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目的:探讨甘肃省白银地区砂金矿工人肺纤维化临床特点。方法:选取2003年至2012年期间在白银市第二人民医院临床确诊为肺纤维化的20例住院砂金矿工人进行临床分析。结果:20例患者均来自私营企业,普遍存在乱采滥挖现象,主要采用打竖井和打隆道的方式开矿。均使用柴油机,矿井内烟雾、粉尘浓度很高,站在几米以外的人无法看见。其中风钻工5例(25%),爆破工7例(35%),装卸工8例(40%),发病工龄1~6年,平均3年。并发单侧气胸6例(80%),双侧气胸2例(10%),合并肺部感染20例(100%),合并肺心病20例(100%),20例中未发现合并结核及肺癌。患者均有明显的呼吸系统症状,主要表现为咳嗽、咳痰、胸闷、胸痛、进行性呼吸困难、乏力等。体征有低氧血症、杵状指、爆裂音(velcro罗音)等。结论:白银地区砂金矿工人接触粉尘中含有柴油机尾气烟雾,游离二氧化硅等,肺纤维化发病工龄短,病情进展快,以中上肺病变为主,气胸合并率高,呼吸系统症状明显,预后差。
Objective: To investigate the clinical features of lung fibrosis among gold miners in Baiyin area, Gansu Province. Methods: The clinical data of 20 hospitalized placer gold miners clinically diagnosed as pulmonary fibrosis in the Second People’s Hospital of Baiyin City from 2003 to 2012 were selected for clinical analysis. Results: All of the 20 patients were from private enterprises. There was widespread indiscriminate digging and digging, and the main ways were to open shafts by means of shaft and tunneling. Diesel engines were used. Smoke and dust in mines were high and could not be seen by people standing a few meters away. Among them, 5 were stroke workers (25%), 7 were blasting workers (35%), and 8 were loading and unloading workers (40%). The patients were aged 1 to 6 years with an average of 3 years. Six patients (80%) had unilateral pneumothorax, two patients (10%) had bilateral pneumothorax, 20 patients (100%) had pulmonary infection, and 20 patients (100%) had pulmonary heart disease. No tuberculosis was found in 20 patients Lung cancer. Patients have obvious respiratory symptoms, mainly manifested as cough, sputum, chest tightness, chest pain, progressive dyspnea, fatigue and so on. Signs of hypoxemia, clubbing, crackle (velcro rales) and so on. Conclusion: The contact dusts of silver and gold mine workers in Baiyin area contain diesel exhaust fumes and free silica, etc. The incidence of pulmonary fibrosis is short, and the disease progresses rapidly. The main pathological changes of pulmonary fibrosis are middle and upper lung lesions, high rate of pneumothorax and respiratory symptoms, Poor prognosis.