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目的研究10℃的冷水复温试验(CWLT)在手传振动职业危害中的临床应用。方法以从事手传振动作业且诊断为职业性手臂振动病的42例患者为发病组,以从事手传振动作业但未能诊断为职业性手臂振动病的17名工人为接振组,以从事非手传振动作业的24名健康办公室人员为对照组。对3组人员进行10℃的CWLT,用数字皮温计测量CWLT前后手部皮温,并对结果进行统计分析。结果 3组工人手麻、手痛、手胀、手臂无力和关节疼痛的发生率分别比较,差异均有统计学意义(P<0.01)。3组手部主要症状的发生率从小到大依次为对照组<接振组<发病组。3组组间手部皮温差异有统计学意义(P<0.01);左手和右手皮温差异无统计学意义(P>0.05);CWLT前和CWLT后0、5、10、15、20、25、30 min 8个时间点间手部皮温差异有统计学意义(P<0.01);时间和组别之间存在交互效应(P<0.05);时间和手别之间、组别和手别之间均不存在交互效应(P>0.05);时间、组别和手别三者之间无交互效应(P>0.05)。交互效应进一步分析结果显示:无论左手还是右手,CWLT前3组皮温差异均无统计学意义(P>0.05);CWLT后0~30 min时,发病组皮温均低于对照组(P<0.05);CWLT后0~20 min时,发病组皮温均低于接振组(P<0.05);CWLT后0~30 min时,接振组和对照组皮温差异均无统计学意义(P>0.05)。3组组间5 min、10 min复温异常率以及30 min未复温率分别比较,差异均无统计学意义(P>0.05)。结论10℃的CWLT方法有待改进,建议采用皮温实测值和皮温恢复时间作为评价指标。
Objective To study the clinical application of CWLT at 10 ℃ in the occupational hazards of hand-transmitted vibration. Methods Forty-two patients diagnosed as occupational arm vibration disease by hands-on vibration operation were selected as the incidence group, 17 workers engaged in hand-transmitted vibration operation but not diagnosed as occupational arm vibration disease as vibration-receiving group, Twenty-four health office workers who did not hand-vibrate were the control group. Three groups of workers were subjected to CWLT at 10 ° C. The skin temperature of the hands before and after CWLT was measured by a digital dermatometer, and the results were statistically analyzed. Results The incidence of hand anesthesia, hand pain, hand swelling, weakness of arm and joint pain in the three groups were statistically significant (P <0.01). The incidence of the main symptoms of hand in 3 groups was as follows: control group 0.05). Before and after CWLT, there was no significant difference between the two groups (P> 0.05) There was a significant difference (P <0.05) between the time and the group (P <0.05) at 25 and 30 min at 8 time points; There was no interaction effect between them (P> 0.05). There was no interaction between time, group and hand (P> 0.05). The results of further interaction analysis showed that there was no significant difference in skin temperature between the first three groups of CWLT (left ventricle) and the right ventricle (left ventricle) or right ventricle (p> 0.05). At 0-30 min after CWLT, 0.05). At 0-20 min after CWLT, the skin temperature in the onset group was lower than that in the vibration-receiving group (P <0.05). At 0-30 min after CWLT, there was no significant difference in skin temperature between the vibration-receiving group and the control group P> 0.05). There was no significant difference between the 3 groups in 5 min, 10 min rewarming rate and 30 min rewarming rate (P> 0.05). Conclusion The CWLT method at 10 ℃ needs to be improved. It is suggested that skin temperature measurement and skin temperature recovery time be used as evaluation indexes.