卫生学精品教学（南方医学院）18.Pneumoconiosis.pptVIP

* * * * * * * * * * * * * * * * * * * Modern medicine Preclinical medicine Clinical medicine Preventive medicine The ILO/WHO Global Programme for the Elimination of Silicosis (GPES) The ILO/WHO Launged a global Programme for the Elimination of Silicosis. The ILO/WHO Program target is to promote the advancement of National Programs for the Elimination of Silicosis to reduce its incidence drastically by 2015, and have silicosis as a public health problem eliminated by 2030. 4 lines of action in China Governmental policies and legislation Effective organization and management Improvement of technology Health care Governmental policies and legislation Regulations of pneumoconiosis prevention Effective organization and management Health education Managing dust-proof equipment Implementation of related regulations and laws Health education to coal miners’ workers by a doctor Improvement of technology Automation Wet work Local Ventilation Health care Periodic physical examination Personal protection and hygiene Air helmet Dust mask Thank you * * * * * * * * * * * * * * * * * * Hyaline change * * * Massive progressive , confulent * * Cell and molecular mechanism An cellular, hyalinized center is surrounded concentrically arranged collagen fibers and a peripheral rim of dust-containing macrophages. Courtesy of Dr. Vallyathan Albrecht et al. 2002 Ann Occup Hyg SiO2 inhaled Control Asbestosis Asbestosis Round Irregular 矽肺病例尸解可见：肺体积增大，含气量减少，肺呈灰白或黑灰，晚期病例的肺脏可呈花岗岩状，肺重量增加，入水下沉。肺脏表面可触及砂粒状结节，并失去弹性，融合团块处质地硬似橡皮。 矽肺的基本病理改变是肺组织纤维化和矽结节（silicotic nodule）形成。矽结节是矽肺特征性病理改变。 细胞性结节（成纤维细胞为主，尘细胞、淋巴细胞、浆细胞） 胶原纤维结节 纤维性结节 纤维增生 透明样变 矽结节形成 尘细胞堆积于肺门淋巴结 肺间质弥漫性纤维化 肺门淋巴结纤维化，淋巴管阻塞 尘细胞扩散至全肺 肺间质广泛纤维化 淋巴液倒流 Clinical manifestation and diagnosis symptoms 即使X线胸片上已呈现典型矽肺影像，患者也可能在相当长时间内无明显自觉症状。随着病情进展，特别是有合并症时，会出现胸痛、胸闷、气短、咳嗽、咳痰、心悸等症状，并逐渐加重，但症状的程度与X线胸片表现的严重程度并不一定呈平行关系。 X线胸片表现 矽肺X线影像主要为小阴影（small opacity）和大阴影(large opacity)。小阴影和大阴影是矽肺X线诊断依据。X线胸片的肺门改变、肺纹理和胸膜改变以及肺气肿等影像对矽肺的诊断也有重要参考