GBZ 7-2002 Diagnostic criteria for occupational hand-arm vibration disease
Some standard content:
ICS 13.100
National Occupational Health Standard of the People's Republic of China GBZ7-2002
Diagnostic Criteria of Occupational Hand-Arm Vibration Disease Issued on 2002-04-08
Ministry of Health of the People's Republic of China
Implementation on 2002-06-01
Article 6.1 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 the original standard GB4869-1985 is inconsistent with this standard, this standard shall prevail. Hand-arm (local) vibration disease may occur in occupational activities involving contact with hand-transmitted (local) vibration. In order to protect the health of the contactors and effectively prevent and treat hand-arm vibration disease, GB4869-1985 was issued. The revised standard adopts the name of hand-arm vibration disease; the classification standard is changed to three levels: mild, moderate and severe; the examination of nail fold microcirculation, two-point discrimination and depth perception is cancelled; and the improved cold water rewarming test and vibration perception reading value examination method are adopted. Appendix A of this standard is an informative appendix, and Appendix B and C are normative appendices. This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard is drafted by Jining Medical College. The participating drafting units include Shanxi Medical University, the Institute of Labor Hygiene of the Ministry of Railways, the Institute of Labor Hygiene and Occupational Disease Prevention and Control of Liaoning Province, the Institute of Labor Hygiene and Occupational Disease Prevention and Control of Shandong Province, the Institute of Occupational Disease Prevention and Control of Guangxi Zhuang Autonomous Region, the Health and Epidemic Prevention Station of Guangxi Zhuang Autonomous Region and the Institute of Labor Hygiene and Occupational Disease Prevention and Control of Henan Province. This standard is interpreted by the Ministry of Health of the People's Republic of China. Diagnostic Standards for Occupational Hand-Arm Vibration Disease
GBZ7-2002
Hand-arm vibration disease is a disease caused by long-term hand-transmitted vibration work, which is mainly characterized by peripheral circulation and/or arm nerve dysfunction, and can cause damage to the arm bones, joints and muscles. Its typical manifestation is vibration white fingers. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational hand-arm vibration disease. This standard applies to hand-arm vibration disease caused by long-term hand-transmitted vibration work in occupational activities. 2 Normative references
The clauses in the following documents become the clauses of this standard through reference in this standard. For all dated references, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, the parties who reach an agreement based on this standard are encouraged to study whether the latest versions of these documents can be used. For all undated references, the latest versions apply to this standard.
GB/T16180
3 Diagnostic principles
Diagnostic criteria for occupational acute chemical toxicity of nervous system diseases Assessment of the degree of disability caused by work-related injuries and occupational diseases of employees with a history of long-term hand-transmitted vibration work, the main symptoms and signs of hand-arm vibration disease, combined with peripheral circulation function and peripheral nerve function examinations, and reference to the labor hygiene survey data of the working environment, a comprehensive analysis is conducted, and similar diseases caused by other causes are excluded before diagnosis can be made. 4 Observation subjects
Those who have a long-term occupational history of hand-transmitted vibration work, and have symptoms such as hand numbness, hand swelling, hand pain, palm sweating, arm weakness and joint pain, and have one of the following manifestations: a) The rewarming time of the cold water hand rewarming test is prolonged or the rewarming rate is reduced (see Appendix B); b) The vibration sensation of the fingertips and the pain sensation of the fingers are reduced (see Appendix C). 5 Diagnosis and classification standards
5.1 Mild hand-arm vibration disease
Those who have one of the following manifestations:
a) White finger attacks involve the fingertips, not exceeding the range of the distal knuckles, and occasionally occur when exposed to cold; b) The pain sensation and vibration sensation of the hands are significantly reduced or the finger joints are swollen and deformed, and the nerve conduction velocity is slowed or the distal latency is prolonged in the neuro-electromyography examination. 5.2 Moderate arm vibration disease
Those with one of the following manifestations:
a) White finger attacks affect the distal and middle knuckles of the fingers (occasionally proximal knuckles), often in winter; b) Mild atrophy of hand muscles, neurogenic damage in neuro-EMG examination. 5.3 Severe arm vibration disease
Those with one of the following manifestations:
Gangrene;
White finger attacks affect all knuckles of most fingers, even the whole hand, often occur, and in severe cases, the fingertips may be b) Obvious atrophy of hand muscles or "eagle claw-like" hand deformity may occur, seriously affecting hand function. Treatment principles
Treatment principles
6.1.1 Comprehensive treatment is carried out according to the condition. Use drugs that dilate blood vessels and nourish nerves for treatment. Traditional Chinese medicine treatment can be combined with physical therapy, exercise therapy, etc. Surgical treatment is carried out when necessary. 6.1.2 Strengthen personal protection, pay attention to keeping hands and body warm 6.2 Other treatments
The subject of observation generally does not need to be transferred from vibrating work, but should be reexamined once a year and closely observe the changes in the condition. Mild hand-arm vibration disease should be transferred from work that is exposed to hand-transmitted vibration, and appropriate treatment should be carried out, and other work should be arranged according to the situation. Moderate hand-arm vibration disease and severe hand-arm vibration disease must be transferred from vibrating work and actively treated. If labor capacity assessment is required, refer to the relevant provisions of GB/TI6180 for processing. Instructions for the correct use of this standard
See Appendix A (Informative Appendix), and see Appendix B and C (Normative Appendix). Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
A.1 The types of work that can cause hand-arm vibration disease are mainly the use of vibrating tools and the work of hand-transmitted vibration. According to previous surveys, the main types of workers are rock drillers, riveters, pneumatic shovel workers, tamping workers, fixed and hand-held grinding wheel grinders, chain saw workers, electric saw workers, forgers, milling workers, and extruders. Other hand-transmitted vibration jobs that have been confirmed to cause hand-arm vibration disease are subject to this standard. Occupational hazards caused by whole-body vibration that is mainly transmitted through the feet and buttocks are not subject to this standard. A.2 Regarding "having a long-term occupational history of hand-transmitted vibration jobs", it generally refers to a continuous working age of more than one year in close contact with hand-transmitted vibration: the vibration parameters of each job and the epidemiological data of hand-arm vibration disease can also be referred to to consider the length of time.
A.3 Vibration white finger or occupational Raynaud's phenomenon has transient and phase characteristics. Generally, the affected finger becomes numb, swollen, and painful after being cold, and changes from gray to pale, developing from the distal end to the proximal end, with clear boundaries, which can last for several minutes to tens of minutes, and then gradually changes from pale and gray to flushed, and returns to normal color. The basis for judgment should be mainly based on the findings of professional medical personnel; the main complaint of white fingers, and the circumstantial evidence consistent with the relevant personnel in the workplace should also be used as an important reference. If necessary, a white finger induction test can be performed. However, the induction rate of local cooling is very low. As for what method to use to induce white fingers, this standard does not make a unified regulation, and it is based on the premise that it does not endanger the health of the subjects. A.4 The scope of vibration white finger attacks should be judged separately on a single hand. "Majority" fingers refer to three or more fingers. For the diagnostic grading of white fingers, if the left and right hands are inconsistent, the diagnostic grading of the more serious side should be used as the standard, but they should be described separately such as L moderate (2) / R mild (1), meaning moderate in the left hand (involving 2 fingers); mild in the right hand (involving 1 finger) A.5 For the examination method of neuro-electromyography and the judgment criteria of neurogenic damage, please refer to the diagnosis of occupational acute chemical poisoning Part 5: Diagnosis of nervous system diseases caused by occupational acute chemical poisoning. Appendix B
(Normative Appendix)Www.bzxZ.net
Hand skin temperature measurement and cold water rewarming test method This test is required to be carried out in a room with a room temperature of 20℃±2℃. The subjects are required to wear ordinary clothes, not smoke for at least 2 hours before the test, not take vasoactive drugs for 24 hours, and not be hungry. The test is carried out after 30 minutes of rest in the room. A semiconductor thermometer (or thermocouple thermometer) is used to measure the skin temperature (i.e., basal skin temperature) of the middle point on the back of the middle knuckle of the subject's ring finger, and then the lower part of both wrists is immersed in a 10℃±0.In 5℃ cold water, separate your fingers naturally without touching the water container, soak for 10 minutes, and quickly use a towel to gently wet the water on the above parts after getting out of the water, and immediately measure the temperature of the above parts (immediate skin temperature). When measuring, relax your hands naturally and place them on the table at the same height as your heart. Measure and record once every 5 minutes, and observe the time (min) it takes for the finger temperature to recover to the basal skin temperature. Those who have not recovered after 30 minutes of the cold test are considered abnormal. The rewarming rate can also be calculated according to the following formula:
Rewarming rate 5 minutes and 10 minutes after the cold test =
Skin temperature 5 minutes (or 10 minutes) after the cold test - immediate skin temperature after the cold test Basal skin temperature before the cold test - immediate skin temperature after the cold test. The 5-minute rewarming rate is less than 30% and the 10-minute rewarming rate is less than 60%, which are abnormal reference values. 100%
Appendix C
(Normative Appendix)
Method for testing the vibration threshold and pain threshold of the fingertips. Check the room temperature and the rest time of the subjects in the room. Same as the requirements of Appendix A. Vibration threshold test
When there is no unified test instrument, the test method of vibration reading value should meet the following requirements: Vibration frequency, mainly 125Hz, and when conditions permit, 63Hz and 250Hz should be included. Test position, mainly the index finger, and the middle finger and ring finger should be checked when necessary. Result expression, the measurement result is expressed in dB (0dB is equivalent to 0.308m/S). Under the above conditions, the normal reference value of the vibration reading value of the index finger is generally 7.5-15.5dB, with 17.5dB as the upper limit reference.
2 Pain threshold test
Use the injection needle weight method. That is, a 2ml syringe is used as a cannula, and a No. 6 injection needle is made into pain needles with weights of 1, 2, 3, 4, ... 15g. During the examination, the subject is asked to sit quietly with eyes closed, hands stretched out flat on the table, and concentrate on the feeling during the examination. The examiner places the needle in the cannula, holds the cannula, and allows the needle tip to vertically touch the subject's skin. The ascending method, that is, the weight from small to large, is used to check the pain sensation on the back of the middle knuckle of the left ring finger. The weight at which the subject first feels the stinging pain is the pain threshold (g). The normal reference value of the pain reading for adults is below 6g.
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