required, the disease still occurs due to individual differences, high labor intensity or various environmental factors that cause insufficient relative decompression. ℃. 3 Diagnosis of decompression sickness
Doppler bubble meter can measure the flowing bubbles with larger diameter in the blood flow, but cannot measure the static bubbles that stay in the tissue and cause muscle bone and joint pain and lesions such as atrial fissure, so the instrument has diagnostic reference value for some positive cases. C.4 The section of compression bone necrosis
has a special occupational history and no other medical history that can cause ischemic bone necrosis. X-rays show quite specific bone necrosis, which mainly occurs in the humeral head and the upper, middle and lower segments of the upper femur and the upper tibia, that is, the specific parts of the long bones of the limbs, and can be limited to: a certain part of the iliac radiculitis: in terms of joints, only the shoulder and iliac joints are diseased. There is no I and I stage lesions without articular surface destruction, which do not cause subjective symptoms. Isotopic bone scanning can show bone necrosis lesions at an early stage, but cannot show old lesions that have been calcified or formed cavities, so it is only of diagnostic reference value for some positive cases.
C.5 The division and grading method of the area of the cerebral head and femoral head on X-ray films adopts the self-comparison method. For the cerebral head, a line is drawn between the outermost protrusion of the greater tuberosity and the inner depression. For the femoral head, a line is drawn between the two depressions at the junction of the femoral head and the femoral neck. The area above the line belongs to the humeral head or femoral head. The dorsum of the humerus, femoral kidney and tibia are staged according to the size of the lesion area and the presence or absence of damage to the articular surface. For each patient, the bone joint with the heaviest lesion is used as the regular marker. C.6 Therapeutic principles
Therapeutic principles for acute decompression sickness are formulated according to the working pressure, the time in the high pressure environment, the condition and the response to the treatment pressure. The stay and decompression time under high pressure should not be too short. The treatment plan can be adjusted according to the changes in symptoms and signs. Oxygen can be added in the later stage of decompression to accelerate the discharge of oxygen, except for those caused by decompression. If the patient fails to receive timely recompression treatment after acute decompression sickness, or if the patient fails to receive correct treatment and some symptoms still persist, no matter how long the onset of the disease lasts, as long as there are conditions for recompression treatment, the patient should still actively receive additional treatment to avoid losing the chance of possible cure. C. 7 Physical examination
After high-pressure work, the patient who has not experienced acute decompression sickness and has not undergone decompression according to regulations may still have bubbles in the body; patients with stage I and II decompression osteonecrosis have no subjective symptoms. Therefore, high-pressure workers should undergo a physical examination once a year. If acute decompression sickness has occurred, or there has been long-term pain and activity disorders in the shoulder and spinal cord joints, a physical examination can be performed in advance. Decompression osteonecrosis can only appear on the radiographs 2 years after the diving operation is stopped. Therefore, the period for health examinations for those who are free of high-pressure work is extended to 3 years. If a suspicious lesion is found, it should be checked until it is confirmed. If it is confirmed that there is reductive osteonecrosis, it should be checked every year.
C.8 Occupational contraindications
GB 878288
The physical requirements for high-pressure workers are very high, especially for divers, who have many occupational contraindications. Since the physical requirements for various divers are different, each unit can make appropriate adjustments according to the specific situation. Additional remarks t
This standard was proposed by the Occupational Disease Diagnosis Standard Subcommittee of the National Health Standard Technical Committee. This standard was drafted by Shanghai Yangpu District Central Hospital, Dalian Labor Hygiene Institute, Shanghai Beach Rescue and Salvage Bureau, Navy 401 Hospital, Guangdong Occupational Disease Prevention and Treatment Institute, Qingdao Medical College. This standard was commissioned by the Ministry of Health and the Institute of Labor Hygiene and Occupational Diseases of the Chinese Academy of Preventive Medicine to interpret it.4 Dark technology
The developer uses the specified formula of the film, and the temperature of the liquid is controlled at 18-20. Fixation should be sufficient and washing should be thorough. C.1 Scope of application
GB 8782-88
Instructions for correct use of the standard
(reference)
Various workers in high-pressure environments such as divers, caisson workers, tunnel workers, and medical personnel, scientific and technological personnel in the compression chamber and hyperbaric oxygen chamber, and submarine escape personnel.
c.2 Common sources of improper pressure
This disease occurs due to improper decompression after high-pressure operations. Improper decompression refers to failure to decompress as required, and even if the decompression is decompressed as required, the disease still occurs due to individual differences, high labor intensity or various environmental factors that cause insufficient relative decompression. ℃. 3 Diagnosis of decompression sickness
Doppler bubble meter can measure the flowing bubbles with larger diameter in the blood flow, but cannot measure the static bubbles that stay in the tissue and cause muscle bone and joint pain and lesions such as atrial fissure, so the instrument has diagnostic reference value for some positive cases. C.4 The section of compression bone necrosis
has a special occupational history and no other medical history that can cause ischemic bone necrosis. X-rays show quite specific bone necrosis, which mainly occurs in the humeral head and the upper, middle and lower segments of the upper femur and the upper tibia, that is, the specific parts of the long bones of the limbs, and can be limited to: a certain part of the iliac radiculitis: in terms of joints, only the shoulder and iliac joints are diseased. There is no I and I stage lesions without articular surface destruction, which do not cause subjective symptoms. Isotopic bone scanning can show bone necrosis lesions at an early stage, but cannot show old lesions that have been calcified or formed cavities, so it is only of diagnostic reference value for some positive cases.
C.5 The division and grading method of the area of the cerebral head and femoral head on X-ray films adopts the self-comparison method. For the cerebral head, a line is drawn between the outermost protrusion of the greater tuberosity and the inner depression. For the femoral head, a line is drawn between the two depressions at the junction of the femoral head and the femoral neck. The area above the line belongs to the humeral head or femoral head. The dorsum of the humerus, femoral kidney and tibia are staged according to the size of the lesion area and the presence or absence of damage to the articular surface. For each patient, the bone joint with the heaviest lesion is used as the regular marker. C.6 Therapeutic principles
Therapeutic principles for acute decompression sickness are formulated according to the working pressure, the time in the high pressure environment, the condition and the response to the treatment pressure. The stay and decompression time under high pressure should not be too short. The treatment plan can be adjusted according to the changes in symptoms and signs. Oxygen can be added in the later stage of decompression to accelerate the discharge of oxygen, except for those caused by decompression. If the patient fails to receive timely recompression treatment after acute decompression sickness, or if the patient fails to receive correct treatment and some symptoms still persist, no matter how long the onset of the disease lasts, as long as there are conditions for recompression treatment, the patient should still actively receive additional treatment to avoid losing the chance of possible cure. C. 7 Physical examination
After high-pressure work, the patient who has not experienced acute decompression sickness and has not undergone decompression according to regulations may still have bubbles in the body; patients with stage I and II decompression osteonecrosis have no subjective symptoms. Therefore, high-pressure workers should undergo a physical examination once a year. If acute decompression sickness has occurred, or there has been long-term pain and activity disorders in the shoulder and spinal cord joints, a physical examination can be performed in advance. Decompression osteonecrosis can only appear on the radiographs 2 years after the diving operation is stopped. Therefore, the period for health examinations for those who are free of high-pressure work is extended to 3 years. If a suspicious lesion is found, it should be checked until it is confirmed. If it is confirmed that there is reductive osteonecrosis, it should be checked every year.
C.8 Occupational contraindications
GB 878288
The physical requirements for high-pressure workers are very high, especially for divers, who have many occupational contraindications. Since the physical requirements for various divers are different, each unit can make appropriate adjustments according to the specific situation. Additional remarks t
This standard was proposed by the Occupational Disease Diagnosis Standard Subcommittee of the National Health Standard Technical Committee. This standard was drafted by Shanghai Yangpu District Central Hospital, Dalian Labor Hygiene Institute, Shanghai Beach Rescue and Salvage Bureau, Navy 401 Hospital, Guangdong Occupational Disease Prevention and Treatment Institute, Qingdao Medical College. This standard was commissioned by the Ministry of Health and the Institute of Labor Hygiene and Occupational Diseases of the Chinese Academy of Preventive Medicine to interpret it.
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