| ?Objective?Since GBZ/T 237-2011 Standard was promulgated and implemented in 2011,few occupational COPD cases have been reported.Diagnostic doctors generally reflect that the diagnostic terms are too strict to be implemented.In recent years,the clinical research of chronic obstructive pulmonary disease(COPD)has made rapid progress.In order to fully understand the problems existing in the implementation of GBZ/T 237-2011,and to adapt the revision of the Standard to the clinical research progress and the clinical practice of occupational diseases,this research was carried out.?Methods?1.Literature retrieval: The latest research progress on COPD,occupational COPD and diagnostic criteria at home and abroad was systematically retrieved by using professional literature retrieval tools at home and abroad,and the related literature was analyzed and summarized.2.case analysis: 5 years after the implementation of the standard,the cases diagnosed by the occupational disease diagnostic agencies in China were collected and analyzed retrospectively.3.Delphi Expert Survey: Delphi Expert Survey was conducted by questionnaire survey method.After the demonstration of senior experts,the evaluation system of Standard was established and the rationality of indicators at all levels was established.A questionnaire survey was conducted among representative occupational disease experts from hospitals of different regions and levels in China.The rationality and scientificity of the selection of comprehensive indicators are evaluated by the number of Delphi expert consultation,the number,representativeness,enthusiasm,authority and consensus of opinions.4.AHP method: On the basis of Delphi expert consultation,based on the improved analytic hierarchy process(AHP),the weights of the evaluation index system and the first-level and second-level indicators of the Standard are determined,which reduces the subjective and random components in the traditional process of determining the weights,and makes the evaluation results of Delphi expert consultation objective and fair,and has high credibility.?Results?1.The second-level evaluation system of the Standard is constructed from six aspects: scope of application,diagnostic principle,diagnostic index,treatment principle,diagnostic classification and appendix A.The structure of the index system is 6-27.2.The weight values of the six aspects are 0.21,0.26,0.18,0.18,0.11 and 0.06 respectively.The consistency test results are: l = 6.45,CI = 0.09,CR = 0.07.3.Two rounds of Delphi expert consultation were conducted.The recovery rates of the first and second rounds of consultation questionnaires were 100%.Experts authority on six aspects respectively is 0.85,0.85,0.85,0.84,0.80 and 0.82.4.The first round Delphi expert consultation results: experts agreed on six first-level indicators: scope of application,diagnostic principles,diagnostic indicators,treatment principles,diagnostic classification,appendix A;disagreement of secondary indicators mainly concentrated in the scope of application,diagnostic indicators;in the scope of application,secondary indicators A1,A3 mean less than 7,coefficient of variation greater than 0.25,A2 mean 7.47(greater than 7),The variance coefficient is 0.16(less than 0.25);the mean of the secondary indicators C1,C5,C10,C13 and C14 in the diagnostic indicators is greater than 7,the coefficient of variation is less than 0.25,and the mean of other secondary indicators is less than 7 or the coefficient of variation is greater than 0.25.The second round of Delphi expert survey was conducted on the indicators of inconsistent expert opinions in diagnostic indicators.The results of the second round of investigation: the average of secondary indicators A1 is 3.35(less than 7),the coefficient of variation is 0.23(less than 0.25).Experts agree that the average of secondary indicators in diagnostic indicators C1,C3,C4,C5,C8 and C9 is more than 7,the coefficient of variation is less than 0.25,the average of C2 and C7 is less than 7,the coefficient of variation is less than 0.25,the average of C6 is 1.78(less than 7),and the coefficient of variation is greater than 7.The score was 0.55(greater than 0.25),of which 14(61%)were experts with a score of 1 and 9(39%)were experts with a score of 3.?Conclusions?Based on the comprehensive analysis of literature,case analysis and expert survey opinions,the main amendments to the criteria for the diagnosis of chronic obstructive pulmonary disease caused by occupational irritant chemicals(GBZ/T 237-2011)were proposed.1.According to experts opinions and literature at home and abroad,there are many kinds of irritant gases causing respiratory diseases,and the application scope of the standard should be expanded.2.According to expert opinions and literature analysis,smoking is an important risk factor for COPD.The smoking interference factors should be fully considered in the diagnosis of occupational COPD,but smoking history should not be considered as the only negative factor.The weight of occupational irritant gas exposure and smoking volume should be comprehensively analyzed.3.Based on the clinical experience and literature of experts,the long-term history of high-risk occupational exposure to irritant chemicals is determined.The cumulative length of service can be appropriately shortened compared with the previous five years.Specific indicators need to be further explored. |
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