Vibration is a vibration disease. Drug treatment of vibration disease
76. Vibration disease from the effects of general vibrations, classification, features of damage internal organs, principles of diagnosis, therapy, VTE.
Classification of vibration disease from exposure to general vibration:
I degree (initial manifestations).
1. Angiodystonic syndrome (cerebral or peripheral).
2. Vegetative-vestibular syndrome.
3. Syndrome of sensory (vegetative-sensory) polyneuropathy of the lower extremities.
I I degree (moderate manifestations).
1.Cerebral-peripheral angiodystonic syndrome.
2. Syndrome of sensory (vegetative-sensory) polyneuropathy of the lower extremities in combination with:
a) polyradicular disorders (polyradiculoneuropathy syndrome);
b) secondary lumbosacral radicular syndrome (against the background of osteochondrosis of the lumbar spine);
c) functional disorders of the nervous system (neurasthenia syndrome).
I I I degree (pronounced manifestations).
1. Sensorimotor polyneuropathy syndrome.
2. Discirculatory encephalopathy syndrome in combination with peripheral polyneuropathy
(encephalopolyneuropathy syndrome).
I degree of vibration disease (initial manifestations) manifests itself as early peripheral or cerebral vascular disorders. During development peripheral angiodystonic syndrome patients complain of paresthesia and mild pain in the lower limbs, cramps in the feet and calf muscles. On examination, there is acrocyanosis, hyperhidrosis, and hypothermia on the feet and hands. During development cerebral angiodystonic syndrome patients are concerned about complaints of diffuse headaches, increased fatigue, irritability, and sleep disturbances. A moderate increase in blood pressure and signs of non-systemic dizziness (flickering spots before the eyes, blurry vision of objects) are detected. Vegetative-vestibular syndrome manifested by the phenomena of vestibulopathy with non-systemic dizziness, intolerance to riding in transport, instability in the Romberg position and when walking, the presence of nystagmus and an increase in vestibulo-vegetative reactions. Sensory (vegetative-sensory) polyneuropathy syndrome of the lower extremities is manifested by diffuse pain, numbness, and a burning sensation in the legs. During the examination, cyanosis, hyperhidrosis, hypothermia of the feet and the development of hypalgesia of the distal parts of the lower extremities of the polyneuritic type are noted.
II degree of vibration disease (moderate manifestations). This stage is characterized by the addition of cerebral vascular changes to peripheral vascular disorders. Formed cerebral-peripheral angiodystonic syndrome. Worrying headaches of an intermittent or progressive nature without clear localization, attacks of non-systemic dizziness. This symptomatology is provoked by vestibular stress, fatigue, changes in body position, and intensifies towards the end of the working day.
With moderately pronounced manifestations of vibration disease from exposure to general vibration, sensory (vegetative-sensory) polyneuropathy most often develops not only of the lower, but also upper limbs. A combination of polyneuropathy with radicular syndromes, which are primary or secondary in nature (due to osteochondrosis), is possible. Polyradiculoneuropathy is characterized by pain in the extremities, lumbar and, less commonly, in the cervical regions spine. Developing reflex muscular-tonic syndrome. It is manifested by pain on palpation of paravertebral points, muscle deflation in the corresponding areas, pain when moving in the spine. Later, radicular disorders appear in the form of pain, numbness, paresthesia, and suppression of tendon reflexes in the area of the affected root. There is a distal decrease in sensitivity. Movement disorders (up to paresis) are possible. Peripheral neurovascular disorders may be combined with functional disorders nervous system(neurasthenia syndrome). Patients are concerned about general weakness, increased fatigue, headache, and tearfulness. Decreased memory and attention, impaired night sleep, decreased mood, and decreased performance are detected.
III degree of vibration disease (pronounced manifestations) currently practically never found. One of the forms of pathology of this degree is sensorimotor polyneuropathy syndrome. It is manifested by a decrease in strength in the lower extremities, wasting of the muscles of the legs and feet, pain in the nerve trunks and sensitivity disorders of the polyneuritic type. Peripheral polyneuropathy can be combined with cerebral angiodystonic disorders with microorganic symptoms from the central nervous system (encephalopolyneuropathy syndrome). In this case, asthenoorganic syndrome joins the manifestations of polyneuropathy. Persistent tremor of the fingers, asymmetry of tendon reflexes, sometimes anisocoria, unevenness of the palpebral fissures, and smoothness of the nasolabial fold are noted. Violations of cortical-subcortical relationships are more pronounced: memory, mood background (to depressive manifestations), and performance decrease. Sleep is persistently disturbed. Asthenoorganic syndrome characterized by persistence of disorders and a tendency to progress.
Principles for diagnosing vibration disease as an occupational disease
1. Study of the patient’s complaints, medical history and life history.
2. Study of the patient’s current condition with the involvement of the necessary specialists (neurologist, rheumatologist, orthopedist, etc.).
3. Widespread use of functional and instrumental methods examinations (rheovasography, thermography, algesimetry, pallesthesiolmetry, etc.)
4. Study of the professional route according to the patient’s work record book.
5. Study of sanitary and hygienic characteristics data working conditions(compiled by the Territorial Department of the Territorial Administration of Rospotrebnadzor).
6. Study of data from extracts from outpatient records about past illnesses and the results of preliminary (before employment) and periodic (during work) medical examinations.
Instrumental methods for diagnosing vibration disease.
Capillaroscopy serves to assess the degree of changes in small vessels. The capillaries of the nail bed of the fourth finger of both hands are examined. Normally, the background is pale pink, the number of capillary loops is at least 8 in 1 millimeter. With vibration disease, a spastic or spastic-atonic state of the capillaries is observed.
Pallesthesiometry (study of vibration sensitivity). For the study, use the palmar surface of the terminal phalanx of the I I I finger of both hands. With vibration disease, there is an increase in the threshold of vibration sensitivity at all frequencies.
Skin thermometry. Normally, the temperature fluctuates between 27-31 0C. With vibration disease it decreases to 18-20 0C.
Cold test. Hands are immersed in a container with water at a temperature of + 8-10 0C for 5 minutes. The test is considered positive if at least one phalanx of the fingers turns white. In healthy individuals, recovery occurs no later than 20-25 minutes, and with vibration disease it slows down to 40 minutes or more.
Algesimetry (study of pain sensitivity). The method is based on determining the amount of needle immersion in millimeters that causes pain. Normally, on the dorsum of the hand it does not exceed a needle depth of 0.5 mm. In patients with vibration disease, the threshold is much higher.
Study of complex electrical resistance of the skin using the Electrodermatometer device. This study helps to judge the state of the autonomic-vascular innervation of the studied areas. With vibration pathology, significant changes in parameters occur, which are most pronounced at the site of vibration application.
Dynamometry. In severe forms of vibration disease, a decrease in strength up to 15-20 kg (normally 40-50 kg in men and 30-40 kg in women) and endurance up to 10-15 seconds (normally 50-60 seconds) can be observed.
Electromyography used to assess the state of the sensorimotor system. According to stimulation electroneuromyography, with vibration disease there is a combination of polyneuropathy with local compression of the peripheral nerves, especially the ulnar and median nerves in the area of the cubital and carpal tunnels.
Rheovasography and rheoencephalography. Using these methods, it is possible to assess vascular tone and the intensity of pulse blood filling of peripheral and cerebral vessels of various sizes. With vibration disease, an increase in vascular tone, a decrease in pulse blood supply, and difficulty in venous outflow due to a decrease in venous tone are detected.
Electroencephalography. It is used to assess the degree of neurodynamic disorders, especially in patients exposed to general vibration.
X-ray examination of joints. Narrowing of the joint space, thickening of the closing bone plate at the articular ends, compaction (sclerosis) of the subchondral layers of bone tissue in both articular ends, especially in their loaded areas, bone growths along the edges are revealed. articular surfaces, deformation of the articular surfaces, the appearance of rounded clearings at the articular ends of the bones - cystic formations.
X-ray examination of the spine (including nuclear magnetic resonance imaging). Reveals signs of concomitant osteochondrosis of the spine, herniated intervertebral discs, protrusion, signs of compression of the dural sac.
Peculiaritiesdamage to internal organs.
Dysfunctions of the digestive glands often occur, and disturbances in the motor and secretory functions of the stomach may be associated with prolapse of the abdominal organs as a result of exposure to jerky vibration.
General principles of treatment
1. Start of treatment at the earliest stages of the disease.
2. Differentiated approach, depending on the severity and form of the disease.
3. Compliance with the etiological approach, which consists in the need to temporarily or permanently eliminate the effect of vibration on the body.
4. Elimination of temporary or permanent exposure associated factors: cooling, significant static and dynamic loads, toxic substances, unfavorable microclimatic conditions and meteorological factors.
5. The use of complex pathogenetic therapy aimed at normalizing the main clinical disorders (improving microcirculation and peripheral blood supply, eliminating trophic disorders, normalizing neurodynamic disorders, improving the function of the sensory-motor system).
6. Symptomatic therapy aimed at improving the quality of life of patients.
7. Carrying out activities aimed at restoring disorders of the musculoskeletal system.
8. Widespread use of physical and reflex treatment methods along with drug therapy.
9. Labor and social rehabilitation.
Drug treatment of peripheral angiodystonic syndrome.
In case of vibration disease caused by exposure to local vibration, occurring with predominant neurovascular disorders, in the event of pain, the combined use of ganglion blockers (pachycarpine, difacil, hexametone) with small doses of central anticholinergics (aminazine, amizil) and vasodilators (nicotinic acid, no-spa) is recommended , novocaine). Trental is taken 2 tablets (0.2 g) 3 times a day after meals. Halidor – 2 tablets (200 mg) 3 times a day, course – 16 days; no-spa (0.02 g) – 2 tablets 3 times a day; course – 16–20 days. Among the antiadrenergic substances, methyldopa (dopegit) is recommended - 0.25 g 2 times a day; course – 15–20 days under blood pressure control.
For vibration disease with a predominant lesion of the musculoskeletal system, combinations of ganglion blockers, central anticholinergics and various sedatives are prescribed. Among the gangliolytics, benzohexonium is widely known. Benzohexonium is prescribed as a 1% solution, 1 ml intramuscularly daily for 3 weeks or orally 0.1 g 3 times a day for 20 days. After taking the drug, orthostatic collapse is possible, so the patient should lie down for at least 1 hour. Benzohexonium is effective in combination with amizil. Amizil is given in a dose of 0.001 g 30 minutes before benzohexonium injection. In severe stages of the disease, sacrospinal or paravertebral blockades in the area of segments C3 and D2 with a 0.25% solution of novocaine (up to 40–50 ml) are indicated.
Physiotherapy the use of electrophoresis in combination with various medicinal substances (electrophoresis of a 5% novocaine solution or a 2% benzohexonium solution on the hands or on the collar area).
EXAMINATION OF WORK ABILITY
In the presence of stage I vibration disease, when the pathological processes are sufficiently reversible, there are no pronounced trophic and sensory disorders, and the phenomena of vasospasm are not clearly expressed active treatment without interruption from production.
In grade II, the patient should be considered temporarily limited in ability to work. He must be excluded from performing work associated with occupational hazards: vibration, noise, physical activity, exposure to an unfavorable microclimate and toxic substances. If treatment and preventive measures do not give the expected effect and the patient experiences persistent pathological phenomena, he should be considered disabled in professions associated with exposure to vibration, noise, adverse meteorological factors, as well as significant physical stress.
77. Toxic-radiation injuries from exposure to radionuclides. Chronic uraniumintoxication. Main clinical syndromes, their differential diagnosis. Occupational lung cancer, etiological factors, diagnosis, VTE issues.
Direct exposure to radiation is characterized by damage to biological molecules, disruption of intracellular metabolism and cell death. The indirect effect of radiation on biological molecules is carried out by the resulting free radicals and peroxide compounds. These substances, being strong oxidizing agents, damage cells. Some products of the degradation of biological molecules, which occurs under the influence of strong oxidizing and reducing agents, have pronounced toxic properties and enhance the damaging effects of ionizing radiation. As a result, the membranes and nuclei of cells, the chromosomal apparatus responsible for genetic information, are damaged. It is well known that proteins and nucleic acids are crucial for cell life. They are the first to become victims of ionizing radiation. As a result, vital activity is disrupted, and then cell death occurs.
The most sensitive to ionizing radiation are organs and tissues with rapidly dividing cells. These primarily include the organs of the hematopoietic system (bone marrow, spleen, lymph nodes), digestion (mucous membranes of the small intestine, stomach) and gonads.
Clinic of intoxication with uranium decay products. The influence of uranium isotopes on the body When isotopes enter the mouth, destructive-necrobiotic changes in the gastrointestinal tract come to the fore; when administered through the upper respiratory tract, foci of fibrinous-necrotic pneumonia appear in the lungs with an almost complete absence of polymorphonuclear leukocytes in the exudate; when applied to the skin or introduced into the subcutaneous tissue, local necrotic changes develop, up to the formation of extensive ulcers involving the underlying soft tissue; when emitters are introduced directly into the blood (2-5 µCi/g), the most pronounced changes are detected in the spleen, lymph nodes and liver. Autoradiographic studies show that, regardless of the route of entry of radioactive substances into the body, the greatest activity is determined in the bones and in places of primary localization. With increasing life expectancy of the affected organism, various forms of cell and tissue degeneration with vascular changes develop, characteristic of the long-term development of acute radiation sickness caused by external irradiation.
The incorporation of small amounts of uranium fission products (0.1-0.5 μCi/g) causes subacute and chronic damage, in which, along with hypoplastic and hyperplastic changes in hematopoietic tissue, bone restructuring, cirrhotic changes in the liver, nephrosclerosis, etc. in the long term of the disease, malignant neoplasms of the skeleton, liver, endocrine glands and other organs. In practical terms, information about the pathological anatomy of the lesion with the following nucleoids is of greatest importance: 90Sr, 9,Y, 144Ce, 236Pu, 137Cs, 131I. It is the listed isotopes that cause global radioactive pollution of the environment and, as a result, their increased content in the human body. Studies show, for example, that as a result of global contamination with uranium fission products, the 90Sr content in human bones is higher than in the UN Radiation Committee reference samples.
EMERGENCIES
Acute heart failure during myocardial infarction, diagnosis and emergencytherapy.
Myocardial infarction- necrosis (death) of the heart muscle as a result of an acute and pronounced imbalance between the myocardial need for oxygen and its delivery (Greek. infarcere- stuff). Previously, it was accepted to divide myocardial infarction into transmural (necrosis of the entire thickness of the myocardium) and non-transmural.
Causes of myocardial infarction. Atherosclerotic: transmural MI, non-transmural MI. Non-atherosclerotic: spasm of the coronary artery, thrombosis, embolism.
Myocardial necrosis occurs, as a rule, in the left ventricle. This is because the left ventricle has more muscle mass, does a lot of work, and requires more blood supply than the right ventricle.
Consequencesnecrosismyocardium
The occurrence of myocardial infarction is accompanied by disturbances in the systolic and diastolic functions of the heart, remodeling of the left ventricle, as well as changes in other organs and systems.
Stunnedmyocardium- post-ischemic state of the myocardium, characterized by a decrease in the contractile function of the myocardium after a short-term, no more than 15 minutes, occlusion of the coronary artery with subsequent restoration of blood flow. This disturbance persists for several hours.
Hibernatingmyocardium- constant decrease in the contractile function of part of the myocardium of the left ventricle in the zone of chronic decrease in coronary blood flow (does not participate in heart contraction, which leads to a decrease in cardiac output, damage to more than 40% of the myocardial mass leads to the development of cardiogenic shock. Violation of the diastolic function of the left ventricle occurs as a result of a decrease myocardial distensibility (the myocardium becomes inelastic). This leads to an increase in end-diastolic pressure in the left ventricle. After 2-3 weeks, the end diastolic pressure in the left ventricle is normalized.
Remodeling of the left ventricle occurs during transmural myocardial infarction and consists of two pathological changes: - An increase in the necrosis zone. The infarction area increases as a result of thinning of the necrotic area of the myocardium. Expansion of the myocardial infarction zone is observed more often in common anterior myocardial infarctions and is associated with higher mortality, the risk of myocardial rupture and more frequent formation of post-infarction left ventricular aneurysm. -Dilatation of the left ventricle. The remaining unaffected (viable) myocardium is stretched, which leads to expansion of the cavity of the left ventricle (a compensatory reaction to maintain the normal stroke volume of the heart). At the same time, excessive load on the preserved myocardium leads to its compensatory hypertrophy and can provoke further impairment of the contractile function of the left ventricle.
Remodeling factors: 1) size of the infarction (the larger the size of the infarction, the more pronounced the changes); 2) peripheral vascular resistance (the higher it is, the greater the load on the preserved myocardium and, therefore, the more pronounced the remodeling); 3) histological properties of the myocardial scar.
Changes in other organs and systems. As a result of deterioration in left ventricular systolic and diastolic function, pulmonary function is impaired due to an increase in extravascular fluid volume (as a result of increased pulmonary venous pressure). Cerebral hypoperfusion with associated symptoms may occur. An increase in the activity of the sympathoadrenal system leads to an increase in the content of circulating catecholamines and can provoke cardiac arrhythmias. In the blood plasma, the concentrations of vasopressin, angiotensin and aldosterone increase. Hyperglycemia occurs due to transient insulin deficiency resulting from pancreatic hypoperfusion. ESR increases, leukocytosis appears, platelet aggregation increases, fibrinogen levels and blood plasma viscosity increase.
Vibration disease is an occupational disease. It is based on pathological changes that occur in various parts of the nervous system as a result of long-term exposure to local or general vibration.
Causes
Vibration disease develops in workers manual labor, which is associated with the use of tools of a rotational or percussive nature. In most cases, it occurs in those who work in construction, mining, transport, metallurgy, aircraft and shipbuilding, as well as in the agricultural sector.
To the risk group possible development Vibration disease includes such professions as:
- grinders;
- drillers;
- polishers;
- choppers;
- asphalt pavers;
- tram drivers and others.
The main cause of the disease is exposure mechanical influences, that is, vibrations, on the human body. The most adverse effect is caused by vibration with a frequency of 16-200 Hz.
The disease develops most quickly if vibration is accompanied by other unfavorable working conditions, such as:
- working in the cold;
- constant awkward body position;
- static muscle tension.
The effect of vibration is negative on all tissues human body, but bone and nerve tissue. First of all, vibration affects peripheral receptors, which are located in the skin of the hands and soles of the feet. Mechanical vibrations also influence the receptors of the vestibular analyzer in the ear labyrinth.
Classification
In classical neurology, there are three main forms of vibration disease that occur when exposed to:
- local vibration;
- general vibration;
- combined vibration (including local and general).
Degrees
Vibration disease has 4 degrees of severity:
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- initial;
- moderate;
- expressed;
- generalized (affecting the entire body).
Generalized vibration disease occurs in very rare cases these days.
Symptoms
Symptoms characteristic of vibration disease depend on the frequency and nature of exposure to mechanical vibrations and a number of associated factors. Each stage of the disease has its own clinical picture:
- Stage I is characterized by the development of transient painful sensations localized in the fingers. Numbness and paresthesia are possible.
- Stage II is characterized by more pronounced pain sensations, which, like paresthesia, are persistent. At this stage, changes in vascular tone (capillaries and large vessels) occur, and distinct sensitivity disorders occur. Phenomena of asthenia and autonomic dysfunction.
- Stage III is characterized by severe attacks of pain, numbness and paresthesia. There are pronounced trophic and vasomotor disturbances, a distinct vasospasm syndrome, in which whitening of the fingers occurs. This stage is characterized by complete loss of sensitivity, loss of tendon reflexes, and vegetative-vascular dystonia, accompanied by hypertension. Neurotization of the personality according to the asthenic type is noted. Disorders in the functioning of the gastrointestinal tract occur, and x-rays reveal significant changes in the bones and joints.
- Stage IV is generalized organic lesions. Encephalomyelopathy may occur, but this is rare. The patient has pronounced sensory and trophic disorders, severe pain in the fingers, joints and along the nerve trunks. Affected peripheral vessels hands, as well as cerebral and coronary vessels.
Diagnostics
Diagnosis of vibration disease is carried out by a neurologist and therapist. Consultations are often scheduled vascular surgeon, cardiologist, otolaryngologist, gastroenterologist.
During the examination, the emphasis is on studying the skin color of the distal parts of the extremities, pain and vibration sensitivity, analysis of the osteoarticular apparatus, muscular system, work of the heart and blood vessels.
When diagnosing, use:
- thermography;
- electrocardiography;
- capillaroscopy.
A cold test is also used, which involves immersing the patient’s hands in cold water. The test is positive if the fingers turn white. If there is a delay in restoring the temperature of the skin of the hands for more than 20 minutes, then this is evidence of a violation of the regulation of vascular tone.
If there are indications, then in case of vibration disease, a hearing test is additionally performed - threshold audiometry, acoustic impedance measurement, electrocochleography, as well as an examination of organs digestive tract– Ultrasound of the liver, gastroscopy, gastric intubation.
It is of great importance when treatment for vibration disease was started. The sooner this happened, the better. The main thing in therapy is the complete elimination of vibration affecting the human body. At the same time, patients with diagnosed vibration disease should avoid unnecessary physical activity and hypothermia. Therapy is prescribed individually and depends on the symptoms that appear.
If vibration disease is characterized by the presence of neurosensory disorders, then the doctor prescribes a combination treatment using:
- vasodilators medicines(cavinton, nicotinic acid, drotaverine);
- ganglion blockers (hexamethonium, pachycarpine, difacil);
- anticholinergics (aminazine, amizil).
To improve microcirculation, trental (pentoxifylline) is prescribed.
Complex treatment necessarily includes restorative therapy - vitamins, glucose, calcium gluconate. Physiotherapy is effective - reflexology, UHF, electrophoresis on the collar area. Massages are provided, and hydro procedures are recommended - oxygen, nitrogen, radon and hydrogen sulfide baths, four-chamber bath, foot and hand baths.
Prevention
Preventive measures include strict adherence to accepted labor organization standards, especially for professions that are at risk. Prevention also includes the exception negative impact vibrations on the body, timely medical examination, organization of special dispensaries in production.
Forecast
The prognosis for vibration disease in most cases is favorable, but only if it is diagnosed early and the issue of eliminating the effects of vibration and hypothermia in the work process is addressed.
If treatment is started late, vibration disease is advanced, and exposure to vibration is not stopped, then the disease can progress to a pronounced stage and lead to disability of the patient.
Mainly agricultural machine operators, truck drivers, excavator operators, pile drivers, etc. are exposed to general vibration.
WB classification from the action of general vibration was approved in 1982. It is built on a syndromic principle and distinguishes 3 degrees of severity of the pathological process:
Initial manifestations
1) angiodystonic syndrome (cerebral or peripheral),
2) vegetative-vestibular syndrome,
3) syndrome of sensory (vegetative-sensory) polyneuropathy of the lower extremities.
Moderate manifestations:
1) cerebral-peripheral angiodystonic syndrome,
2) sensory (vegetative-sensory) polyneuropathy syndrome in combination:
a) with polyradicular disorders (polyradiculoneuropathy syndrome),
b) with secondary lumbosacral radicular syndrome (due to osteochondrosis of the lumbar spinal column),
c) with functional disorders of the nervous system (neurasthenia syndrome)
Expressed manifestations:
1) sensory-motor polyneuropathy syndrome,
2) discirculatory encephalopathy syndrome in combination with peripheral polyneuropathy (encephalopolyneuropathy syndrome).
Clinical picture. Modern production is characterized by relatively low levels vibrations of workplaces with a predominance of low-frequency vibration spectrum.
Stage 1 disease includes unstable cerebral or peripheral neurovascular disorders. PADS is characterized by intermittent and moderately severe paresthesia and pain in the lower extremities, sometimes cramps of the calf muscles. On examination, mild cyanosis or marbling, hypothermia of the feet, hyperhidrosis of the soles, and decreased perception of vibration and pain sensitivity on the toes are observed. Increased pain and paresthesia in the feet and legs, the severity of peripheral vegetative-vascular disorders, a decrease in superficial sensitivity (especially pain) of the polyneuritic type, mainly in the distal parts of the lower extremities, are the basis for establishing the syndrome of VSP of the lower extremities. A clear predominance of sensitivity disorders in the clinical picture indicates sensory polyneuropathy of the lower extremities.
The presence of cerebral angiodystonic syndrome is indicated by mildly expressed symptoms of a neurasthenic or asthenoneurotic nature (recurrent headache, irritability, fatigue, sleep disturbance) in combination with autonomic dysfunction (lability of pulse, blood pressure with a predominance of hypertension, sweating, impaired dermographic reaction, etc.).
Autonomic-vegetative disorders are manifested by motion sickness syndrome, dizziness, staggering when walking and in the Romberg position, unstable horizontal nystagmus, increased vestibular-vegetative reactions under vestibular loads.
One of the variants of moderate manifestations of the disease is the simultaneous development of cerebral and peripheral angiodystonic disorders, which is regarded as cerebral-peripheral syndrome. Moreover, in some cases, along with the development of vegetative-vascular disorders in the lower extremities, similar symptoms appear in the area of the hands.
Clinical manifestations of VSP syndrome at this stage of the disease become more pronounced and are observed not only in the lower extremities, but also in the upper extremities. Against this background, radicular symptoms may appear (polyradiculoneuropathy syndrome).
Along with VSP, secondary lumbosacral radicular syndrome develops due to osteochondrosis of the lumbar spinal column. This is explained by the fact that the aperiodic shocks that occur as a result of vibration, which drivers of heavy-duty vehicles and self-propelled equipment experience at their workplaces, have a microtraumatic effect on the lumbosacral vertebrae, intervertebral discs, and joints with a violation of their trophism. This is, apparently, one of the reasons for the development or progression of osteochondrosis, deforming arthrosis of the lumbosacral spine and secondary radicular, pain and reflex syndromes.
At this stage of the disease, pronounced vegetative-vascular dystonia and functional changes in the central nervous system, occurring as neurasthenia, can be observed. These changes are usually accompanied by autonomic-vestibular disorders.
Workers exposed to general vibration often experience dysfunction of the digestive glands, menstrual irregularities in women, and exacerbation of the inflammatory process in the pelvic organs. These changes are explained by a violation of the regulatory influence of the central nervous system, as well as organ prolapse abdominal cavity and irritation of the celiac plexus under the influence of vibration.
With the combined effects of general and local vibration, a complex symptom complex is formed, consisting of a combination of syndromes characteristic of VD from exposure to local and general vibration. This form The disease occurs, for example, in those working on vibration compaction of concrete, drillers and miners, when not only the limbs, but also all supporting surfaces are exposed to vibration.
Diagnosis of vibration disease. Early diagnosis of VD is carried out during periodic medical examinations. At the same time, attention is paid to characteristic complaints, objective examination data, tuning fork, cold test and dynamometry indicators. Each specialist participating in the PME must carefully describe complaints, objective data in medical card. If necessary, an outpatient follow-up examination is prescribed.
In a clinic setting, it is possible to perform rheovasography, electromyography, electroencephalography, rheoencephalography, and radiography of the musculoskeletal system.
Diagnosis of VD in the occupational pathology center is based on the following data:
professional route (according to a copy of the work book confirming a sufficiently long professional experience in contact with vibration),
sanitary and hygienic characteristics of working conditions, indicating systematic exposure of workers to vibration exceeding the maximum permissible limit. The work operations performed by the patient, the nature various sources vibration and its main parameters. In addition, you should have information about other unfavorable occupational factors (significant muscle tension, forced body position, uncomfortable working posture, general cooling, as well as cooling of the hands and wetting them with solvents, water; industrial noise, etc.). Important information about preventive measures, use individual funds protection;
history of the disease: typical complaints, gradual development of the disease and significant improvement in the patient’s condition with more or less long breaks at work (during vacation, carrying out course treatment and using additional paid sick leave,
objective examination - a thorough description of the status localis (assessment of the state of peripheral blood supply: coloring of the skin of the palms, hypothermia of the hands, hyperhidrosis, sometimes dry palms, the presence of trophic disorders in the form of hyperkeratosis, changes in the nail plates, etc.),
symptoms: “white spot” (the patient clenches his hands tightly into a fist and quickly unclenches them after 5 seconds. Normally, the resulting white spots on the palms and fingers should disappear after 5 seconds, but if traces of whitening persist longer, the test is considered positive).
Bogolepova (a person with his arms stretched forward is asked to raise one of them and lower the other for 15 seconds, and then extend them horizontally again. The color of both hands is normally restored after 15 seconds. If peripheral blood circulation is impaired, it will take much longer to restore the color of the hands) .
Palya (in a sitting patient, a synchronous pulse is found on both radial arteries, and then with a quick movement, both of the patient’s arms are raised up, while the pulse may disappear on one or both sides for several seconds. Such a test is assessed as positive).
clinical and functional research methods that allow assessing functional state peripheral and central blood supply, peripheral nerves, determine thresholds of vibration and pain sensitivity, etc. Thus, the study of vibration sensitivity is carried out on VCh or VT devices, as well as on a vibration thermal analyzer and using a tuning fork test. Algesimetry is used to study pain sensitivity. Peripheral vascular disorders are studied using capillaroscopy, rheovasography, thermal imaging studies, as well as a cold test with determination of the time of recovery of temperature on the fingers after it. In addition, dynamometry, electromyography (global and stimulation), radiography of the musculoskeletal system are performed, according to indications: electroencephalography, rheoencephalography, Dopplerography of peripheral vessels.
Treatment of vibration disease. The etiological principle of therapy involves eliminating the impact on the body of vibration and such unfavorable production factors as cooling and physical stress. Pathogenetic therapy is aimed at normalizing peripheral blood circulation, eliminating foci of stagnant excitation, etc. The goal of symptomatic therapy is to normalize polymorphic reflex disorders, etc. The most effective is complex treatment of patients using medications, physical and reflex methods.
For angiospasms, vasodilators are recommended (nicotinic acid, halidor, trental (pentoxifylline), drugs that improve the rheological properties of blood (reogluman, reopoliglucin). For severe pain syndrome combined with neurovascular disorders, the use of ganglion blockers in combination with small doses of anticholinergics and vasodilators is indicated .
To improve microcirculation processes (correction of oxygen balance, collagen metabolism, etc.), injections of ATP, pyridoxine, angiotrophin, as well as ascorbic acid are indicated.
In case of severe pain, the complex of therapy must include injections of vitamins B1 and B12, non-steroidal anti-inflammatory drugs (indomethacin, ortofen, etc.), novocaine blockades. In the complex of treatment, the use of biostimulants and adaptogens is practiced.
Physiotherapeutic methods of treatment: phonophoresis with analgesic mixtures, amplipulse therapy, electrophoresis of a 5% novocaine solution, 1% analgin solution or 1% papaverine solution on the limbs, applications with a 25% dimexide solution, electrophoresis with peloidin, laser therapy for hands, paraffin-ozokerite applications, 2- and 4-chamber baths, SMT on the cervicothoracic segments of the sympathetic nervous system, reflexology, circular shower.
In the complex treatment of vibration disease, great importance is attached to balneotherapy. Hydrogen sulfide, iodine-bromine, nitrogen-thermal baths, and mud applications have a beneficial effect on the course of the disease.
Work ability examination. Issues of assessing the ability to work in cases of vibration disease are resolved taking into account the stage, leading clinical syndrome, features of the course of the disease, the presence of concomitant diseases, and the effectiveness of treatment.
The main reasons for the decreased ability to work in patients with VD are persistent pain, decreased hand strength and endurance to static force, frequent and long-lasting vasospasms of the fingers, and severe peripheral vegetative-vascular disorders.
With the first degree of VD, there is a temporary loss of ability to work (full - sick leave, partial - additional paid sick leave). Gives a lasting therapeutic effect hospital treatment in a specialized department of occupational pathology or a neurological department, recovery in a sanatorium, subject to the temporary transfer of the patient for a period of 1-2 months to work outside the influence of vibration, physical overexertion and cooling with the issuance of an additional paid sick leave. DBL is formalized as BL, only with “labor” indicated at the top, and is extended every 10 days by a neurologist indicating the dynamics of the pathological process. During a calendar year, DBL is issued for a period of up to 2 months.
Clinical examination sick carried out depending on the stage and clinical syndromes. Patients with VD need to be examined by a neurologist, therapist and otorhinolaryngologist once a year for periodic medical examinations. In addition, every year, in a specialized occupational pathology center, to clarify the severity of clinical syndromes, they undergo an examination (vibration sensitivity study, algesimetry, dynamometry, electrothermometry, cold test, capillaroscopy, thermal imaging examination). According to indications, radiography of the osteoarticular apparatus, electromyography, determination of vibration and temperature (heat and cold) sensitivity on a vibration-thermal analyzer, rheovasography, electroencephalography, etc. are prescribed. If necessary, patients are consulted by an angiosurgeon or traumatologist (orthopedist).
Treatments are carried out twice a year, taking into account the syndromes and degree of VD. One course is carried out in the occupational pathology department, the second - in a health care facility or in a sanatorium-preventorium of the enterprise.
Persons with residual manifestations of VD are subject to dispensary observation according to the same scheme. When signs of VD disappear, they are considered practically healthy in the absence of concomitant diseases. These individuals are able to work in a wide range of professions, except for vibration ones. Returning to your previous job is not advisable, especially at the age of 45 and older, because... they may develop early vibration pathology.
According to Order No. 90 of the Ministry of Health and the MP of the Russian Federation, periodic medical examinations of persons working in contact with local vibration are carried out once a year and once every 2 years when the general vibration limit is exceeded according to the “Sanitary Standards...”. The frequency of examinations at the occupational pathology center is once every 3 years (local vibration), once every 5 years (general vibration).
Additional medical contraindications for working in contact with local and general vibration:
Obliterating arterial diseases, peripheral vasospasm,
Chronic diseases of the peripheral nervous system,
Anomalies in the position of the female genital organs. Chronic inflammatory diseases of the uterus and appendages with frequent exacerbations,
High and complicated myopia (above 8.0 D).
It is quite easy to upset the balance in the nervous system and sometimes simple vibration is enough, as is the case with vibration disease. This disease occurs as a result of professional activity, especially among drivers and workers at construction sites. This happens due to constant feeling vibration in the range from 20 to 210 Hz and it is divided into several types depending on its impact:
- Local action (local). In such a situation, vibration disease occurs due to constant exposure to the hands. Most often, builders who work with heavy tools, for example, with a hammer drill, jackhammer, or behind a machine in a factory, suffer from this;
- Impact on the whole body (general). It is this form of vibration disease that drivers are susceptible to, so it is important for them to know after what time the first symptoms appear and sensitivity is impaired. The pathology is especially common in people who drive large machines.
Vibration disease manifests itself in different ways and depends on the following circumstances:
- Type of concussion;
- Noise from operation, for example from a jackhammer;
- Hypothermia;
- Uncomfortable position.
Sometimes trembling can be both general and local, so it is important to identify the problem in time. In this case, vibration disease develops much faster.
A concussion affects the peripheral part of the analyzer, which represents receptors responsible for sensations like external stimuli, and internal. The information passing through them passes into the network-like formation (reticular formation) and into the sympathetic ganglion chains, which are vegetative part nervous system. This means that a person cannot influence them, and with prolonged irritation of these structures, malfunctions occur in various body systems:
- Musculoskeletal;
- Cardiovascular;
- Nervous.
Initially they are expressed in the form of spasms in the vessels located at the site of the concussion, and then throughout the body. This phenomenon manifests itself in impaired blood circulation, poor nutrition tissues and high pressure. Over time, due to damage to cells, as well as to the intercellular substance due to poor blood circulation, signs of degeneration appear in the organs.
Vibration disease in advanced stages does not go away so easily, and even after removing its culprit, it is often not possible to completely get rid of the manifestations of the pathology right away.
In the most advanced cases, the changes are irreversible. You can confirm the diagnosis with a certificate from your place of work, the main thing is that you have at least 5-7 years of experience, but generally the first symptoms become noticeable after 2-4 years.
Symptoms of pathology caused by local exposure
For people who have vibration disease due to local exposure, there are 4 main stages of manifestation of the pathology and each of them has its own characteristics. For the first stage they are:
- Loss of sensitivity in the fingertips;
- Slight tingling in the hands;
- Feeling of goosebumps on the skin.
All these signs can be characterized as manifestations of paresthesia. The second stage, in addition to the aggravation of the above symptoms, is characterized by the following symptoms:
- Blood circulation worsens due to changes in vascular tone;
- Sensitivity to shock is significantly reduced;
- Neurocirculatory dystonia (NCD) or, as it is also called, autonomic dysfunction occurs. This syndrome is characterized by a violation of the sensitivity of blood vessels, that is, weak expansion and narrowing;
- Symptoms of asthenia (psychological disorder) appear.
In the third stage, attacks of paresthesia, asthenia and pain in the patient become more severe, and vibration sensitivity drops significantly below normal. The following signs are also added to this stage of the disease:
- Symptoms of vasospasm appear, that is, vasoconstriction (white fingertips, sensitivity disorders);
- Tendon reflexes weaken (low sensitivity when struck with a hammer);
- Malfunctions in the functioning of the autonomic nervous system (vegetative-vascular dystonia) occur, which manifest themselves in the form of increased sweating (hyperhidrosis) and high blood pressure (hypertension);
- X-rays are used to monitor pathological changes in the joints and bones of the hands.
Against the background of this entire clinical picture, the patient often has problems with the gastrointestinal tract, which manifest themselves in the form of stomach pain, diarrhea and constipation. Stage 4 is characterized by a worsening of the symptoms of the first 3 stages, as well as extensive damage to organs and tissues. In addition to the old symptoms, vibration disease at such an advanced stage of development can manifest itself as follows:
- The pain becomes constant and is poorly relieved with painkillers;
- Mixed and vegetative-vascular paroxysms (sharp increase in symptoms);
- Impaired blood circulation (angiodystonic crisis) spreads to the vessels in the brain.
It is extremely difficult to remove the manifestations of stage 4 and most often they are irreversible, so it is worthwhile to treat the pathology in advance. You should find out what course of therapy you will need for this from a neurologist after examination. Vibration disease develops over more than 10 years, so you can have enough time to learn everything you need about it and about preventive measures.
Combinations of local and widespread exposure to vibration
This type of impact occurs through directed shock to the hands and body as a whole, for example, during construction work to compact concrete using vibration. Due to their combination, people experience angiopolyneuropathic syndrome, which is a mixture of paresthesia and impaired sensitivity. Along with it appears, which manifests itself in irritability for any reason, suspiciousness, sleep disturbance, etc.
Find out what complaints arise about early stage development of the disease with mixed type vibration exposure can be from the list below:
- Head pain and dizziness;
- High sensitivity to environmental stimuli;
- Groundless irritability;
- Aching pain in the lower extremities and numbness;
- Paresthesia.
When the disease develops painful sensations vegetative crises are also becoming more frequent ( severe attack anxiety) is becoming increasingly obvious. The following signs are also added to the previous signs:
- Problems with remembering;
- Outbursts of emotions;
- Insomnia at night and constant desire sleep during the day;
- Pallor;
- Attacks of vasospasm;
- Hyperhidrosis;
- Paresthesia and impaired sensitivity in the upper and lower extremities;
- Deterioration of tendon reflexes;
- Trophic disorders due to impaired blood circulation, which manifest themselves in the form of thinning of the skin on the fingers and decreased muscle tone;
- Hypertension and sudden surges in pressure;
- Pathological changes detected on the electrocardiogram (ECG);
- Epileptiform activity shows its bursts on the EGG, which can serve as an alarming signal for the development of epilepsy.
General vibration
Vibration disease, which appears after prolonged exposure to general shaking, has its own distinctive symptoms:
- Dizziness in different time day (vestibulopathy) and headaches;
- Deterioration of vision and hearing;
- Stem and spinal signs (lesions of the brain and spinal cord);
- Dyskinesia of the gastrointestinal tract, which doctors call complex intestinal disorders arising due to poor intestinal motility;
- Pain in the area solar plexus and in the lower back near the sacral region.
Diagnosis of pathology
Knowing what symptoms are characteristic of vibration disease is an important step in identifying the disease, but you should also analyze working conditions by questioning the patient and inspecting the workplace. These points are considered key for making a diagnosis and prescribing treatment, since the doctor must make sure that the problem is vibration in the workplace.
The specialist will need to appoint and various kinds examinations:
- Determination of sensitivity to vibrations;
- Capillaroscopy (examination of soft tissue capillaries);
- Skin thermometry (study of skin temperature);
- Algesimetry (degree of pain perception);
- Examination of the skin for electrochemical resistance;
- Electrocardiogram (determining heart activity);
- Rheography (pulse fluctuations);
- Electromyography (study of muscle fiber vibrations);
- Complete examination of the gastrointestinal tract and digestive organs;
- Polycardiography (study of heart contractions);
- Electroencephalography (studying the degree of brain activity);
- Audiometry (determining hearing acuity);
- X-ray of joints.
An x-ray will show how much it has grown. nail phalanx. This examination method will also help determine the degree of thickening:
- Central Department tubular bones(diaphysis);
- Metaepiphysis of the phalanges;
- Trabeculae in spongy substance (inside bone);
- Metacarpal (in the cyst) and metatarsal (in the foot) bones located in front of the phalanges.
Treatment
Treatment for vibration disease includes the whole complex measures depending on the severity of the pathological process. First, the patient needs to change his place of work to remove the factor causing the disease. It wouldn’t hurt to make sure that your new workplace doesn’t have:
- Loud noise;
- Cold;
- Excessive physical activity.
The course of therapy itself includes medications and physiotherapeutic methods to speed up the effect of treatment. Among the drugs that help the most are:
- Anti-inflammatory drugs, such as ibuprofen, are suitable to relieve pain;
- For cardiovascular syndrome (pain in the heart after physical and emotional overload), you need to take pills for the cardiovascular system, namely beta-blockers, papaverine, etc.;
- To eliminate the blockade of impulses going to the autonomic part of the nervous system, doctors advise taking amizil or pachycarpine;
- You can eliminate spasms in blood vessels and slow down the formation of blood clots using nicotinic acid and Cavinton;
- Cell nutrition (trophism) and metabolism in general can be improved with B vitamins, ascorbic acid and glutamic acid. This also includes preparations based on aloe extract and Riboxin;
- To eliminate the vegetative syndrome of a nervous system disorder, it is recommended to take drugs with a calming effect such as bromine, valerian, adaptol.
Treatment of vibration disease can be carried out using physical therapy methods, such as:
- Laser therapy;
- UHF (ultra high frequency energy) into the collar area ( top part back below the neck) 10-20 minutes 20 procedures;
- Various baths with a healing effect, for example, based on hydrogen sulfide or naftalan oil;
- Bernard currents (diadynamic currents);
- Electrophoresis on the hands, feet or collar area for 15 minutes with a power of 15 mA;
- Mud wrap;
- Physiotherapy;
- Acupuncture;
- Ultraviolet irradiation (UVR) in small doses;
- Therapeutic massage of the lower and upper limbs, as well as the back.
Preventive measures
In order not to look for ways to treat vibration disease, doctors advise following the rules of prevention:
- Properly organize your work and your working time;
- Comply with all hygiene standards;
- Observe the vibration level. It should not exceed permissible limits;
- When using special tools, it is necessary to take a 5-10 minute break at least once an hour and you are allowed to work with them no more than 60-70% of the working time;
- After work associated with constant shaking, self-massage and warm baths for hands and feet are necessary.
- It is recommended to undergo a course of professional therapeutic massage once a year;
- It is advisable to do the course at least 2 times a year ultraviolet irradiation in a hospital setting;
- Every year it is necessary to go for health purposes to the sea, to a sanatorium, forest, mountains and other recreational places;
- When hiring for a job that involves constant shaking, you need to know what its contraindications are, for example, polyneuropathy, Rhine syndrome, etc.;
- Must be done once a year full examination body with all the necessary tests to identify hidden pathological processes at the very beginning.
Vibration disease can be successfully treated in the early stages and leaves no consequences. If the course of therapy has not been completed and the pathology develops further, then it is no longer so easy to eradicate it, and it can leave its traces that will seriously harm a person’s health. In especially severe cases, people with this disease remain disabled, so when working with vibration you need to know what preventive measures exist.
Description:
Vibration disease is caused by long-term (at least 3-5 years) exposure to vibration in production conditions. Vibrations are divided into local (from hand tools) and general (from machines, equipment, moving machines). Exposure to vibration occurs in many professions.
Causes of vibration disease:
The main etiological factors are industrial vibration, associated occupational hazards: noise, cooling, static tension in the muscles of the shoulder, shoulder girdle, forced tilted body position, etc.
Symptoms of vibration disease:
The clinical picture is characterized by a combination of vegetative-vascular, sensory and trophic disorders. The most characteristic clinical syndromes: angiodystonic, angiospastic (Raynaud's syndrome), vegetosensory polyneuropathy. The disease develops slowly, after 5-15 years from the start of work associated with vibration, with continued work the disease increases, after cessation there is a slow (3-10 years), sometimes incomplete recovery. Conventionally, there are 3 degrees of the disease: initial manifestations (I degree), moderately expressed (II degree) and pronounced (III degree) manifestations. Typical complaints: pain, chilliness of the extremities, attacks of whitening or cyanosis of the fingers when cooling, decreased strength in the hands. As the disease increases, fatigue and sleep disturbances occur. When exposed to general vibration, complaints of pain and paresthesia in the legs, lower back, headache, etc. predominate.
Objective signs of the disease: hypothermia, hyperhidrosis and swelling of the hands, cyanosis or pallor of the fingers, attacks of “white” fingers that occur during cooling, less often during work. Vascular disorders manifest themselves in hypothermia of the hands and feet, spasm or atony of the capillaries of the nail bed, and a decrease in arterial blood flow to the hand. Can be . It is mandatory to increase the thresholds of vibration, pain, temperature, and less often tactile sensitivity. Sensory impairment is polyneuritic in nature. As the disease progresses, segmental hypalgesia and hypalgesia on the legs are revealed. There is soreness in the muscles of the limbs, thickening or flabbiness of certain areas.
X-rays of the hands often reveal racemose lucencies, small islands of compaction or. With long-term (15-25 years) exposure to general vibration, degenerative-dystrophic changes are often detected lumbar region spine, complicated forms of lumbar.
Characteristics of the main syndromes of vibration disease. Peripheral angiodystonic syndrome (I degree); complaints of pain and paresthesia in the hands, chilliness of the fingers. Mildly expressed hypothermia, cyanosis and hyperhidrosis of the hands, spasms and atony of the capillaries of the nail bed, a moderate increase in the thresholds of vibration and pain sensitivity, a decrease in the skin temperature of the hands, and a slow recovery after a cold test. Strength and endurance of muscles are not changed.
Peripheral angiospastic syndrome (Raynaud's syndrome) (I, II degree) is pathognomonic for exposure to vibration. I'm worried about bouts of whitening of the fingers and paresthesia. As the disease worsens, the command extends to the fingers of both hands. The clinical picture outside of attacks of whitening of the fingers is close to cangiodystonic syndrome. Capillary spasm predominates.
The syndrome of vegetosensory polyneuropathy (II degree) is characterized by diffuse pain and paresthesia in the arms, less often in the legs, and a decrease in pain sensitivity of the polyneuritic type. Vibration, temperature, tactile sensitivity is reduced. Reduced muscle strength and endurance. As the disease increases, vegetative-vascular and sensory disorders are also detected on the legs. Attacks of whitening of the fingers become more frequent and lengthen in time. Dystrophic disorders develop in the muscles of the arms and shoulder girdle (myopathosis). The structure of the EMG changes, the speed of excitation along the motor fibers ulnar nerve. Asthenia and vasomotor headache are often detected. Vibration disease of the third degree is rare, the leading one being the syndrome of sensorimotor polyneuropathy. Usually it is combined with generalized vegetative-vascular and trophic disorders, expressed by cerebrovascular disease.
Vibration disease should be differentiated from Raynaud's syndrome of a different etiology, polyneuropathies (alcoholic, diabetic, medicinal, etc.), vertebrogenic pathology nervous system.
Treatment of vibration disease:
Temporary or permanent cessation of contact with vibration. An effective combination of medication, physiotherapy and reflex treatment. Ganglioblockers are shown - halidor, bupatol, vasodilators- nicotinic acid preparations, sympatholytics, drugs that improve trophism and the microcirculation system: ATP, phosphaden, complamin, trental, chimes, injections of B vitamins, injections of gumisol. Chamber galvanic baths with emulsion are effective Naftalan oil, electrophoresis of novocaine, papain or heparin on the hand, diathermy, UHF or UV radiation on the cervical area sympathetic nodes, diadynamic currents, ultrasound with hydrocortisone, massage, exercise therapy. Shown hyperbaric oxygen therapy: Resort factors are widely used: mineral water(radon, hydrogen sulfide, iodine-bromine, nitrogen thermal), therapeutic mud.
The ability to work of patients with vibration disease of the first degree remains intact for a long time; Preventive treatment is recommended once a year with temporary transfer(for 1-2 months) for work without exposure to vibration. Patients with vibration disease II and especially III degree must be transferred to work without vibration, cooling and overexertion of the hands; they are prescribed repeat courses treatment. At stage II, patients remain able to work in a wide range of professions. At grade III, the professional and general working capacity of patients is persistently reduced.
Prevention consists in the use of so-called vibration-proof tools, compliance optimal modes labor. During shift breaks, self-massage and hand heating (dry air heat baths) are recommended. Courses shown preventive treatment(1-2 times a year).
