人造石矽肺文献病例分析

doi:10.16265/j.cnki.issn1003-3033.2023.06.2172

摘要/Abstract

摘要：

为降低我国人造石矽肺发病率,分析文献病例作业场所人造石成分、接触机会、临床特征、流行病学特点,并提出预防人造石矽肺的发生应采取湿式作业、通风除尘、个体防护等综合措施。结果表明:作业场所干式作业、结晶型二氧化硅质量浓度超标,无通风除尘、个体防护措施是引起人造石矽肺的主要原因。2010—2019年,西班牙、以色列、意大利、美国、澳大利亚和我国分别报道了本国人造石矽肺病例,共计131例。随着人造石的大量生产加工和使用,病例数也在不断增加。文献病例多集中在30~50岁,工龄在10年以上,且均为男性。很多病例早期无明显自觉症状。随着病情进展,或有合并症时,可出现咳嗽、咳痰、胸闷、气短、胸痛等症状。有时临床特征与X线胸片改变不一致。工作场所人造石中结晶型二氧化硅含量均在70%以上,粉尘质量浓度均超过其本国的职业接触限值。工作时多采用干式切割,无通风除尘等防尘措施,且大多没有佩戴合格的呼吸防护用品。

关键词: 人造石矽肺, 病例, 结晶型二氧化硅, 人造石英石

Abstract:

In order to reduce the incidence rate of artificial stone silicosis in China, the composition, exposure opportunity, clinical characteristics and epidemiological characteristics of literature cases of workplace silica dust were analyzed. Finally, comprehensive measures such as wet cutting, ventilation, personal protection, et al, to prevent the occurrence of silicosis in the workplace were proposed. The results show that dry cutting, excessive concentration of crystalline silica, without ventilation and personal protective measures in the workplace were the main causes of artificial stone silicosis. From 2010 to 2019, Spain, Israel, Italy, the United States, Australia and China reported a total of 131 literature cases of artificial stone silicosis. With the mass production, processing and use of artificial stone, the number of cases increased. Most of the literature cases were about 30-50 years old. They had exposed to silica dust exposure for more than 10 years, and they were usually male. Many cases had no obvious symptoms in the early stage. As the disease progresses or complications, symptoms such as cough, expectoration, chest tightness, shortness of breath and chest pain might appear. Sometimes the clinical features were different from the changes of X-ray chest film. The content of crystalline silica in artificial stone was more than 70%, and the concentration of silica dust exceeded occupational exposure Limits in the working environment of their own countries. There were no dust suppression measures, such as dry cutting, without ventilation, et al, in most workplace. Most literature cases did not wear qualified respiratory protective equipment at work.

Key words: artificial stone silicosis, cases, crystalline silica, artificial quartz stone

唱斗, 丁翠, 叶俏, 马骏, 王生. 人造石矽肺文献病例分析[J]. 中国安全科学学报, 2023, 33(6): 207-213.

CHANG Dou, DING Cui, YE Qiao, MA Jun, WANG Sheng. Analysis of literature cases of artificial stone silicosis[J]. China Safety Science Journal, 2023, 33(6): 207-213.

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国家	行业	台面装饰主要石材	主要成分 (含量/%)
以色列^[6⇓⇓-9]	建筑行业	人造石板	结晶型二氧化硅(>85)
西班牙^[10-11]	建筑行业	人造石板	结晶型二氧化硅(70~90)
美国^[12]	建筑行业	人造石板	结晶型二氧化硅(70~90)
意大利^[13]	建筑行业	人造石板	结晶型二氧化硅(70~90)
澳大利亚^[14-15]	建筑行业	人造石板	结晶型二氧化硅(>85)
中国^[5,16]	建筑行业	人造石板	结晶型二氧化硅(>70)

国家	病例数/人	性别(男)	年龄/岁	接尘工龄/a
西班牙^[10]	1	1	32.0	17.0
西班牙^[11]	46	46	33.0(中位数)	11.0(中位数)
以色列^[7]	9	9	44.1(均数)	15.6±6.8
以色列^[8]	68	68	48.3±11.1	20.5±10.0
美国^[12]	1	1	37.0	10.0
意大利^[13]	3	3	49.7± 4.5	27.0±2.9
澳大利亚^[14]	7	7	26.0-61.0	4.0-10.0
中国^[5]	18	18	36.1 ±9.6	6.4±2.9
中国^[24]	98	98	38.5±9.5	5.6±2.4

国家	病例数/人	FEV1/%	FVC/%	FEV1/FVC/%
以色列^[7]	9	48.4± 26.4	53.6±24.9	91.4± 20.2
以色列^[8]	68	74.6±22.5	79.0±19.8	76.0±12.1
西班牙^[6]	1	81.0	82.0	84.0
中国^[5]	18	65.2±29.4	69.0±29.5	80.7±11.5
中国^[29]	46	95.3±22.5	104.2±22.3	83.0±8.8

国家或国际组织	矽尘职业接触限值/(mg·m^-3)
西班牙^[10]	0.05
以色列^[8]	0.1(≤7μm);0.3(飘尘)
意大利^[13]	0.05
澳大利亚^[14]	0.1
巴西^[37-38]	0.1
WHO^[37-38]		0.04
NIOSH^[37-38]		0.05
美国职业安全与健康管理局^[37]		0.05
加拿大^[37-38]		0.025
中国(GBZ2.1—2019)		10%≤游离二氧化硅≤50%,总尘:1,呼尘:0.7; 50%<游离二氧化硅≤80%,总尘:0.7,呼尘:0.3; 游离二氧化硅>80%,总尘:0.5,呼尘:0.2