某有色金属冶炼厂职业健康损害及关键控制点的分析
|
摘要
目的：通过12年回顾性队列研究评估有色金属冶炼厂的职业性有害因素所致职业健康危害风险，并通过评价生产工艺、生产环境和劳动过程，结合现场监测结果分析该厂职业危害的关键控制点。
方法：采用回顾性对列研究的设计及logistic回归分析的方法，选择1999年1月1日-2010年12月31日在册满1年的所有冶炼工人为队列成员，以司炉工、收尘工、制酸工、行车工、剥锌工、操作工、过滤工、铸型工、电解出装槽工人为接触组,以该厂的辅助工种及职能科室工人为对照组。回顾性收集这12年期间职工的职业病与其他工作相关疾病资料，计算各种疾病人年发病率在接触组与对照组的相对危险度，再通过logistic回归分析的方法，分析职工接触因素与其他个人因素与尘肺病发病的相关关系，然后结合现场调查分析，定性地发现职业危害防护的关键控制点。
结果：（1）尘肺病例集中在司炉工及铸型工，其中司炉工的尘肺发病风险高于对照组，差异有统计学意义；尘肺病发病风险随着工龄的增加而升高。（2）高血压病、慢性砷中毒、慢性镉中毒、肝胆疾病各工种发病风险均高于对照组，且有统计学意义；肾结石在司炉工及铸型工中发病风险高于对照组，有统计学意义。司炉工此5类疾病的发病风险与对照组相比具有统计学差异。接触组女性肾结石发病风险高于男性，有统计学意义。（3）司炉工与收尘工尿砷、镉超标的发生风险高于对照组且存在统计学意义。（4）进行Logistic单因素回归分析，得出尘肺病发病与工作环境矽尘的时间加权平均浓度（TWA）、工龄权重的粉尘浓度（TWA*工龄）、职工年龄、职工工龄呈正相关关系。（5）尘肺病的发病概率预测模型(其中a1代表年龄36-45岁，a2代表年龄46-60岁，a3代表年龄大于60岁，t*T代表工龄与TWA乘积）
（6）硫酸车间的关键控制点为：司炉和收尘岗位，主要应控制的职业病危害因素有粉尘、二氧化硫、氧化锌、镉和砷。粗炼车间的关键控制点为出装槽、司炉和铸型岗位，主要应控制的职业病危害因素有硫酸、硫酸雾、氧化锌、镉和砷。精炼车间的关键控制点为：司炉和收尘岗位，主要应控制的职业病危害因素有粉尘、砷、镉、一氧化碳、二氧化硫和氧化锌。结论：该厂有色金属冶炼作业促进了肝胆疾病、肾结石与慢性砷镉中毒在接触组的发生；在其他变量年龄、工龄、性别、吸烟、饮酒不变的情况下，TWA每增加1个单位，接尘者尘肺病发病风险增加10倍，在其他变量年龄、性别、吸烟、饮酒不变的情况下，随着工龄TWA乘积每增加1个单位，接尘者尘肺病发病风险增加0.32倍；该厂有色金属冶炼作业防护关键点主要为司炉、收尘、铸型、出装槽等岗位。
Objective:To assess the occupational health damage risk by retrospective cohort study of12years and to analyze the occupational hazards'key control point by evaluating productive technology、production environmennt and labour process combining with field monitoring results.
Methods:We used retrospective cohort research and logistic regression analysis and chose the smelter workers worked one year enough between Jan.lst,1999and Dec.31st,2010in cohort. We divided these cohort members in to exposed group including firemen、dust collecting workers、 acid workers、driving worker、strip zinc workers、operators、filterers、mold workers and electrolysis loaded trough workers, and control group including workers in auxiliary type of work and functional department with low or zero level occupational hazards exposure. We collected the datas of occupational diseases and work-related diseases in the study and we analyzed some elements related with the pneumoconiosis using ligistic regression analysis methods,then find out the key control point qualitatively combined with field investigation.
Results:(1) We find pneumoconiosis patients are from firemen and mold workers. Firemen have a higher incidence of pneumoconiosis than control group,the difference is statistically significant. The risk of suffering pneumoconiosis increase with the increase of length of service.(2) Workers in various types of work of exposed group have a higher incidence risk of hypertension、chronic arsenic poisoning、chronic cadiminm poisoning、liver and gallbladder disease than in the control group,and the difference is statistically significant.The incidence risk of kidney stone is higher in firemen and mold workers than in the control group,the difference is statistically significant. Every kind of the5diseases in the study list have a higher incidence risk in firemen than in the control group, and the difference is statistically significant. The female workers in exposed group have a higher incidence risk of kidney stone than male workers.(3) Firemen and dust collecting workers have a higher risk of suffering excessive urinary arsenic and excessive urinary cadimium,and the difference is statistically significant.(4) The incidence of pneumoconiosis is positively correlated with the time-weighted average concertration(TWA) of silica dust in working environment、seniority-weighted dust concentration(TWA*seniority). Workers'age and workers'length of service.(5) The probability prediction model about the incidence of pneumoconiosis: (T is short for TWA,a1is on behalf of the age36-45years old, a2is46-60years old,a3is morethan60years of age,t1is on behalf of length of service of10-20years,t2is21-30years,t3is(a1is on behalf of the age36-45years old,a2is46-60years old,a3is more than60years ofage,t*T represents the length of service multiplied by TWA)
(6) The critical control points of sulfuric acid workshop: stoker and dust collection post,theoccupational hazards to be controled:dusts、SO_2、ZnO_2、Cd and As。The key control points insmelting workshop:loaded trough section、stoker and cast post,the main occupational hazards tobe controled:sulfuric acid、sulfuric acid mist、zinc oxide、cadmium and arsenic;The key controlpoint in refining workshop: stoker and dust collecting status,the main occupational hazards to becontroled:dust、arsenic、cadmium、CO、SO_2and ZnO_2.
Conclusions: The non-ferrous metal smelting operations in the plant promote the incidence riskof liver and gallbladder disease；In the case of other variables (age, length of service, gender, smoking,alcohol consumption)constant,the incidence risk of pneumoconiosis increased by10times witheach additional TWA unit and in the case of other variables (age, gender, smoking, alcoholconsumption)constant,the incidence risk of pneumoconiosis increased by0.32fold with eachadditional t*T unit; The key control point for protecting injuries in the non-ferrous metalsmelting plant is mainly concertrated in following post: stoker、dust collecting、casting、loadedtrough position.
方法：采用回顾性对列研究的设计及logistic回归分析的方法，选择1999年1月1日-2010年12月31日在册满1年的所有冶炼工人为队列成员，以司炉工、收尘工、制酸工、行车工、剥锌工、操作工、过滤工、铸型工、电解出装槽工人为接触组,以该厂的辅助工种及职能科室工人为对照组。回顾性收集这12年期间职工的职业病与其他工作相关疾病资料，计算各种疾病人年发病率在接触组与对照组的相对危险度，再通过logistic回归分析的方法，分析职工接触因素与其他个人因素与尘肺病发病的相关关系，然后结合现场调查分析，定性地发现职业危害防护的关键控制点。
结果：（1）尘肺病例集中在司炉工及铸型工，其中司炉工的尘肺发病风险高于对照组，差异有统计学意义；尘肺病发病风险随着工龄的增加而升高。（2）高血压病、慢性砷中毒、慢性镉中毒、肝胆疾病各工种发病风险均高于对照组，且有统计学意义；肾结石在司炉工及铸型工中发病风险高于对照组，有统计学意义。司炉工此5类疾病的发病风险与对照组相比具有统计学差异。接触组女性肾结石发病风险高于男性，有统计学意义。（3）司炉工与收尘工尿砷、镉超标的发生风险高于对照组且存在统计学意义。（4）进行Logistic单因素回归分析，得出尘肺病发病与工作环境矽尘的时间加权平均浓度（TWA）、工龄权重的粉尘浓度（TWA*工龄）、职工年龄、职工工龄呈正相关关系。（5）尘肺病的发病概率预测模型(其中a1代表年龄36-45岁，a2代表年龄46-60岁，a3代表年龄大于60岁，t*T代表工龄与TWA乘积）
（6）硫酸车间的关键控制点为：司炉和收尘岗位，主要应控制的职业病危害因素有粉尘、二氧化硫、氧化锌、镉和砷。粗炼车间的关键控制点为出装槽、司炉和铸型岗位，主要应控制的职业病危害因素有硫酸、硫酸雾、氧化锌、镉和砷。精炼车间的关键控制点为：司炉和收尘岗位，主要应控制的职业病危害因素有粉尘、砷、镉、一氧化碳、二氧化硫和氧化锌。结论：该厂有色金属冶炼作业促进了肝胆疾病、肾结石与慢性砷镉中毒在接触组的发生；在其他变量年龄、工龄、性别、吸烟、饮酒不变的情况下，TWA每增加1个单位，接尘者尘肺病发病风险增加10倍，在其他变量年龄、性别、吸烟、饮酒不变的情况下，随着工龄TWA乘积每增加1个单位，接尘者尘肺病发病风险增加0.32倍；该厂有色金属冶炼作业防护关键点主要为司炉、收尘、铸型、出装槽等岗位。
Objective:To assess the occupational health damage risk by retrospective cohort study of12years and to analyze the occupational hazards'key control point by evaluating productive technology、production environmennt and labour process combining with field monitoring results.
Methods:We used retrospective cohort research and logistic regression analysis and chose the smelter workers worked one year enough between Jan.lst,1999and Dec.31st,2010in cohort. We divided these cohort members in to exposed group including firemen、dust collecting workers、 acid workers、driving worker、strip zinc workers、operators、filterers、mold workers and electrolysis loaded trough workers, and control group including workers in auxiliary type of work and functional department with low or zero level occupational hazards exposure. We collected the datas of occupational diseases and work-related diseases in the study and we analyzed some elements related with the pneumoconiosis using ligistic regression analysis methods,then find out the key control point qualitatively combined with field investigation.
Results:(1) We find pneumoconiosis patients are from firemen and mold workers. Firemen have a higher incidence of pneumoconiosis than control group,the difference is statistically significant. The risk of suffering pneumoconiosis increase with the increase of length of service.(2) Workers in various types of work of exposed group have a higher incidence risk of hypertension、chronic arsenic poisoning、chronic cadiminm poisoning、liver and gallbladder disease than in the control group,and the difference is statistically significant.The incidence risk of kidney stone is higher in firemen and mold workers than in the control group,the difference is statistically significant. Every kind of the5diseases in the study list have a higher incidence risk in firemen than in the control group, and the difference is statistically significant. The female workers in exposed group have a higher incidence risk of kidney stone than male workers.(3) Firemen and dust collecting workers have a higher risk of suffering excessive urinary arsenic and excessive urinary cadimium,and the difference is statistically significant.(4) The incidence of pneumoconiosis is positively correlated with the time-weighted average concertration(TWA) of silica dust in working environment、seniority-weighted dust concentration(TWA*seniority). Workers'age and workers'length of service.(5) The probability prediction model about the incidence of pneumoconiosis: (T is short for TWA,a1is on behalf of the age36-45years old, a2is46-60years old,a3is morethan60years of age,t1is on behalf of length of service of10-20years,t2is21-30years,t3is(a1is on behalf of the age36-45years old,a2is46-60years old,a3is more than60years ofage,t*T represents the length of service multiplied by TWA)
(6) The critical control points of sulfuric acid workshop: stoker and dust collection post,theoccupational hazards to be controled:dusts、SO_2、ZnO_2、Cd and As。The key control points insmelting workshop:loaded trough section、stoker and cast post,the main occupational hazards tobe controled:sulfuric acid、sulfuric acid mist、zinc oxide、cadmium and arsenic;The key controlpoint in refining workshop: stoker and dust collecting status,the main occupational hazards to becontroled:dust、arsenic、cadmium、CO、SO_2and ZnO_2.
Conclusions: The non-ferrous metal smelting operations in the plant promote the incidence riskof liver and gallbladder disease；In the case of other variables (age, length of service, gender, smoking,alcohol consumption)constant,the incidence risk of pneumoconiosis increased by10times witheach additional TWA unit and in the case of other variables (age, gender, smoking, alcoholconsumption)constant,the incidence risk of pneumoconiosis increased by0.32fold with eachadditional t*T unit; The key control point for protecting injuries in the non-ferrous metalsmelting plant is mainly concertrated in following post: stoker、dust collecting、casting、loadedtrough position.
引文
[1]有色金属工业职业健康[EB/OL].http://zybpd.zybw.com/zybyf/2010/04/24/11485115613.shtml.2011-7-28．
[2]王羚,严曙鹏.云南某公司电锌系统技改工程项目竣工验收职业卫生评价[J].《职业与健康》,2006,22(17):1395-1396.
[3]如何预防有色金属导致的职业病[EB/OL].http://zybpd.zybw.com/zybyf/2011/07/07/10183334784.shtml.2011-7-28．
[4] Sarang V,Dhatrak, Subroto S etal. Risk assessment of chronic poisoning among Indian metallic miners[J].Indian J Occup Environ Med.2009August;13(2):60–64.
[5] GERHARDSSONG. DustPreventioninSwendishfoundries[J].Staub-ReinhaltLuft，1976，36:433-439.
[6] SIUfANENE,KOPONENM,KOKKOA,etal. Dust exposure in Fitinish foundries[J].Scand JWork Environ Health,1976,2(SuPPl.l):19-31.
[7]罗学昌,王剑波,付强等.云锌冶炼工尘肺发病情况调查[J].《工业卫生与职业病》,2006,26(3):164-165.
[8]赵正平.关于中国有色金属工业职业危害的分析[C].中国有色金属学会.中国有色金属学会第三届学术会议论文集,长沙:中国工业大学出版社,1997:364-367.
[9]牛侨．职业卫生与职业医学[M]．北京：中国协和医科大学出版社．2003．286—330．
[10]金泰庾．职业卫生与职业医学[M]．北京：人民卫生出版社．2004．346—364．
[11]牛侨．职业卫生与职业医学[M]．北京：中国协和医科大学出版社．2003．349—390．
[1]、王杰,徐新云：职业性砷中毒[J].中国职业医学,2000,27(4):45-47.
[2]、徐新云,赵光明，张乐书：职业性慢性砷中毒的临床表现及其诊断[J].中华劳动卫生职业医学杂专,1996,14(3):163-164.
[3]、徐新云等：职业性慢性中毒15年观察，中国公共卫生，1995，11（8）：P353-354
[4]、高守之：100例慢性砷中毒的临床观察与护理体会齐齐哈尔医学院学报，2007，28（l）：121-122
[5]、、刘保安,粟占三,陈森林,职业性慢性砷中毒的皮肤病变[J].中国现代医学杂,1995,5(3):43,45.
[6]、赖燕,肖雄斌,李海霞.94例职业性慢性砷中毒病例临床特征分析[J].中国职业医学,2010,37(3):235-237
[7]、傅恩惠．尚波：玻璃厂慢性砷中毒7例临床分析[J].工业卫生与职业病，2006，32（4）：237～238
[8]、李明进，俞永熹：慢性砷中毒12例临床分析，职业与健康，2003，19（4）：26
[9]、马艳,郑玉建,吴顺华：砷对神经系统损伤的研究进展[J]中国地方病学杂志，2007，26(1)111-112.
[10]、齐丽，韩莉，吴立文：152名接砷工人神经传导速度测定结果分析[J]中国工业医学杂志，2005，18（5）：282～283
[11]、刘桂成，董学新，黄晓欣：燃煤污染型砷中毒患者的神经电生理检测[J]中国地方病学杂志，2000，19(1)：l3-l5．
[12]、吕伯钦,邓海,丁俊清：砷作业工人神经生理研究中华劳动卫生职业病杂志，19908（2）：65
[13]、赖燕，文忠，李胜：职业性慢性砷中毒所致颅神经损害[J]职业与健康，2002，18（6）：34～35
[14]、苏丽琴,金银龙.现场流行病学研究对慢性砷中毒判定的意义[J]卫生研究，2005,34(5):636-639
[15]、葛宪民,苏素花,农康等：广西H市4起急性水源性砷中毒715例的临床研究[J].中华劳动卫生职业病杂志,2009,27(3):212-215.
[16]、M. Jak i, Jelena Krmpoti-Nemani, F. Watt et al. Trace metal enrichment on the surface of the nasalseptum bone[J]. Nuclear Instruments and Methods in Physics Research Section B: Beam Interactionswith Materials and Atoms，1988,30(3):417-419.
[17]、M HARPER.Occupational health aspects of the arsenic extractive industry in Britain(1868-1925)[J].British Journal of Industrial Medicine1988,45:602-605.
[18]、NIOSH. Criteria for a recommended standard:occupational exposure to inorganic arsenic[M]. U. S.Dept. of health educations welfare, Public Health Service,1976.
[19]、洪峰，张爱华：燃煤砷污染致人群肾功能损害评价[A].中华预防医学会第二届学术年会暨全球华人公共卫生协会第二届年会论文集[C]，2006.
[20]、杨运旗，孙兰英等：慢性燃煤污染型砷电毒患毒肾功能改变[J]微量元素与健康研究，2000，17(2):21-22.
[21]、金泰廙,孙贵范.职业卫生与职业医学[M].北京:人民卫生出版,2006:173-175.
[22]、Allan H. Smith，Ayse Ercumen，Yan Yuan et al.Increased lung cancer risks are similar whether arsenicis ingested or inhaled[J]. J Expo Sci Environ Epidemiol.2009,19(4):343–348.
[23]、Jay H. Lubin, Lee E. Moore, Joseph F. Fraumeni Jr. et al. Respiratory Cancer and Inhaled InorganicArsenic in Copper Smelters Workers: A Linear Relationship with Cumulative Exposure that Increases withConcentration[J]. Environmental Health Perspectives,2008,116(12):1661-1665.
[24]、李金保，宋交才，黄觉之：职业性急性砷中毒15例临床分析[J]实用预防医学,2007,14(3):787.
[25]、陈沅江.《职业卫生与防护》[M].北京：机械工业出版社,2009,60.
[26]、赵坚,许天培,鲜思凯.36例急性砷中毒皮炎的临床分析[J].中华皮肤科杂志,2000,33(2):106.
[27]、农桂德：一起急性砷中毒事故的调查分析[J].广西预防医学,2005,11(5):317
[28]、李刚森：急性砷中毒9例报告[J]中国工业医学杂志，2002年，15（4）：215-216
[29]、邓杰：以皮炎表现为特征的急性砷中毒报告[J]卫生研究，1973(5)：42
[30]、Garb LG, Hine CH. Arsenical neuropathy: residual effects following acute industrial exposure [J]. JOccup Med.1977Aug;19(8):567-8.
[31]、朱小平,潘圣鑫.自制炸药炸灼伤并急性砷中毒诊治分析[J].广西医学,2OO5,27(3):422-423.
[32]、Michael S.Gorby,MD,Albuquerque. Arsenic poisoning[J].The western journal of medicine.1988，149(3):308-315.
[33]、李军，王三祥，王正辉等．砷中毒病儿童智力水平调查[J].中国公共卫生，2006，22(7):856-857．
[34]、Glazener FS, Ellis JG, Johnson PK: Electrocardiographic findings with arsenic poisoning[J]. CalifMed，1968，109:158-162
[35]、谷宏勤，王秀荣：经皮急性砷中毒致多器官损害一例救治体会[J]职业医学,1998,25(6):34-35.
[36]、普显宏：砷中毒及其预防[J]劳动保护，2007,(5):93.
[37]、李静华，张远平，赵学英等．急性砷中毒对跟部的损害[J].眼外伤职业眼病杂志，2007，29(12)：946-947.
[38]、张慧：急性砷中毒可能诱发胞系结石[J].中国城乡企业卫生，2003，(5)：22
[39]、洪峰，金泰廙，张爱华．应用基准剂量法探讨砷、镉接触人群肾功能损害危险性评价[J]．中华预防医学杂志，2004，38(6):374-378
[40]、Kristiansen J, Christensen JM, Iversen BS, Sabbioni E. Toxic trace element reference levels in blood andurine: influence of gender and life-style factors[J]. Sci Total Environ,1997,204:147–160.
[41]、Trepka MJ, Heinrich J, Schulz C, Krause C, Popescu M, Wjst M, et al. Arsenic burden among children inindustrial areas of eastern Germany [J]. Sci Total Environ,1996,180:95–105.
[42]、Vahter M, Lind B. Concentrations of arsenic in urine of the general population in Sweden [J]. Sci TotalEnviron,1986,54:1–12.
[43]、刘锐,陈曦等：563例尿砷测定结果分析[J]昆明医学院学,1989,lO(3):34-36.
[44]、张利民李生臣等：大连市355例正常人尿砷值的测定[J]中国工业医学杂志，1998,11(4):240-241.
[45]、秦文华，王国荣等：河南省非职业接触人群尿砷参考值[J]卫生研究，1998，27(5):299-301.
[46]、王凯，金亚平：沈阳地区成人尿中砷含量正常参考值的检测[J]中国工业医学杂志，2010，23(3):234.
[47]、陈福明：南宁市尿砷正常值．广西职防,1984,(2):110.
[48]、郑来义，白广禄，刘慧兰等：尿和头发砷含量与地方性砷中毒相关性研究.中国地方病防治杂志[J].2008,23(3):168-169.
[49]、Allan H. Smith,Ayse Ercumen,Yan Yuan et al. Increased lung cancer risks are similar whether arsenic isingested or inhaled[J].J Expo Sci Environ Epidemiol,2009,19(4):343–348.
[50]、Steinmaus C, Yuan Y, Kalman D et al. Intraindividual variability in arsenic methylation in a U.S.population.[J]. Cancer Epidemiol Biomarkers Prev2005,14:919–924.
[51]、徐新云等，无机砷化物对作业工人健康的影响中华动卫生职业病杂志1993，11（3）：66
[52]、Nurshad Ali,Md Ashraful Hoque et al. Association between arsenic exposure and plasma cholinesteraseactivity: a population based study in Bangladesh[J]. Environmental Health2010,9:36-44.
[53]、林匡飞，徐小清，Paul A等.砷污染区农民头发砷含量与环境中砷含量的关系［J］.中国环境科学,2001,21（5）：440-444.
[54]、G Farmer,L R Johnson. Assessment of occupational exposure to inorganic arsenic based on urinaryconcentrations and speciation of arsenic[J].British Journal of Industrial Medicine,1990,47:342-348.
[55]、王凯.氢化物发生-原子荧光光谱法测定人发砷的国内动态[J].中国工业医学杂志,2005,18(6):122-123.
[56]、R N Ratnaike. Acute and chronic arsenic toxicity[J].Postgrad Med J2003;79:391–396.
[57]、职业性慢性砷中毒诊断标准GBZ36-2001
[58]、营向东，葛宪民．中毒急危重症诊断治疗学[M].北京:人民卫生出版杜，2009：417-720．
[59]、何风生．中华职业医学[M]．北京:人民卫生出版杜，1999:338．
[60]、陈小兰，徐剑等. DDC-Ag法测定中风病人服用化风丹后血、尿中的砷含量[J].贵阳中医学院学报，2005,27(4):59-61.
[61]、许丽萍，伊乐等.长期用药嘎木朱尔涂膜剂家兔血砷浓度的检测[J].中国民族医药杂志，2009,(3):54-55.
[62]、Michael F. Hughes Biomarkers of Exposure: A Case Study with Inorganic Arsenic [J]. EnvironmentalHealth Perspectives,2006,114（11）:1790-1796.
[63]、李润博,刘静华.发砷和指(趾)甲砷含量的相关分析[J].微量元素与健康研究,1995,l2(3):49-50.
[64]、Badal Kumar Mandal, Yasumitsu Ogra, and Kazuo T et al. Speciation of arsenic in human nail and hairfrom arsenic-affected area by HPLC-inductively coupled argon plasma mass spectrometry [J]．Toxicologyand Applied Pharmacology,2003,189(2):73-83.
[65]、张卉，戈林等.慢性砷中毒[J]国外医学医学毒理分册，2003，24(4):176-189.
[66]、Kalia K, Flora SJ. Strategies for safe and effective therapeutic measures for chronic arsenic and leadpoisoning[J]. Occup Health,2005,47(1):1-21
[2]王羚,严曙鹏.云南某公司电锌系统技改工程项目竣工验收职业卫生评价[J].《职业与健康》,2006,22(17):1395-1396.
[3]如何预防有色金属导致的职业病[EB/OL].http://zybpd.zybw.com/zybyf/2011/07/07/10183334784.shtml.2011-7-28．
[4] Sarang V,Dhatrak, Subroto S etal. Risk assessment of chronic poisoning among Indian metallic miners[J].Indian J Occup Environ Med.2009August;13(2):60–64.
[5] GERHARDSSONG. DustPreventioninSwendishfoundries[J].Staub-ReinhaltLuft，1976，36:433-439.
[6] SIUfANENE,KOPONENM,KOKKOA,etal. Dust exposure in Fitinish foundries[J].Scand JWork Environ Health,1976,2(SuPPl.l):19-31.
[7]罗学昌,王剑波,付强等.云锌冶炼工尘肺发病情况调查[J].《工业卫生与职业病》,2006,26(3):164-165.
[8]赵正平.关于中国有色金属工业职业危害的分析[C].中国有色金属学会.中国有色金属学会第三届学术会议论文集,长沙:中国工业大学出版社,1997:364-367.
[9]牛侨．职业卫生与职业医学[M]．北京：中国协和医科大学出版社．2003．286—330．
[10]金泰庾．职业卫生与职业医学[M]．北京：人民卫生出版社．2004．346—364．
[11]牛侨．职业卫生与职业医学[M]．北京：中国协和医科大学出版社．2003．349—390．
[1]、王杰,徐新云：职业性砷中毒[J].中国职业医学,2000,27(4):45-47.
[2]、徐新云,赵光明，张乐书：职业性慢性砷中毒的临床表现及其诊断[J].中华劳动卫生职业医学杂专,1996,14(3):163-164.
[3]、徐新云等：职业性慢性中毒15年观察，中国公共卫生，1995，11（8）：P353-354
[4]、高守之：100例慢性砷中毒的临床观察与护理体会齐齐哈尔医学院学报，2007，28（l）：121-122
[5]、、刘保安,粟占三,陈森林,职业性慢性砷中毒的皮肤病变[J].中国现代医学杂,1995,5(3):43,45.
[6]、赖燕,肖雄斌,李海霞.94例职业性慢性砷中毒病例临床特征分析[J].中国职业医学,2010,37(3):235-237
[7]、傅恩惠．尚波：玻璃厂慢性砷中毒7例临床分析[J].工业卫生与职业病，2006，32（4）：237～238
[8]、李明进，俞永熹：慢性砷中毒12例临床分析，职业与健康，2003，19（4）：26
[9]、马艳,郑玉建,吴顺华：砷对神经系统损伤的研究进展[J]中国地方病学杂志，2007，26(1)111-112.
[10]、齐丽，韩莉，吴立文：152名接砷工人神经传导速度测定结果分析[J]中国工业医学杂志，2005，18（5）：282～283
[11]、刘桂成，董学新，黄晓欣：燃煤污染型砷中毒患者的神经电生理检测[J]中国地方病学杂志，2000，19(1)：l3-l5．
[12]、吕伯钦,邓海,丁俊清：砷作业工人神经生理研究中华劳动卫生职业病杂志，19908（2）：65
[13]、赖燕，文忠，李胜：职业性慢性砷中毒所致颅神经损害[J]职业与健康，2002，18（6）：34～35
[14]、苏丽琴,金银龙.现场流行病学研究对慢性砷中毒判定的意义[J]卫生研究，2005,34(5):636-639
[15]、葛宪民,苏素花,农康等：广西H市4起急性水源性砷中毒715例的临床研究[J].中华劳动卫生职业病杂志,2009,27(3):212-215.
[16]、M. Jak i, Jelena Krmpoti-Nemani, F. Watt et al. Trace metal enrichment on the surface of the nasalseptum bone[J]. Nuclear Instruments and Methods in Physics Research Section B: Beam Interactionswith Materials and Atoms，1988,30(3):417-419.
[17]、M HARPER.Occupational health aspects of the arsenic extractive industry in Britain(1868-1925)[J].British Journal of Industrial Medicine1988,45:602-605.
[18]、NIOSH. Criteria for a recommended standard:occupational exposure to inorganic arsenic[M]. U. S.Dept. of health educations welfare, Public Health Service,1976.
[19]、洪峰，张爱华：燃煤砷污染致人群肾功能损害评价[A].中华预防医学会第二届学术年会暨全球华人公共卫生协会第二届年会论文集[C]，2006.
[20]、杨运旗，孙兰英等：慢性燃煤污染型砷电毒患毒肾功能改变[J]微量元素与健康研究，2000，17(2):21-22.
[21]、金泰廙,孙贵范.职业卫生与职业医学[M].北京:人民卫生出版,2006:173-175.
[22]、Allan H. Smith，Ayse Ercumen，Yan Yuan et al.Increased lung cancer risks are similar whether arsenicis ingested or inhaled[J]. J Expo Sci Environ Epidemiol.2009,19(4):343–348.
[23]、Jay H. Lubin, Lee E. Moore, Joseph F. Fraumeni Jr. et al. Respiratory Cancer and Inhaled InorganicArsenic in Copper Smelters Workers: A Linear Relationship with Cumulative Exposure that Increases withConcentration[J]. Environmental Health Perspectives,2008,116(12):1661-1665.
[24]、李金保，宋交才，黄觉之：职业性急性砷中毒15例临床分析[J]实用预防医学,2007,14(3):787.
[25]、陈沅江.《职业卫生与防护》[M].北京：机械工业出版社,2009,60.
[26]、赵坚,许天培,鲜思凯.36例急性砷中毒皮炎的临床分析[J].中华皮肤科杂志,2000,33(2):106.
[27]、农桂德：一起急性砷中毒事故的调查分析[J].广西预防医学,2005,11(5):317
[28]、李刚森：急性砷中毒9例报告[J]中国工业医学杂志，2002年，15（4）：215-216
[29]、邓杰：以皮炎表现为特征的急性砷中毒报告[J]卫生研究，1973(5)：42
[30]、Garb LG, Hine CH. Arsenical neuropathy: residual effects following acute industrial exposure [J]. JOccup Med.1977Aug;19(8):567-8.
[31]、朱小平,潘圣鑫.自制炸药炸灼伤并急性砷中毒诊治分析[J].广西医学,2OO5,27(3):422-423.
[32]、Michael S.Gorby,MD,Albuquerque. Arsenic poisoning[J].The western journal of medicine.1988，149(3):308-315.
[33]、李军，王三祥，王正辉等．砷中毒病儿童智力水平调查[J].中国公共卫生，2006，22(7):856-857．
[34]、Glazener FS, Ellis JG, Johnson PK: Electrocardiographic findings with arsenic poisoning[J]. CalifMed，1968，109:158-162
[35]、谷宏勤，王秀荣：经皮急性砷中毒致多器官损害一例救治体会[J]职业医学,1998,25(6):34-35.
[36]、普显宏：砷中毒及其预防[J]劳动保护，2007,(5):93.
[37]、李静华，张远平，赵学英等．急性砷中毒对跟部的损害[J].眼外伤职业眼病杂志，2007，29(12)：946-947.
[38]、张慧：急性砷中毒可能诱发胞系结石[J].中国城乡企业卫生，2003，(5)：22
[39]、洪峰，金泰廙，张爱华．应用基准剂量法探讨砷、镉接触人群肾功能损害危险性评价[J]．中华预防医学杂志，2004，38(6):374-378
[40]、Kristiansen J, Christensen JM, Iversen BS, Sabbioni E. Toxic trace element reference levels in blood andurine: influence of gender and life-style factors[J]. Sci Total Environ,1997,204:147–160.
[41]、Trepka MJ, Heinrich J, Schulz C, Krause C, Popescu M, Wjst M, et al. Arsenic burden among children inindustrial areas of eastern Germany [J]. Sci Total Environ,1996,180:95–105.
[42]、Vahter M, Lind B. Concentrations of arsenic in urine of the general population in Sweden [J]. Sci TotalEnviron,1986,54:1–12.
[43]、刘锐,陈曦等：563例尿砷测定结果分析[J]昆明医学院学,1989,lO(3):34-36.
[44]、张利民李生臣等：大连市355例正常人尿砷值的测定[J]中国工业医学杂志，1998,11(4):240-241.
[45]、秦文华，王国荣等：河南省非职业接触人群尿砷参考值[J]卫生研究，1998，27(5):299-301.
[46]、王凯，金亚平：沈阳地区成人尿中砷含量正常参考值的检测[J]中国工业医学杂志，2010，23(3):234.
[47]、陈福明：南宁市尿砷正常值．广西职防,1984,(2):110.
[48]、郑来义，白广禄，刘慧兰等：尿和头发砷含量与地方性砷中毒相关性研究.中国地方病防治杂志[J].2008,23(3):168-169.
[49]、Allan H. Smith,Ayse Ercumen,Yan Yuan et al. Increased lung cancer risks are similar whether arsenic isingested or inhaled[J].J Expo Sci Environ Epidemiol,2009,19(4):343–348.
[50]、Steinmaus C, Yuan Y, Kalman D et al. Intraindividual variability in arsenic methylation in a U.S.population.[J]. Cancer Epidemiol Biomarkers Prev2005,14:919–924.
[51]、徐新云等，无机砷化物对作业工人健康的影响中华动卫生职业病杂志1993，11（3）：66
[52]、Nurshad Ali,Md Ashraful Hoque et al. Association between arsenic exposure and plasma cholinesteraseactivity: a population based study in Bangladesh[J]. Environmental Health2010,9:36-44.
[53]、林匡飞，徐小清，Paul A等.砷污染区农民头发砷含量与环境中砷含量的关系［J］.中国环境科学,2001,21（5）：440-444.
[54]、G Farmer,L R Johnson. Assessment of occupational exposure to inorganic arsenic based on urinaryconcentrations and speciation of arsenic[J].British Journal of Industrial Medicine,1990,47:342-348.
[55]、王凯.氢化物发生-原子荧光光谱法测定人发砷的国内动态[J].中国工业医学杂志,2005,18(6):122-123.
[56]、R N Ratnaike. Acute and chronic arsenic toxicity[J].Postgrad Med J2003;79:391–396.
[57]、职业性慢性砷中毒诊断标准GBZ36-2001
[58]、营向东，葛宪民．中毒急危重症诊断治疗学[M].北京:人民卫生出版杜，2009：417-720．
[59]、何风生．中华职业医学[M]．北京:人民卫生出版杜，1999:338．
[60]、陈小兰，徐剑等. DDC-Ag法测定中风病人服用化风丹后血、尿中的砷含量[J].贵阳中医学院学报，2005,27(4):59-61.
[61]、许丽萍，伊乐等.长期用药嘎木朱尔涂膜剂家兔血砷浓度的检测[J].中国民族医药杂志，2009,(3):54-55.
[62]、Michael F. Hughes Biomarkers of Exposure: A Case Study with Inorganic Arsenic [J]. EnvironmentalHealth Perspectives,2006,114（11）:1790-1796.
[63]、李润博,刘静华.发砷和指(趾)甲砷含量的相关分析[J].微量元素与健康研究,1995,l2(3):49-50.
[64]、Badal Kumar Mandal, Yasumitsu Ogra, and Kazuo T et al. Speciation of arsenic in human nail and hairfrom arsenic-affected area by HPLC-inductively coupled argon plasma mass spectrometry [J]．Toxicologyand Applied Pharmacology,2003,189(2):73-83.
[65]、张卉，戈林等.慢性砷中毒[J]国外医学医学毒理分册，2003，24(4):176-189.
[66]、Kalia K, Flora SJ. Strategies for safe and effective therapeutic measures for chronic arsenic and leadpoisoning[J]. Occup Health,2005,47(1):1-21