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目的提高临床上对蔺草尘肺的认识。方法分析2003年5月至2008年12月浙江大学医学院附属第一医院呼吸内科收治的47例蔺草尘肺患者的病例特点。结果男女比例为0.74:1,年龄平均(34.2±8.1)岁。78.7%患者有咳嗽咳痰,胸痛,胸闷,乏力等症状。4.2%患者动脉血氧分压低于80mmHg(1mmHg=0.133kPa),2.1%患者二氧化碳分压高于45mmHg。85.1%患者胸部X线片及胸部CT检查均可见结节影,10.7%患者为肺纤维化,12.7%患者为毛玻璃样改变等异常征象。42.6%患者肺功能呈限制性通气功能障碍,2.1%患者为阻塞性通气功能障碍,4.2%患者为混合性通气功能障碍,74.5%患者伴有弥散功能降低。10%患者支气管镜检查可见支气管壁有碳末沉积。5%患者可见病变处支气管管腔扭曲,僵直。病理切片均可见慢性炎症反应,巨噬细胞反应,胶原纤维组织增生,21.2%可见有尘细胞。有临床症状的患者均行对症处理。结论蔺草染土是导致蔺草尘肺的主要原因,目前尚无特效方法治疗蔺草尘肺,根治蔺草尘肺的关键在于预防。
Objective To improve the understanding of Lin Pneumoconiosis. Methods From May 2003 to December 2008, the first hospital of Zhejiang University Medical College, Department of Respiratory Medicine, 47 cases of rinderpest patients with pneumoconiosis characteristics. Results The male-female ratio was 0.74: 1 and the average age was (34.2 ± 8.1) years. 78.7% of patients had cough and sputum, chest pain, chest tightness, fatigue and other symptoms. 4.2% of patients with arterial partial pressure of oxygen less than 80mmHg (1mmHg = 0.133kPa), 2.1% of patients with carbon dioxide partial pressure higher than 45mmHg. In 85.1% of the patients, nodules were found on chest X-ray and chest CT. Pulmonary fibrosis was found in 10.7% of patients and abnormal changes of frosted glass in 12.7% of patients. 42.6% patients had restrictive ventilatory dysfunction, 2.1% had obstructive ventilatory dysfunction, 4.2% had mixed ventilatory dysfunction, and 74.5% had decreased diffuse function. Bronchoscopy showed bronchial wall deposition of carbon in 10% of patients. 5% of patients showed lesions of bronchial lumen distorted, stiff. Chronic inflammatory reaction, macrophage reaction, hyperplasia of collagen fiber and 21.2% dusty cells were seen in pathological sections. Patients with clinical symptoms were symptomatic treatment. Conclusions Rush dyed soil is the main reason of rushes pneumoconiosis. At present there is no effective method to treat rushes pneumoconiosis. The key to cure rushes pneumoconiosis is prevention.