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GBZ73-2009 English PDF

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GBZ73-2009: Diagnostic criteria of occupational acute toxic respiratory system diseases
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GBZ73: Evolution and historical versions

Standard ID	Contents [version]	USD	STEP2	[PDF] delivered in	Standard Title (Description)	Status	PDF
GBZ 73-2009	English	189	Add to Cart	3 days [Need to translate]	Diagnostic criteria of occupational acute toxic respiratory system diseases	Valid	GBZ 73-2009
GBZ 73-2002	English	359	Add to Cart	3 days [Need to translate]	Diagnostic Criteria of Occupational Acute Toxic Pulmonopathy	Obsolete	GBZ 73-2002

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Basic data

Standard ID	GBZ 73-2009 (GBZ73-2009)
Description (Translated English)	Diagnostic criteria of occupational acute toxic respiratory system diseases
Sector / Industry	National Standard
Classification of Chinese Standard	C60
Classification of International Standard	13.100
Word Count Estimation	8,834
Date of Issue	2009-03-16
Date of Implementation	2009-11-01
Older Standard (superseded by this standard)	GBZ 73-2002
Quoted Standard	GBZ 78; GB/T 16180
Regulation (derived from)	?Health-Communication [2009] 9
Issuing agency(ies)	Ministry of Health of the People's Republic of China
Summary	This standard specifies the occupational respiratory diseases diagnosis of acute toxicity of chemicals in principle, contact reaction, diagnosis and grading standards and principles. This standard applies to occupational acute toxic chemicals in the diagnosis and treatment of respiratory diseases.

GBZ73-2002: Diagnostic Criteria of Occupational Acute Toxic Pulmonopathy

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(Occupational Acute chemicals - Criteria for the diagnosis of toxic respiratory diseases) ICS 13.100 C60 GBZ People's Republic of China National Occupational Health Standards Occupational acute chemicals - Criteria for the diagnosis of toxic respiratory diseases Diagnostic Criteria of Occupational Acute Toxic Pulmonopathy Caused by Chemicals Released in.2002-04-08 2002-06-01 Implementation Issued by the Ministry of Health of the People's Republic of China

Foreword

Article 6.1 of this standard is recommended and the remainder is mandatory. According to the "People's Republic of China Occupational Disease Prevention Law" to develop this standard. Since the implementation of this standard date, the original GB 16852.6-2000 And this standard is inconsistent with this standard shall prevail. The rules set out in this series of rules, involving the diagnosis of occupational acute chemical poisoning, these rules used to protect The unity of the diagnostic system of occupational acute chemical poisoning, whether known or concealed by the cause, The damage to the target organ caused by poisoning can be diagnosed in accordance with the rules set forth in this standard. In the "occupational acute chemical poisoning diagnostic criteria" under the general heading, including the following 10 parts. each part The scope of the definition will be stated in the preface and the introduction to each section. Part 1. Diagnostic criteria for occupational acute chemical poisoning (general); Part 2. Occupational acute occult chemical poisoning diagnostic rules; Part 3. Occupational acute chemical toxicity - Multiple diagnostic criteria for multiple organ dysfunction syndrome; Part 4. Diagnostic criteria for occupational acute exogenous death; Part 5. Occupational acute chemical toxicity - Criteria for the diagnosis of neurological diseases; Part 6 Occupational acute chemicals - Criteria for the diagnosis of toxic respiratory diseases; Part 7. Diagnostic criteria for occupational acute toxic liver disease; Part 8. Diagnostic criteria for occupational acute toxic nephropathy; Part 9 Occupational Acute Chemicals - Toxic Cardiac Disease Diagnostic Criteria; Part 10 Occupational Acute Chemicals Toxicity Diagnostic criteria for blood system diseases; Appendix A of this standard is an informative appendix. Appendix B, C is a normative appendix This standard is proposed and centralized by the Ministry of Health of the People's Republic of China. This standard is drafted by Shanghai Yangpu District Central Hospital and Shenyang Institute of Labor and Health Occupational Diseases; Shanghai Sixth People's Hospital, China Center for Disease Control and Prevention Occupational Health and Poison Control, Heilongjiang Province, Labor and Health Occupational Diseases Institute, Peking University Third Hospital, Shanghai Chemical Industry Occupational Disease Prevention Institute, Fudan University Affiliated Huashan Hospital, Shanghai Occupation Sick hospital, Fudan University School of Public Health to participate in the drafting. This standard is interpreted by the Ministry of Health of the People's Republic of China. Occupational acute chemicals - Criteria for the diagnosis of toxic respiratory diseases Occupational Acute Chemicals Toxicity Respiratory diseases are those that are exposed to a large amount of chemicals in the short term due to occupational activity Caused by structural damage to the respiratory system and acute dysfunction-based systemic disease. The most severe cases can occur acute respiratory embarrassment Forced syndrome (ARDS).

1 Scope

This standard specifies the diagnostic criteria and principles of occupational acute chemical toxic respiratory disease. This standard applies to the diagnosis and treatment of occupational acute chemical toxic respiratory diseases.

2 normative reference documents

The terms of the following documents are hereby incorporated by reference into this standard. Any reference to the date of the document, All subsequent amendments (excluding corrigenda) or revisions do not apply to this standard, however, The parties to the standard agreement have studied whether the latest versions of these documents can be used. Those who do not mind the date of the reference file, the most The new version applies to this standard. GBZ 76 Occupational acute chemical poisoning Nervous system disease diagnostic criteria Diagnostic criteria for occupational acute toxic nephropathy Identification of Occupational Injury and Occupational Disease Disability in Staff and Workers GB/T 16180

3 diagnostic principles

According to the short-term exposure to a large number of chemical occupational history, clinical manifestations of acute respiratory injury, combined with blood gas analysis And other tests see, refer to the scene of labor hygiene survey data, comprehensive analysis, excluding other causes of similar diseases, Can be diagnosed.

4 stimulus response

There is a transient eye and upper respiratory tract irritation symptoms, chest X-ray showed no abnormal performance.

5 Diagnostic and grading standards

5.1.1 mildly toxic respiratory disease Those who have one of the following conditions can be diagnosed with mildly toxic respiratory disease. a) eye and upper respiratory tract irritation symptoms, such as shame out, tears, sore throat, cough, chest tightness, etc., can also have increased cough, Slightly mucous sputum, occasional sputum bloody; signs of conjunctiva, pharyngeal congestion and edema; lung breath sounds rough, or may have scattered In the dry, wet rales; chest X-ray performance for the increase in lung texture, thickening, extension, or blurred edges; meet the acute trachea Bronchitis or bronchial inflammation. b) symptoms of asthma-based, particularly difficult to exhale, accompanied by cough, chest tightness and so on. Signs of lung diffuse wheeze, Chest X-ray performance can be no exception. Was asthma-like performance. 5.1.2 Moderate toxic respiratory diseases Those who have one of the following conditions can be diagnosed with moderate toxic respiratory diseases. a) cough, expectoration, shortness of breath, chest tightness, etc .; may have sputum bloody, lungs are dry, wet rales, often accompanied by mild hair Cyanosis; chest X-ray performance for the two, the lower lung field visible spot or small patchy shadow; in line with acute bronchial pneumonia. b) cough, expectoration, chest tightness and shortness of breath is more serious, the lungs on both sides of the breath sounds reduced, no obvious rales, chest X Ray performance for the increase in lung texture, hilar shadow widened, the state is unclear, the two lungs scattered in the dotted shadows and reticular shadows, lung field Transparency reduced, often seen horizontal crack thickening, and sometimes visible bronchial cuff sign and (or) Kline B line; meet the acute interstitial Pulmonary edema. c) cough, expectoration, sputum less moderate, shortness of breath, mild cyanosis, lungs scattered in the wet rales, chest X-ray Showing a single or a few cases of hate contours clear, increased density of circular shadow; meet the acute limitations of alveolar pulmonary edema. d) history of inhaled hydrocarbons or other liquid chemicals, severe cough, expectoration, sputum bloody, also May have rust color phlegm, chest pain, difficulty breathing, cyanosis and other symptoms, often accompanied by fever, general discomfort, etc .; X-ray chest Texture thickening and small pieces of shadow to the right side of the more common, a few may be associated with exudative pleurisy; in line with acute aspiration pneumonia. 5.1.3 severe toxic respiratory diseases Where any of the following circumstances can be diagnosed as severe toxic respiratory diseases. a) severe cough, slightly a lot of white or pink foam sputum, difficulty breathing, obvious cyanosis, two lungs wet rales, Chest X-ray performance of the two lungs have different sizes, the edge of the blurred small pieces of pellets or clouds flocculent shadow, and sometimes can be integrated into large Flake shadow, or butterfly-shaped distribution; blood gas analysis PaO2/FiO2 ≤ 40 kPa (300 mmHg); consistent with diffuse alveolar lung Edema or central alveolar pulmonary edema. b) The above situation is more severe, respiratory rate greater than 28 times/min or/and have respiratory distress; chest X-ray display The majority of the two lungs were fused with large lamellar shadows; blood gas analysis Oxygen partial pressure/oxygen concentration (PaO2/FiO2) ≤ 26.7 kPa (200 mmHg); consistent with acute respiratory distress syndrome. c) suffocation. d) complicated by severe pneumothorax, mediastinal emphysema or severe myocardial damage. e) sudden death.

6 Principles of handling

6.1 on-site processing Immediately out of contact, keep quiet, keep warm. The emergence of stimulating response, should be closely observed, the contact may cause breathing Patients with delayed disease lesions (longer latency), the observation period should be extended, the observation period should avoid activities, and to To symptomatic treatment, if necessary, to prevent the treatment of drugs such as inhalation spray, oxygen, injection of adrenal glucocorticoids, etc., And given psychological treatment, is conducive to control the disease progression. Eye by chemical contamination, must be immediately and thoroughly washed, must not be washed and sent to the hospital, so as not to occur eye Reverse the serious lesions, skin contamination of chemical burns should also be washed in the field completely sent to the hospital. 6.2 Principles of treatment 6.2.1 keep the airway open Can be given inhalation therapy, bronchial antispasmodic agents, to the foam agent such as dimethyl silicone oil, if necessary, the implementation of tracheotomy. 6.2.2 Etiology treatment If the application of complexing agents, special antidote, or blood purification therapy indications, timely application. Such as inhalation of a larger amount of powder Dust or liquid, consider the implementation of fiber trachea, early suction of dust or liquid. 6.2.3 Reasonable oxygen therapy Attention to reasonable oxygen therapy, maintenance of water and electrolyte balance, support the treatment and prevention of complications. 6.3 Other processing Mild, moderate toxic respiratory disease cured, can restore the original work. Severe toxic respiratory disease cure After the principle should be transferred from the stimulating gas operations. Acute toxic respiratory diseases such as sequelae, refer to GB/T 16180, combined with the actual situation, properly handled.

7 Correctly use the instructions in this standard

See Appendix A (informative), Appendix B, C (normative).

Appendix A

(Informative) Correctly use the instructions in this standard A.1 acute toxic respiratory damage caused by a lot of pathogenic chemical species, the standard Appendix B, the common pathogenic varieties Listed, and according to their role is divided into two categories, to facilitate a more comprehensive understanding of the common varieties of pathogens. A.2 The diagnostic principles and grading standards of this standard are generalized to apply to acute diseases due to various chemical products Toxic respiratory disease diagnosis, and the relevant varieties to develop diagnostic criteria, under the principle of total diagnosis, add the individual Acute poisoning characteristics, so that both convergence and meet the actual situation. A.3 stimulus response is a contact with a stimulating gas of a transient reaction, has not yet reached the degree of poisoning, no obvious signs of the lungs, But occasionally there may be scattered rales, but in order to prevent and timely detection of delayed lesions, to avoid improper handling and increase the disease Love, so included in the grading standards, to cause vigilance, in the disease statistics, the stimulus response is not as poisoning cases. A.4 classification criteria of the principle is. according to the lesion site, scope, nature and the degree of hypoxemia to comprehensive evaluation. Clinically, according to the patient to select the inspection items, such as ECG, myocardial enzymes, liver, kidney function test, to the whole Body point of view to judge, so that diagnosis, grading more realistic. A.5 the severity of hypoxia, and respiratory disease is often closely related to acute poisoning is particularly evident, so the oxygen Pressure (PaO2) measured value as a reference for the classification of diagnostic indicators, the evaluation must be dynamic observation of the data, should also pay attention to test Determine the technical error, analysis should be aware of hypoxemia and tissue hypoxia both linked and not the same concept, correct Judge the condition. Mild poisoning generally no hypoxemia, blood gas analysis of oxygen partial pressure (PaO2) in the normal range of 10.7 kPa ~ 13.3 kPa (80 mmHg ~ 100 mmHg) or occasional mild hypoxemia, blood gas analysis of oxygen partial pressure (PaO2) Is from 8 kPa to 10.7 kPa (60 mmHg to 80 mmHg). Moderate poisoning, often accompanied by mild or moderate hypoxemia, blood gas points The oxygen partial pressure (PaO2) is 8kPa ~ 10.7 kPa (60 mmHg ~ 80 mmHg) or 8kPa ~ 5.5 kPa (60 mmHg ~ 41 mmHg). Severe poisoning with severe hypoxemia, blood gas analysis of oxygen partial pressure (PaO2) is < 5.3 kPa (40 mmHg). A.6 The diagnostic criteria for acute respiratory distress syndrome in this standard, with reference to domestic and recent international data, ARDS for direct and indirect reasons. With the value of PaO2/FIO2 as toxic and diffuse alveolar pulmonary edema The main indicators, PaO2/FIO2 < 26.7 kPa as the diagnostic criteria for ARDS, so that non-ARDS was misdiagnosed as ARDS Condition to a minimum, this standard, diffuse pulmonary edema and ARDS diagnostic indicators of the difference, but also reflects the difference between the two Severity of different differences, consistent with the development from diffuse pulmonary edema to ARDS quantity to qualitative change point of view. Reflect the lungs Flow indicator Q./Q; has a certain significance for the diagnosis of ARDS, but because Qs/Qt under the conditions of oxygen absorption, measured When the need for mixed venous oxygen content determination, and the current calculation of the results obtained with the measured there is a certain error, therefore, often Difficult to clinically carried out A-aDO2 is also calculated by the calculation, rarely used, so this standard is not included. A.7 inhalation pneumonia often have a more typical clinical manifestations, diagnosis is easy to clear, the lesion is generally limited, but such as inhalation of liquid or Excessive dust can also cause diffuse pulmonary edema, should pay attention. A.8 patients such as the original chronic respiratory diseases, inhalation of irritating gas, the disease can be more complicated after poisoning, Or can induce the original respiratory disease, in this case, the diagnosis, treatment must take these factors into account to determine Graded diagnosis and preparation of treatment plans. A.9 severe toxic respiratory damage after cure, can occur a variety of different diseases such as chronic bronchitis, emphysema, Obstructive bronchiolitis, reactive airway dysfunction syndrome (RADS, reactive airways dysfunction syndrome. The above factors are more complex, and the pathogen species, absorption, dose, disease nature, Severity, treatment, and condition of the patient before the illness, etc., may be the original disease is induced, it may And this poison is not linked, so the diagnosis should be comprehensive analysis to arrive at the objective and practical conclusions, can not appear above the disease Change, that is, all diagnosed as "sequelae", so as to avoid bias. In the future should be more in-depth follow-up to track the work to accumulate More information for the definitive diagnosis of sequelae, provide accurate indicators. A.10 Etiology Therapies are a variety of treatment measures that cause the release of the virion or against its pathogenesis, depending on the different toxic substances Species, using different treatments. A.11 hypoxia can cause many serious consequences such as damage to mitochondria, so that adenosine triphosphate (ATP) is insufficient, depleted, and Can be accelerated by membrane phospholipid degradation, resulting in biofilm damage, intracellular calcium overload, increased oxygen free radicals, these feelings Condition to further increase hypoxia, the formation of a vicious cycle, so early to correct hypoxia, control the progression of the disease is to prevent the occurrence of treatment spear An important part of the shield. According to the patient's condition and objective conditions to choose oxygen way, and to prevent inhalation of high concentrations of oxygen conditions Oxygen poisoning, blood gas analysis can be used as monitoring indicators. The principle is based on the condition to choose the appropriate oxygen method, with the lowest effective Concentration of oxygen, in the shortest possible time to achieve the purpose of correcting hypoxemia. So that arterial oxygen partial pressure maintained at 10.7kPa ~ 13.3 kPa (80 mmHg to 100 mmHg). Severe patients are given a positive ventilation from the mask (intermittent positive pressure to oxygen) or application of exhalation (PEEP) therapy, the end-expiratory pressure should be about 0.5kPa (5 cmH2O), high-frequency ventilation (HFV) Or high-frequency jet ventilation, less impact on cardiac function, can obtain a certain effect can also be used, can also use inverse ventilation (IRV, inverse ratio-ventilation treatment of ARDS. And may consider the extracorporeal oxygen, such as the application of light quantum blood therapy, as adjuvant treatment Treatment. Hyperbaric oxygen has rarely been used to treat respiratory diseases, and some have considered contraindications to ARDS, but in recent years Domestic hyperbaric oxygen therapy for acute toxic pulmonary edema, acute respiratory distress syndrome and achieved a certain degree of efficacy reported, but through Clinical observations and animal experiments have not yet reached a consistent conclusion, so yet to accumulate more information to explore the treatment of indications And the evaluation of efficacy, it can not be used as a conventional treatment measures included in the appendix, for reference, such as the use of hyperbaric oxygen, the With low pressure pressure 〖130 ~ 170 kPa (1.3 ~ 1.7 atm)〗, time 30 ~ 40 min is appropriate. A.12 non-specific antagonists are based on acute chemical toxic pulmonary edema, ARDS pathogenesis, for the main disease To link to drugs, to antagonize its role and block the pathophysiology of ARDS evolution process to achieve the reduction of the lungs And the purpose of systemic damage, it is one of the main treatment measures in the rescue, commonly used adrenal cortex hormones, oxygen free radicals Removal agent, calcium channel blockers and so on. The application of these drugs indications, the choice of drug varieties, dosage and treatment, etc., in the rescue Can be based on the disease, combined with the rescue group of reasonable experience. A.13 maintain good circulatory functions, such as maintaining proper blood volume, improving cardiac pump function and correcting microcirculation, preventing Microthrombosis, commonly used drugs are 6-542, Salvia, Chuanxiong and so on. A.14 correct acid and electrolyte and electrolyte imbalance in pulmonary edema, ARDS course, acid and alkali poisoning has a variety of types such as early due to Degree of ventilation to produce respiratory alkalosis, late there are severe hypoxia with CO2 boring, mixed acidosis, etc., electrolyte Chaos also have a variety of different circumstances, should be based on clinical and laboratory results, targeted to take treatment measures. A.15 severe toxic respiratory diseases, in the event of a heavier secondary infection, not only to make the disease more serious and complex, But also produce one of the main reasons for the treatment of contradictions, prolonged course of disease can lead to lung granulation tissue hyperplasia, Long, but can not save their lives, therefore, from the onset, that is, to take various measures to prevent secondary infection, and closely guard, Timely detection and control is an important part of treatment. A.16 Nutritional support, acute severe patients, for high metabolic status, course of disease due to excessive energy consumption and inadequate nutritional intake, Resulting in reduced immunity, prone to secondary infection, respiratory muscle fatigue, affecting tissue repair, it should be given early nutrition support Holding, and timely to add heat, the total daily calories in 150 kJ/kg or so, protein, fat, respectively, 20% of total calories and About 30%. A.17 to strengthen the nursing work, in the whole process, improve the quality of care is the main link in the rescue. A.18 should be the overall concept of thinking to guide the development of treatment programs, serious diseases to use comprehensive treatment measures, but medication does not Should be too abuse, and close observation of efficacy and side effects, according to changes in condition to adjust the treatment and timely attention to preventive measures. For the support and psychological treatment is very important to promote the recovery of the disease, moderate and severe poisoning in the recovery period to give the necessary rehabilitation treatment. A.19 patients with intensive care are bedside chest X-ray, so the standard Appendix C bedside radiographic requirements for the use of Reference. A.20 With the progress of scientific research, new methods and drugs for clini...

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