This standard specifies the diagnostic criteria and treatment principles for occupational chronic trinitrotoluene poisoning. This standard applies to occupational chronic trinitrotoluene poisoning caused by long-term exposure to trinitrotoluene. GBZ 69-2002 Occupational chronic trinitrotoluene poisoning diagnostic criteria GBZ69-2002 Standard download decompression password: www.bzxz.net

ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ69—2002
Diagnostic Criteria of Occupational Chronic Trinitrotoluene PoisoningPublished 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 GB3231-1996 and this standard, this standard shall prevail. Trinitrotoluene is a chemical raw material. Long-term exposure to it due to improper protection in occupational activities can cause systemic diseases mainly involving liver damage. In order to diagnose and treat trinitrotoluene poisoning at an early stage and protect the health of the contactors, this standard is formulated on the basis of summarizing domestic clinical practical experience and analyzing domestic and foreign research progress. 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 the Ordnance Industry Hygiene Research Institute and the Shandong Provincial Institute of Occupational Health and Occupational Disease Prevention and Control. This standard is interpreted by the Ministry of Health of the People's Republic of China. Occupational chronic trinitrotoluene poisoning diagnostic standard GBZ69-2002
Occupational chronic trinitrotoluene poisoning is a systemic disease characterized by liver damage and lens opacity due to long-term exposure to trinitrotoluene at work. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational chronic trinitrotoluene poisoning. This standard is applicable to occupational chronic trinitrotoluene poisoning caused by long-term exposure to trinitrotoluene. 2 Diagnostic principles
Based on the close history of occupational exposure, the degree of skin contamination, the dynamic observation of liver damage and laboratory test results, with reference to the characteristics of eye lens changes, combined with labor hygiene data such as workshop air concentration monitoring, a comprehensive analysis is conducted, and liver damage caused by other causes is excluded before diagnosis can be made. 3 Observation subjects
Those with any of the following symptoms may be listed as observation subjects: 3.1 Symptoms such as dizziness, fatigue, loss of appetite, and pain in the liver area, enlarged and soft liver, tenderness and immediate pain are not obvious, and liver function tests are normal:
3.2 Clinical symptoms are not obvious, the liver is not enlarged, and the liver function test is abnormal: 3.3 Enlarged liver and trinitrotoluene cataracts have appeared. 4 Diagnosis and classification standards
4.1 Mild poisoning
Those with any of the following symptoms may be diagnosed as mild poisoning. 4.1.1 Symptoms such as fatigue, loss of appetite, nausea, aversion to oil, pain in the liver area, enlarged liver, soft or tough texture, tenderness or percussion pain, abnormal liver function test;
4.1.2 Slow enlargement of the liver, soft or tough texture, tenderness or percussion pain: 4.2 Moderate poisoning
Mild poisoning symptoms worsen, with one of the following manifestations, can be diagnosed as moderate poisoning: 4.2.1 Enlarged liver, tough texture, repeated abnormal liver function test; 4.2.2 Splenomegaly.
4.3 Severe poisoning
Severe poisoning can be diagnosed as one of the following manifestations: 4.3.1 Cirrhosis;
Aplastic anemia.
Treatment principles
Treatment principles
Develop a treatment plan based on the condition, prohibit drinking, prohibit or use with caution drugs that cause liver damage, and treat liver protection according to internal medicine.
Symptomatic and supportive therapy.
5.2 Other treatments
Observation subjects
-Generally, the liver function should be reexamined every 3 to 6 months. Those with abnormal liver function should be reexamined and other examinations should be performed in time to make a clear diagnosis as soon as possible. 5.2.2 Mild to moderate
Should be immediately transferred from the original job and rest for treatment. After recovery, they should generally be transferred from liver toxic jobs. Moderate poisoning
Should be hospitalized for active treatment. After recovery, they should be transferred from harmful and toxic jobs. Severe poisoning
Should be given a long rest. Those who have significantly improved after treatment can be appropriately arranged for non-toxic light work if their health conditions permit. Instructions for the correct use of this standard
See Appendix A (Informative Appendix).
Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
A.1 This standard is only applicable to the diagnosis of occupational chronic poisoning of workers who are exposed to trinitrotoluene for a long time, and is not applicable to non-occupational poisoning or acute poisoning. www.bzxz.net
A.2 In terms of occupational exposure history, in addition to the concentration of toxicants in the working environment, factors such as skin absorption, labor intensity and ambient temperature must also be considered to comprehensively analyze the dose-effect relationship. A.3 This standard does not make rigid provisions for liver size and quality, but emphasizes the dynamic observation of liver status and comprehensive analysis of relevant data for diagnosis of this disease, but changes in liver size and quality are still important in comprehensive judgment. A.4 Type B ultrasound examination is not used as an important diagnostic indicator in this standard, but can be used in combination with clinical reference. A.5 Liver function tests in this standard refer to serum alanine aminotransferase (ALT), r-aminotransferase (r-GT), glycocholic acid (CG), transferrin (TG), prealbumin (PA), etc. Clinically, 2 to 3 items can be selected according to specific conditions.
A.6 Under current production conditions, trinitrotoluene rarely damages the blood system, so this standard does not list changes in the blood system as a diagnostic indicator. If long-term close contacts in a special harsh working environment do develop anemia or aplastic anemia, the differential diagnosis of other causes of anemia should be made based on the data of dynamic observation of the disease and the clinical manifestations. After comprehensive analysis, those who meet the cause of the disease can be diagnosed, and those with aplastic anemia caused by the disease can be classified as severe poisoning. A.7 When differentially diagnosing with viral hepatitis, do not simply rely on the positive serological indicators of viral hepatitis to exclude toxic liver disease. Consider the possibility of cross-action between the two causes. Clinically, the entire condition should be combined with the occupational history to draw conclusions through comprehensive analysis.
A.8 Biological monitoring can reflect the level of exposure. Biological monitoring when necessary is helpful for diagnosis and differential diagnosis.
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