GB 4869-1985 Occupational local vibration disease diagnosis standard and treatment principles
Some standard content:
National Standard of the People's Republic of China
Occupational local vibration disease
Diagnostic criteria and principles ofmanagement of occupational vibration diseaseUDC 616-057
GB 4869—85
Local vibration disease is a disease caused by long-term use of vibrating tools, with peripheral circulation disorders as the main disease, and may also affect limb nerves and motor functions. The onset is generally at the end of the upper limbs, and its typical manifestation is paroxysmal whitening of fingers (hereinafter referred to as white fingers). 1 Diagnostic principles
With a long-term occupational history of local vibration work and related main clinical manifestations, combined with the examination of peripheral circulation function and nerve function, a comprehensive analysis is conducted, and local movement disease can be diagnosed only after other diseases are excluded. 2 Diagnosis and classification standards
2.1 Observation subjectsWww.bzxZ.net
Those with a history of long-term close occupational exposure, generally with a length of service of more than one year, and with local symptoms such as hand pain, numbness, coldness, stiffness, swelling, tingling, and juiciness, and may also have systemic symptoms such as headache, insomnia, tinnitus, and joint pain, and who have one of the following conditions, are listed as observation subjects.
2.1.1 The rewarming time after hand immersion in cold water exceeds 30 minutes. 2.1.2 The microcirculation examination of the nail folds shows a significant increase in the number of heteromorphic vessels, and the capillaries are in a state of spasm. 2.1.3 The pain, touch, and vibration sensations in the hands are reduced. 2.2 Mild local vibration disease
In addition to the above symptoms, those who have one of the following conditions can be diagnosed with mild local vibration disease. 2.2.1 "When the fingertips are in contact with the cold, the fingertips are irritated with clear boundaries, and occasionally the proximal knuckles of individual fingers may be affected. 2.2.2 The peripheral circulation function is not significantly changed, but the electromyography examination shows neurogenic damage, or is accompanied by mild contraction of the hand muscles. 2.3 Severe local vibration disease
Those with any of the following conditions can be diagnosed with severe local vibration disease. White fingers spread to the proximal knuckles of many fingers. Except for winter hands, other knuckles also have attacks after being exposed to cold, which has a certain impact on life and work. Some patients with severe conditions may experience itching of the fingertips. 2.3.1
.2
The lower muscles are obviously contracted, and neurogenic damage can be seen in electromyography. 3 Treatment principles
Comprehensive treatment is performed using drugs that dilate blood vessels and nourish nerves, exercise therapy, physical therapy, and Chinese medicine that has the effect of promoting blood circulation and unblocking collaterals. Surgical treatment is performed when necessary.
4 Assessment of labor capacity
4.1 Observation subjects
Check once every 1 to 2 years according to the situation, and closely observe the changes in the condition. 4.2 Mild local vibration disease
Promulgated by the Ministry of Health of the People's Republic of China on January 14, 1986 and implemented on August 1, 198
GB 486$—85
Should be transferred from the moving work, receive appropriate treatment, and arrange other work according to the situation. 4.3 Severe local vibration disease
Must be transferred from the vibration work and actively receive treatment. After the condition is alleviated, other light work can be done. When frequent cases occur, they can take appropriate rest. Those with motor dysfunction should strengthen functional training. 5 Requirements for health examination
5.1 All personnel who are going to engage in local vibration work should undergo a pre-employment physical examination, which includes general internal medicine and neurology examinations. Months.
5.2 All those who are engaged in local vibration work should have regular physical examinations at intervals of 2 to 3 years. In addition to general internal medicine and neurology examinations, the physical examinations should also include peripheral nerve function examinations of the hand peripheral circulation segment. 6 Occupational contraindications
6.1 Obvious central or peripheral nervous system diseases. 6.2 Peripheral vascular diseases, especially Raynaud's disease. 6.s Severe cardiovascular diseases.
6.4 Obvious endocrine dysfunction,
Severe hearing loss:
GB 4869—-5
Appendix A
Special inspection methods for peripheral circulation function
(Supplement)
All inspections of peripheral circulation function are required to be carried out at room temperature of 20±2℃ and after half an hour of rest in the room. A,1 Determination of basal skin temperature and rewarming test after cold water immersion (hereinafter referred to as cold water rewarming test) First, use a semiconductor thermometer (thermocouple thermometer) to measure the skin temperature (basic skin temperature) of the back of the second knuckle of the ring finger of both hands of the subject. Then let the subject immerse the wrists below the wrist in 4±1℃ cold water for 2 minutes, and stir the cold water at any time. After escaping from the water, quickly use a towel to gently absorb the water, and immediately measure the local finger temperature when escaping from the water. Thereafter, measure and record every 5 minutes, and observe the time required for the finger temperature to return to the basal skin temperature before immersion in cold water. When measuring, relax both hands, bend them in a fan-shaped shape, and place them on the table at chest height. Normal people usually recover within 20 minutes. Those whose rewarming time is extended to less than 30 minutes are considered abnormal. People with hypertension (blood pressure above 160/95mmlg) or coronary heart disease should not do this test.
A,2 Nail fold microcirculation examination
A.2.1 Main equipment
Nail fold microcirculation microscope and micrometer. If ordinary microscope is used instead, cold light source should be used. A.2.2 Inspection method
Wash hands with warm water and soap at about 30 degrees, or wipe the nail fold skin of the ring finger or white finger of one hand with ethanol, and then place a drop of cedar oil locally after heating, and observe directly under the microscope at 80-160 times magnification. During the inspection, the upper limbs should be relaxed, and the hand should be at the same height as the heart water level. A,2.3 Observation indicators and reference judgment criteria A2.3.1 Tube morphology: Observe the first row of tubes and calculate the percentage of abnormal tubes. More than 70% of normal adults have normal capillary tubes (hairpin type).
A.2.3.2 Capillary tube diameter Under microscope magnification 100 times, use eyepiece micrometer to directly measure the diameter of three tube chains and take the average value. The diameter of the arterial arm (limb) of normal human tubes is 10-20μm, and those less than 1.0μm are painful tubes. A.2.3.3 Blood flow velocity and other indicators can also be observed and measured according to needs and possibilities for comprehensive analysis. The above tests should be carried out before the water rewarming test. GB4869-86
Appendix B
Methods for peripheral nerve sensation examination
(Supplement)
General clinical nervous system examination cannot determine the changes in sensation. In recent years, some units at home and abroad have begun to develop some instruments to perform relative quantitative determination of changes in peripheral sensation. Here are several methods for reference and trial use by units with conditions. The room temperature requirements and rest time before the following tests are the same as those in Appendix A. B.1 Pain test (weight test method)
Use a 2 ml syringe as a sleeve and make a 6-gauge injection needle with a weight of 1, 3, 5...15. The test subject is asked to close his eyes and sit quietly, with his hands raised and placed on the table, and pay attention to the feeling during the test. The examiner places the needle in the sleeve, holds the sleeve so that the needle tip touches the subject's skin vertically, and uses small to large weights to test the pain sensation on the back of the second knuckle of the middle finger and the phalanx of both hands. The pain sensation of normal people is generally below.
B.2 Tactile test (including the test of the tactile sensation and the two-point discrimination test) uses the improved test instrument and two-point discrimination instrument of Calsun et al. (refer to Journal o『Occupationa!Medicine 21(4)t260, 1979). The subject closes his eyes and pays attention to the feeling during the test. The middle fingers of both hands are attached in the "V" shape, and the fingertips are made to contact the tunnel-type fixing plate with a 100g stick. The examiner slowly pulls the fixing plate to make it slide forward and backward on the elastic track 1 at a steady speed. The values when the subject just feels the rise and the two-point separation are recorded respectively. Each finger is tested 3 times and the average is taken. The measurement of normal people is mostly below 0.3mm in the test and below 2.0mm in the two-point discrimination test. B.3 Kinesthetic test
Use a vibration sense meter (see Journal of Jining Medical College (1): 87, 1982) to check the vibration sense of the distal finger pulp of both hands (frequency is 62.5, 125 and 25Hz). GB 4-5:1997-1999, Appendix A to the Diagnostic Criteria and Treatment Principles of Occupational Chronic Chlorene Poisoning (Supplement) 34865-85 ...1 Scope of application of this standard
GB4869—85
Appendix D
Instructions for correct use of the standard
(reference)
According to the current national survey results, this standard applies to types of workers that can cause local vibration diseases, such as: pneumatic tool operators (such as pneumatic shovel workers, rock drillers, riveters, etc.), electric tool operators (such as electric saw workers, finger grinders, etc.), other vibration operation operators (such as extruders, chain saws, etc.) and other types of workers that have been confirmed to have local vibration hazards in surveys. This standard does not apply to types of workers that have systemic vibration operations. D.2 Regarding "long-term close occupational exposure history", it generally refers to those who have been engaged in vibration operations for more than one year: the vibration parameters of the operation and the epidemiological data of local vibration diseases can also be referred to, and the length of operation time and the degree of exposure can be considered. D. The typical manifestation of local vibration disease is pulsating white fingers. The basis for its judgment refers to the white finger attack observed or induced by medical staff. The attack process is generally that the fingers gradually change from gray to white after being cold, and develop from the distal end to the proximal end, with clear boundaries. When recovering, they turn from white to gray, and the gray turns to red. Atypical attacks should refer to other examination items for comprehensive judgment. D.4 Regarding what method to use to induce white fingers, this document does not make a unified provision. The principle should be not to endanger the health of a person. Additional explanation:
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, the Heilongjiang Provincial Labor Health and Occupational Disease Research Institute, the Liaoning Provincial Labor Health Research Institute, the Dalian Labor Health Research Institute, the Shenyang Labor Health and Occupational Disease Research Institute and the Jining Medical College. This standard was entrusted by the Ministry of Health to the China Preventive Medicine Center for interpretation.
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