职业性中暑是在高温作业环境下,由于热平衡和(或)水盐代谢紊乱而引起的以中枢神经系统和(或)心血管障碍为主要表现的急性疾病。
1 范围
本标准规定了职业性中暑的诊断标准和处理原则。
本标准适用于从事生产劳动(工厂、矿山、农场及其他露天作业等)、体育竞赛时所发生的中暑的诊断和处理。非职业性中暑也可参照执行。
2 规范性引用文件
下列文件中的条款通过本标准的引用而成为本标准的条款。凡是注日期的引用文件,其随后所有的修改单(不包括勘误的内容)或修订版均不适用于本标准,然而,鼓励根据本标准达成协议的各方研究是否可使用这些文件的最新版本。凡是不注日期的引用文件,其最新版本适用于本标准。
GB/T16180 职工工伤与职业病致残程度鉴定
3 诊断原则
根据高温作业人员的职业史(主要指工作时的气象条件)及体温升高、肌痉挛或晕厥等主要临床表现,排除其他类似的疾病,可诊断为职业性中暑。
4 中暑先兆
中暑先兆(观察对象)是指在高温作业场所劳动一定时间后,出现头昏、头痛、口渴、多汗、全身疲乏、心悸、注意力不集中、动作不协调等症状,体温正常或略有升高。
5 诊断及分级标准
5.1 轻症中暑
轻症中暑除中暑先兆的症状加重外,出现面色潮红、大量出汗、脉搏快速等表现,体温升高至38.5℃以上。
5.2 重症中暑
重症中暑可分为热射病、热痉挛和热衰竭三型,也可出现混合型。
5.2.1 热射病
热射病(包括日射病)亦称中暑性高热,其特点是在高温环境中突然发病,体温高达40℃以上,疾病早期大量出汗,继之"无汗",可伴有皮肤干热及不同程度的意识障碍等。
5.2.2 热痉挛
热痉挛主要表现为明显的肌痉挛,伴有收缩痛。好发于活动较多的四肢肌肉及腹肌等,尤以腓肠肌为著。常呈对称性。时而发作,时而缓解。患者意识清,体温一般正常。
5.2.3 热衰竭
起病迅速,主要临床表现为头昏、头痛、多汗、口渴、恶心、呕吐,继而皮肤湿冷、血压下降、心律紊乱、轻度脱水,体温稍高或正常。
6 处理原则
6.1 治疗原则
6.1.1 中暑先兆:暂时脱离高温现场,并予以密切观察。
6.1.2 轻症中暑:迅速脱离高温现场,到通风阴凉处休息;给予含盐清凉饮料及对症处理。
6.1.3 重症中暑:迅速予以物理降温和(或)药物降温;纠正水与电解质紊乱;对症治疗。
6.2 其他处理
中暑患者经及时处理,一般可很快恢复,不必调离原作业。需劳动能力鉴定者按GB/T16180处理。
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