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目的分析职业性慢性1-溴丙烷(1-BP)中毒性周围神经病的临床特点。方法回顾性分析4例职业性慢性1-BP中毒性周围神经病病例的临床资料。结果 4例病例均为某五金真空镀膜企业从事超声波清洗作业的男性工人,在工作中均接触高水平1-BP,接触时间为9~11个月。临床表现主要有不同程度的感觉、运动障碍,主要症状为渐进性加重的肢体麻木、乏力,以下肢多见,可伴有步态不稳。体格检查可见双下肢肌力减弱;双下肢或四肢痛觉和触觉减退,位置觉和振动觉减退;双侧跟腱反射多呈减弱或消失;1例病例出现感觉性共济失调。神经-肌电图检查均存在不同程度的周围神经损害,以运动和感觉神经传导速度减慢多见,且轴索和髓鞘的损害均可见。依据GBZ/T 247—2013《职业性慢性化学物中毒性周围神经病的诊断》,均诊断为职业性慢性1-BP中毒性周围神经病。结论长期接触高水平1-BP可导致以周围神经系统损害为主的慢性中毒,根据1-BP接触史、临床表现和神经-肌电图见神经源性损害可作出诊断。
Objective To analyze the clinical features of occupational chronic 1-bromopropane (1-BP) toxic peripheral neuropathy. Methods The clinical data of 4 cases of occupational chronic 1-BP toxic peripheral neuropathy were retrospectively analyzed. Results All the 4 cases were male workers engaged in the ultrasonic cleaning operation of a hardware vacuum coating company. All the workers were exposed to high level of 1-BP during work, and the contact time was 9 to 11 months. Clinical manifestations mainly have different degrees of feeling, dyskinesia, the main symptoms of progressive exacerbation of limb numbness, fatigue, more common in lower extremities, may be associated with unsteady gait. Physical examination showed weakening of both lower extremities; pain and tactile sensation of both lower extremities or limbs, diminished position and vibration; bilateral Achilles tendon reflexes were mostly weakened or disappeared; sensory ataxia occurred in one patient. Neuro-EMG there are varying degrees of peripheral nerve damage to motor and sensory nerve conduction slow down more common, and axonal and myelin lesions are visible. According to GBZ / T 247-2013 “occupational chronic chemical toxic peripheral neuropathy diagnosis”, were diagnosed as occupational chronic 1-BP toxic peripheral neuropathy. Conclusions Long-term exposure to high levels of 1-BP can lead to chronic poisoning based on peripheral nervous system damage. Diagnosis can be made based on 1-BP exposure history, clinical manifestations, and neuro-EMG neurogenic lesions.