Chinn D J, Cotes J E, el Gamal F M, Wollaston J F
Department of Environmental and Occupational Medicine, University, Newcastle upon Tyne.
Occup Environ Med. 1995 Jan;52(1):33-42. doi: 10.1136/oem.52.1.33.
To assess the effectiveness of current measures for protecting shipyard welders and caulker/burners (WCBs) from the respiratory effects of fumes.
Shipyard tradesmen born after 1953 (cohort 1), and 181 older men, subjects of a previous study (cohort 2), were assessed, then followed up after an average interval of 6.7 years. The respiratory associations with shipyard trades were assessed cross sectionally and longitudinally and an estimate made of the likely effects of selection bias. Cohort 1 comprised 90% of the 462 eligible WCBs and 239 other tradesmen; there were 31 exclusions. At follow up 139 of 146 men still in the shipyard and 43% of those who had left were reassessed. The lapses were mainly due to migration. All members of cohort 2 were followed up for respiratory symptoms (from MRC questionnaire), were recorded, and indices reflecting all aspects of lung function were measured.
At the initial assessment and independent of smoking, trade as a WCB was associated with increased prevalences of chronic cough, phlegm, and wheeze, a reduced transfer factor, and an enhanced age related deterioration in peak expiratory flow (measured cross sectionally). Continued work as a WCB was associated with enhanced deterioration in lung function despite some amelioration of respiratory symptoms; the deterioration was influenced by whether or not exhaust ventilation had been used for every weld. The effects of fume on forced expiratory volume, flow-volume curvilinearity, mean transit time, and moment ratio were independent of and at least as large as those due to smoking. Enhanced deterioration in peak expiratory flow was confined to WCBs who smoked. These effects of trade, but not those of smoking, were nearly independent of atopy.
In WCBs the working practices over the period of the study did not prevent the development of mild respiratory impairment. In WCBs who used exhaust ventilation at all times, the impairment seemed to reverse by discontinuation of exposure. Thus existing hygiene measures should be applied rigorously. The biological effectiveness of these and any other necessary supplementary measures should be assessed by long term monitoring of forced expiratory volume and peak expiratory flow.
评估当前保护造船厂焊工及铆工/气割工（WCBs）免受烟尘呼吸影响措施的有效性。
对1953年后出生的造船厂工人（队列1）以及181名老年男性（前一项研究的对象，队列2）进行评估，然后平均间隔6.7年后进行随访。对与造船厂工种相关的呼吸情况进行横断面和纵向评估，并对选择偏倚的可能影响进行估计。队列1包括462名符合条件的WCBs中的90%以及239名其他工种工人；有31人被排除。在随访时，对仍在造船厂的146名男性中的139名以及已离职者中的43%进行了重新评估。失访主要是由于迁移。对队列2的所有成员随访呼吸症状（来自医学研究委员会问卷）并记录，同时测量反映肺功能各方面的指标。
在初始评估时，与吸烟无关，作为WCBs的工种与慢性咳嗽、咳痰和喘息患病率增加、转移因子降低以及呼气峰值流速随年龄增长的恶化加剧（横断面测量）相关。继续从事WCBs工作与肺功能恶化加剧相关，尽管呼吸症状有所改善；这种恶化受每次焊接是否使用排气通风的影响。烟尘对用力呼气量、流量-容积曲线、平均通过时间和矩比的影响与吸烟无关且至少与吸烟的影响一样大。呼气峰值流速的恶化加剧仅限于吸烟的WCBs。工种的这些影响而非吸烟的影响几乎与特应性无关。
在WCBs中，研究期间的工作方式未能预防轻度呼吸功能损害的发生。在始终使用排气通风的WCBs中，停止接触后这种损害似乎会逆转。因此，应严格应用现有的卫生措施。这些措施以及任何其他必要补充措施的生物学有效性应通过对用力呼气量和呼气峰值流速的长期监测来评估。
