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目的探讨退休脱离粉尘接触(脱尘)老年晚发性矽肺患者的发病特征和临床特点。方法回顾性分析106例退休脱尘后诊断的老年晚发性矽肺患者的职业病诊断资料和临床资料。结果 106例患者均在退休后因体格检查或者患病检查发现疑似尘肺病而要求诊断,所有患者及其用人单位(或上级单位)在诊断过程中均无法提供工作场所粉尘检测资料。确诊年龄61～77(68.8±3.7)岁,接尘工龄8～40(27.5±4.8)年,脱尘时间6～22(13.8±3.7)年。患者呼吸道症状明显,主要表现为胸闷、胸痛、咳嗽、咯痰和气促,但阳性体征不明显。高千伏X射线后前位胸片影像学改变主要表现为圆形小阴影q影(74.5%,79/106),大阴影以单发多见(59.2%,16/27)。37.7%患者合并肺气肿,34.9%患者出现胸膜增厚或粘连。肺通气功能减退发生率为50.0%,矽肺叁期患者肺通气功能减退发生率高于矽肺壹期、贰期患者(P<0.01),并且肺通气功能减退程度较后者严重(P<0.01)。69.8%患者完全丧失劳动能力(伤残等级2～4级)。结论退休老年晚发性矽肺确诊时脱尘时间相对较短,应建立合理有效机制,加强对退休粉尘作业人员的职业病防治工作。
Objective To investigate the onset and clinical characteristics of senile patients with late silicosis after retirement from exposure to dust (dust). Methods The diagnostic data and clinical data of occupational diseases in 106 senile patients with late-onset silicosis diagnosed after retirement were retrospectively analyzed. Results All 106 patients were required to diagnose suspected pneumoconiosis after physical examination or illness examination after retirement. All patients and their employer (or their superiors) were unable to provide workplace dust test information during the diagnosis. The diagnosed age ranged from 61 to 77 years old (68.8 ± 3.7) years old, followed by dusting for 8-40 years (27.5 ± 4.8 years) and dusting time 6-22 (13.8 ± 3.7 years). Patients with respiratory symptoms were obvious, mainly chest tightness, chest pain, cough, expectoration and shortness of breath, but the positive signs are not obvious. High kV X-ray anteroposterior chest radiograph changes mainly in the form of small circular shadow (74.5%, 79/106), large single shadow more common (59.2%, 16/27). Thirty-seven (37.7%) patients had emphysema, and 34.9% had pleural thickening or adhesions. The incidence of hypogonadism was 50.0%. The incidence of pulmonary dysfunction in patients with silicosis was higher than those in patients with silicosis stage I and II (P <0.01), and the degree of pulmonary dysfunction was significantly worse than that of the latter (P <0.01) . 69.8% of patients lost their ability to work completely (disability grade 2-4). Conclusion Retirement senile late silicosis lung clearance time is relatively short, should establish a reasonable and effective mechanism to strengthen the prevention and treatment of occupational diseases for retired dust workers.