台灣職業醫學五十年之回顧

Occupational Hepatic, Renal, Neurological, Hematologic, Dermatologic, Cardiovascular and Musculoskeletal Diseases in Taiwan

劉紹興(Saou-Hsing Liou) ； 顧天倫(Tyan-Luen Gu) ； 徐尚為(Shang-Wei Hsu) ； 陳明宏(Ming-Hon Chen) ； 林春蓮(Chuan-Lian Lin) ； 陳麗美(Li-Mei Chen)

《中華民國公共衛生學會雜誌》 12卷4期 (1993/12) Pp. 335-353

https://doi.org/10.6288/JNPHARC1993-12-04-03

摘要

工業化的結果造成工業界大量使用有毒物質。這些有毒物質沒有標示正確的成分，加上雇主和勞工缺乏正確使用的知識，勞工可能經由呼吸道，腸胃這或皮膚吸收有毒物質而造成各種器官系統疾病。向於台灣職業病醫師的不足，過去被診斷的病例不多；本文收集近五十年報告的職業疾病，藉此提醒各科醫師把職業因素列入鑑別診斷。中毒性肝炎是最常見的職業性肝臟疾病，被報告的肝臟毒物包括四氯乙烷、四氯化碳、二甲基甲醯胺和氯仿。另外，氯乙烯和油漆或黏膠中的混合有機溶劑亦被發現會造成肝功能異常。肝臟毒物也是腎臟毒物；除此之外，重金屬如鎘、汞亦被發現造成腎功能異常。周邊神經毒物被報告者有正己烷，鉛和二硫化碳。機械性的壓迫如射擊或重覆動作亦會造成周邊神經病變。硫化氫，一氧化碳，錳和有機溶濟則被發現造成中樞神經病變。職業性血液疾病中較常見的是苯造成的再生不良性貧血；鉛也是造成貧血的毒物之一。另外，Aniline染料會造成變性血紅素症。職業性皮膚疾病，是次常見的職業病，但台灣被診斷的職業性皮膚病例不多。肌肉骨骼關節病變是第一常見的職業疾病，但缺乏系統性的調查其發生情形，僅有的報告也衹是小型工業而己。心臟血管疾病一般不被認為與職業有關，但噪音被發現與血壓增高有關。這些報告的病例數目可能嚴重低估台灣職業病的嚴重程度；要正確診斷職業病就是詢問職業史，臨床醫師多花一兩分鐘詢問工作史可能就會香現許多的職業病例。

關鍵字

職業病 ； 毒性化學物質 ； 職業史

並列摘要

With industrialization, many toxic substance was used in various kinds of industries. Without knowledge of the contents and improper handling of these toxic chemicals may lead to occupational diseases through the routes of respiratory, gastrointestinal tracts or skin. The occupational diseases have seldom been recognized in Taiwan on account of shortage of occupational physicians. This article is to collect the occupational diseases reported in Taiwan in order to provide the information in recognizing occupational diseases.
Toxic hepatitis is the most common occupational liver diseases. The causing agents which have been documented in Taiwan included tetrachioroethane, carbon tetrachloride, dimethyl formamide and chloroform. Vinyl chloride monomer and mixed organic solvents used in paint or glue were found to cause hepatic dysfunctions. Hepatic toxins may also cause renal damage. Heavy metals, e.g. cadmium and mercury were found to be renal toxins. n-Hexane, lead and carbon disulfide have been documented to cause polyneuropathy. Mechanical compression induced by target shooting and repetitive movement may lead to peripheral neuropathy. Hydrogen sulfide, carbon monoxide, manganese and organic solvents have found to cause central neuropathy. Benzene induced aplastic anemia was the well known occupational hematologic diseases. Lead poisoning may also be manifested with anemia. Methemoglobinemia induced by aniline have been found in dye workers. Contact dematitis is usually the second common and musculoskeletal disorder is the first common occupational diseases. However, few of these two diseases were reported to be associated with occupations. Cardiovascular diseases are too common to be considered as occupational diseases. But, noise exposure has been found to be related to hypertension. The number of occupational diseases currently recognized in Taiwan is considered to be seriously underestimated. All the physicians should bear in mind that a few minutes of questioning about occupational history will often reveal a large number of occupational illnesses.

並列關鍵字

occupational diseases ； toxic chemicals ； occupational history