This standard specifies the diagnostic criteria, diagnostic writing format and treatment principles for occupational benzene poisoning. This standard applies to the diagnosis and treatment of poisoning caused by exposure to benzene in occupational activities. This standard can be used for benzene poisoning caused by exposure to industrial toluene, xylene and other chemicals containing benzene. This standard can also be used for the diagnosis of benzene poisoning caused by exposure to benzene in non-occupational activities. GBZ 68-2002 Occupational Benzene Poisoning Diagnosis Standard GBZ68-2002 Standard Download Decompression Password: www.bzxz.net

ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ 68—2002
Diagnostic Criteria of Occupational Benzene Poisoning Issued on April 8, 2002
Implemented on June 1, 2002
Ministry of Health of the People's Republic of China
Article 5.1 of this standard is recommended, and the rest are mandatory. This standard is formulated in accordance with the Law of the People's Republic of China on the Prevention and Control of Occupational Diseases. From the date of implementation of this standard, if there is any inconsistency between the original standard GB3230-1997 and this standard, this standard shall prevail. Acute and chronic benzene poisoning may occur when exposed to benzene vapor in occupational activities. This standard is formulated to protect the health of the exposed persons and effectively prevent and control benzene poisoning.
Appendix A of this standard is an informative appendix.
This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard was drafted by Huashan Hospital Affiliated to Fudan University, Shanghai Occupational Disease Hospital, Shanghai Sixth People's Hospital, Shanghai Yangpu District Central Hospital, Shanghai Center for Disease Control and Prevention, and Zhejiang Academy of Medical Sciences Occupational Disease Prevention and Control Institute. This standard is interpreted by the Ministry of Health of the People's Republic of China. ..comDiagnostic Standard for Occupational Benzene Poisoning
GBZ68-2002
Occupational acute benzene poisoning is a systemic disease with central nervous system depression as the main manifestation caused by workers inhaling large doses of benzene vapor in a short period of time during their occupational activities: Occupational chronic benzene poisoning refers to a systemic disease with hematopoietic system damage as the main manifestation caused by workers' long-term exposure to benzene vapor in their occupational activities. 1 Scope
This standard specifies the diagnostic standard, diagnostic writing format and treatment principles for occupational benzene poisoning. This standard is applicable to the diagnosis and treatment of poisoning caused by exposure to benzene in occupational activities. This standard can be used for benzene poisoning caused by exposure to industrial toluene, xylene and other chemicals containing benzene. This standard can also be used for the diagnosis of benzene poisoning caused by exposure to benzene in non-occupational activities.
2 Diagnostic principles
Acute benzene poisoning is diagnosed based on the inhalation of a large amount of high-concentration benzene vapor in a short period of time, clinical manifestations of impaired consciousness, and the exclusion of changes in central nervous system function caused by other diseases. Acute benzene poisoning can be diagnosed based on the degree of impaired consciousness, which can be divided into mild and severe levels.
Chronic benzene poisoning is diagnosed based on the occupational history of close contact with benzene for a long period of time. The clinical manifestations are mainly hematopoietic inhibition, and there may also be abnormal proliferation. With reference to the work environment survey and the on-site air benzene concentration measurement data, a comprehensive analysis is conducted, and the blood picture changes caused by other reasons are excluded before it can be diagnosed as chronic benzene poisoning. Chronic benzene poisoning is divided into mild, moderate and severe levels according to the series and degree of blood cell involvement, as well as the presence or absence of malignant changes. 3 Observation subjects
If the blood test of benzene workers is found to have one of the following changes, and there is no improvement after reexamination every 1 to 2 weeks within 3 months, and no other reasons can be found, they can be listed as observation subjects. The white blood cell count fluctuates between 4×10~4.5×10L (4000~4500/mm); a)www.bzxz.net
The platelet count fluctuates between 60×10~80×10L (60,000~80,000/mm); b)
The red blood cell count is lower than 4×102/L (4 million/mm) for men and lower than 3.5×10/2/L (3.5 million/mm) for women; the hemoglobin quantification is lower than 120g/L (12g/dL) for men and lower than 110g/L (11g/dL) for women: the peripheral blood cell count increases, and immature or abnormal blood cells appear. d)
4 Diagnosis and classification standards
4.1 Acute benzene poisoning
4.1.1 Acute mild poisoning
After inhaling high concentrations of benzene vapor in a short period of time, people may experience a drunken state such as dizziness, headache, nausea, vomiting, excitement, gait mites, etc., which may be accompanied by mucosal irritation symptoms. Increased values ​​of exhaled benzene, blood benzene, and urine phenol can be used as indicators of benzene exposure. 4.1.2 Acute severe poisoning
After inhaling high concentrations of benzene vapor, people may experience irritability, confusion, coma, convulsions, decreased blood pressure, and even respiratory and circulatory failure. Increased values ​​of exhaled benzene, blood benzene, and urine phenol can be used as indicators of benzene exposure. 4.2 Chronic poisoning
..com4.2.1 Chronic mild poisoning
Recheck every 1-2 weeks within 3 months. If the white blood cell count is continuously or basically lower than 4×10/L (4000/mm2) or the neutrophil count is lower than 2×10L (2000/mm2), there are often symptoms such as dizziness, headache, fatigue, insomnia, and memory loss. 4.2.2 Chronic moderate poisoning
Mostly there are symptoms of chronic mild poisoning, and there is a tendency to infection and (or) bleeding. Those who meet one of the following conditions: white blood cell count less than 4×10/L (4000/mm2) or neutrophil count less than 2×10/L (2000/mm2), accompanied by a) platelet count less than 60×10/L (60,000/mm2); b) white blood cell count less than 3×10/L (3000/mm2) or neutrophil count less than 1.5×10/L (1500/mm2); 4.2.3 Chronic severe poisoning
One of the following conditions:
Pancytopenia;
b) aplastic anemia;
c) myelodysplastic syndrome;
d) leukemia.
5 Treatment principles
5.1 Treatment principles
5.1.1 Acute poisoning
The poisoned patient should be quickly moved to a place with fresh air, take off the clothes contaminated by benzene immediately, wash the contaminated skin with soapy water, and keep warm. In the acute stage, the patient should rest in bed. The first aid principles are the same as those in internal medicine. Glucuronic acid can be used, but adrenaline should not be used.
5.1.2 Chronic poisoning
There is no specific antidote. The treatment is symptomatic according to the blood disease caused by damage to the hematopoietic system. 5.2 Other treatments
5.2.1 Acute poisoning: After recovery, mild poisoning can generally rest for 3 to 7 days before work. The rest time for severe poisoning should be determined according to the degree of recovery.
5.2.2 Chronic poisoning: Once the diagnosis is confirmed, the patient should be transferred away from work involving contact with benzene and other toxic substances. During the illness, work or rest should be arranged according to the condition. Mild poisoning can generally be performed light work, or half-day work; moderate poisoning, according to the condition, appropriate rest arrangements; severe poisoning, full rest. 5.2.3 Observation object: According to occupational contraindications, they should be transferred away from benzene work positions. 6 Instructions for the correct use of this standard
See Appendix A (Informative Appendix)
..com A.1 About the blood routine test method
Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
Each medical unit has different blood routine test methods. Some use visual methods, and some use automatic blood cell counters. The latter are also different in brand and model. This standard does not make unified regulations on the test method, and the results obtained are valid. However, no matter which method is used, the results have a certain error range. Therefore, when making a diagnosis, do not draw a conclusion based on a single result or a simple re-examination result. It is necessary to take a stable value based on multiple re-examination results, fully consider the error factors, and combine the overall data for comprehensive analysis before drawing a conclusion. If necessary, a period of close observation should be made before diagnosis. A.2 Bone marrow examination
Bone marrow examination is helpful to understand the situation of hematopoietic damage. In patients with chronic poisoning, it is very helpful for the timely diagnosis and differential diagnosis of abnormal blood cells, pancytopenia, aplastic anemia, myelodysplastic syndrome, and leukemia.
A.3 About the determination of neutrophil alkaline phosphatase activity and neutrophil toxic granules Based on the principle of practicality and the poor stability of this examination, this standard believes that the actual application of this provision in the original standard is in name only, so it is deleted from the diagnostic indicators. In the future, this indicator will not be used to diagnose new cases, nor will it be used to exclude diagnoses. However, it does not rule out that some units will continue to explore and accumulate experience in clinical work. A.4 About myelodysplastic syndrome
There are many advances in the research and understanding of myelodysplastic syndrome. From clinical observation, we should be alert to myelodysplastic syndrome caused by benzene poisoning. Applying the research results in the field of hematology to the clinical treatment of occupational diseases is not only conducive to the diagnosis and treatment of severe benzene poisoning, but also can play a good role in the research of benzene poisoning. A.5 About benzene-induced leukemia
Benzene-induced leukemia has been included in the national list of occupational diseases. Due to insufficient clinical experience and a long latent period of onset, diagnosis is more difficult. Relevant units are studying special diagnostic criteria. Clinical units should conduct sufficient research, in-depth analysis and be cautious when considering the type of leukemia caused by chronic severe benzene poisoning. A.6. Acute aplastic anemia caused by short-term benzene exposure. In clinical work, it was found that acute aplastic anemia can occur after exposure to high concentrations of benzene in a relatively short period of time. The disease progresses rapidly, but after active treatment, most patients can gradually recover, which is different from the pathogenesis of aplastic anemia commonly seen in chronic severe benzene poisoning. Since there is not much information on this aspect and there is no unified understanding, such patients are still included in chronic severe benzene poisoning in this diagnostic standard. More experience needs to be accumulated in the future to propose a precise classification. A.7. The naming and writing format of chronic benzene poisoning diagnosis. The standardized diagnosis naming format is conducive to the accumulation of clinical data, guidance of treatment, and timely treatment and subsequent research. The standardized principle of naming is to indicate the name of the blood disease after the diagnostic classification. The expression is as follows: a) Chronic mild benzene poisoning:
1) Chronic mild benzene poisoning (leukopenia): ..com2) Chronic mild benzene poisoning (neutropenia). Chronic moderate benzene poisoning:
Chronic moderate benzene poisoning (leukopenia with thrombocytopenia); 1
Chronic moderate benzene poisoning (neutropenia with thrombocytopenia). 2)
Chronic severe benzene poisoning:
Chronic severe benzene poisoning (pancytopenia): 1)
Chronic severe benzene poisoning (aplastic anemia): 2)
Chronic severe benzene poisoning (myelodysplastic syndrome) 3)
Chronic severe benzene poisoning (leukemia).
3 About the diagnosis of benzene poisoning caused by benzene-containing chemicals A.8
Industrial toluene and xylene and other chemicals contain a certain amount of benzene, which can cause benzene poisoning. The diagnosis should be benzene poisoning rather than toluene or xylene poisoning, but the name of the benzene-containing chemical should be added in brackets after the diagnosis to distinguish it from benzene poisoning caused by pure benzene.
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