【作者】 吴家兵；

【导师】 杨磊；

【作者基本信息】 华中科技大学 ， 劳动卫生与环境卫生， 2013， 博士

【摘要】 目的肌肉骨骼疾患(Musculoskeletal Disorders,MSDs)在许多工业发达国家是一个主要的健康问题和经济负担。在美国,职业相关疾病的费用大部分是由职业性MSDs所引起的,最近的评估表明因MSDs支出的费用约为130—540亿美元/年。汽车制造业中存在快节奏和高度重复的体力工作、费力的手工操作、非中性的姿势(包括动态或静态)、机械压力、局部或全身振动等职业特征,而这些特征多数是MSDs的危险因素。2009年以来,中国已成为汽车生产量最多的国家,然而汽车生产的自动化程度和工效学环境远不如发达国家,我国的汽车工人可能接触更为严重的MSDs危险因素。以往在汽车行业已开展MSDs流行病学研究,但调查或分析的因素较少,难以对职业危害因素的接触情况进行较为全面的了解,也不易对各因素的危害程度进行比较。本次研究的目的是在前面研究的基础上,较为全面地描述汽车生产工人MSDs危险因素的接触情况,同时调查汽车制造企业不同人群MSDs的患病率,并在此基础上对危险因素进行分析,为企业采取健康干预措施提供依据。方法通过横断面调查的方法,对某汽车制造企业3家工厂的工人进行了随机抽样调查,共调查1566人。调查问卷是根据荷兰肌肉骨骼疾患调查表(DMQ)和北欧肌肉骨骼疾患调查表(NMQ)结合实际工作经验编制而成。统计分析：1、先计算不同部位MSDs总的患病率,再计算不同人群MSDs的患病率,不同人群患病率之间的比较用卡方检验；2、利用单因素logistic回归分析计算粗OR值,将有统计学意义的个体因素作为混杂因素,利用logistic进一步计算调整OR值；3、对以往研究较少的膝部及患病率最高的腰、颈部建立多因素logistic回归模型。结果(1)MSDs以腰、颈患病率最高,年患病率分别为66.5%和57.4%；(2)利用logistic回归分析,控制混杂因素后,计算出各因素调整OR值,发现：搬举很重的物体(大于20kg)对颈、腰、膝均具有影响,OR值分别为1.4,1.7和1.4；长时间站立工作颈、腰、膝MSDs的OR值分别为1.5、2.1、1.6。蹲或跪只在很频繁时才对膝MSDs有影响；人员短缺使颈、腰、膝MSDs患病风险上升到1.8倍、1.5倍和1.6倍,而工间休息则使颈、腰、膝的MSDs的患病风险分别下降到90%、80%和60%；颈部和膝部MSDs的患病率在工种间的差异无统计学意义,仅在腰部MSDs的分析中发现电焊工、机加工患病率明显高于维修工；每分钟多次重复动作对颈、腰、膝的OR值分别为1.6、2.1、1.5；工作场所没有足够的空间使颈、腰、膝MSDs的患病风险上升到1.6倍、1.8倍和1.7倍。(3)对腰部MSDs建立多因素Logistic回归模型,结果表明,性别、年龄、工龄、颈前倾、手保持在肩部或肩部以下水平、以不舒服的姿势工作、长时间蹲着工作、以不舒服的体位搬举重物、躯干重复动作、每分钟做多次重复动作、有时脚底打滑或跌倒、驾驶车辆、在同一车间工作是主要的危险因素；而休息时间充足则是腰部MSDs的保护因素。(4)对颈部MSDs建立多因素Logistic回归模型,结果表明：性别、年龄、工龄、吸烟、长时间走动工作、颈前倾、颈扭转、以不舒服姿势工作、以不舒服体位搬举重物、寒冷、驾驶车辆、经常替班是颈部MSDs的主要危险因素。(5)对膝部MSDs建立多因素Logistic回归模型,结果表明：年龄、工龄、以不舒服姿势工作、长时间站立、用一只手搬举重物、有时脚底打滑或跌倒、寒冷、每天做同样的工作、每周工作时间是主要的危险因素。结论(1)搬举很重的物体(大于20kg)对颈、腰、膝均具有影响,但对腰部的影响最大；而搬举重物(大于5kg)则仅对腰有影响,对颈、膝部的影响不明显；(2)长时间站立工作增加颈、腰、膝MSDs患病风险,而蹲或跪只在很频繁时才对膝MSDs有影响；(3)劳动组织对MSDs的发生具有重要影响,工厂可通过适当增加人员数量和工间休息时间,降低MSDs患病率；(4)重复性动作、每天做同样的工作均使MSDs患病风险上升。(5)工作环境工效学因素复杂、众多,对颈、腰、膝均具有影响,应予以足够的重视。更多还原

【Abstract】 Background In many developed countries, MSDs are a major problem of occupational health and an economic burden. MSDs account for a main component of the cost of work-related diseases in the United States. Recent evaluation of the cost related to MSDs varied from$13to$54billion annually. Some features of automobile manufacturing are just the risk factors of MSDs, such as rapid work pace and repetitive movement, forceful exertions, non-neutral postures (either dynamic or static), mechanical pressure, vibration; Since2009, China has been the largest automobile manufacturing country in the world. However, the automation degree and ergonomic conditions of auto industry in the country were far lower than in developed countries. The automobile manufacturing workers of China may suffer from more unreasonable working conditions. Previous studies conducted among automobile industry workers, due to cover less potential risk factors of MSDs, could not illustrate to the point the overall effect of occupational risk factors to MSDs, and therefore the comparison of the risk factors was limited. This study was aimed to examine the prevalence of MSDs and its potential risk factors among Chinese automobile industry workers, and provide the basis of intervention measures for the disorders.Method A total of1566automobile industry workers as subjects were investigated in a cross-sectional study. The questionnaire was developed according to the Dutch Musculoskeletal Questionnaire (DMQ) and the Nordic Musculoskeletal Questionnaire (NMQ). Data analysis:The prevalence of MSDs was calculated for each group classified by individual factors. Differences of prevalence between these groups were determined using chi-square tests. Univariate logistic regressions were used to estimate the crude odds ratios (ORs) of each potential risk factor. The individual factors with statistical significance were taken into account as potential confounders to estimate the adjusted ORs in each multivariate logistic regression model. Finally, multivariate logistic regression models were developed for MSDs of low back, neck and knee.Results (1) The MSDs occurred primarily in low back and neck, with annual prevalence of66.5%and57.4%, respectively.(2) The adjusted ORs of risk factors were calculated using logistic regression analysis. The main findings were as follows: lifting heavy loads(more than5kg) had positive impact on MSDs of neck, low back and knee, with ORs1.4,1.7and1.4respectively; prolonged standing increased the risk of MSDs in neck, low back and knee(OR:1.5,2.1, and1.6, respectively), whereas only the "always" category of squatting or kneeling can impose an significant effect on MSDs of knee; personnel shortage had a positive association with MSDs of neck, low back and knee(OR:1.8,1.5and1.6, respectively), while breaks at work decrease the risks to90%,80%and60%for MSDs of neck, low back and knee separately. Job title had no significant association with MSDs of neck and knee, but the prevalence of MSDs for low back significantly higher among welder and machining workers than maintainers; repetitive movement per minute also significantly associated with MSDs in neck, low back, and knee(OR:1.6,2.1and1.5, respectively); Having no enough room increase the risk of MSDs in neck, low back, and knee(OR:1.6,1.8and1.7, respectively).(3) Multivariate logistic regression models showed that the main risk factors for MSDs of low back were gender, age, neck in a bent forward posture for long periods, holding the hands at or under shoulder level, working in uncomfortable postures, prolonged squatting, lifting with uncomfortable position, repetitive movement of trunk, repetitive movement per minutes, Slipping or falling during work, driving, working in the same workshop, while the protective was having sufficient normal breaks.(4) Multivariate logistic regression models showed that the main risk factors for neck MSDs were gender, age, years of service, smoking, prolonged walking, neck in a bent forward posture for long periods, neck twisted for long periods, working in uncomfortable postures, lifting in uncomfortable position, coldness, driving, having to replace colleagues often.(5) Multivariate logistic regression models showed that the main risk factors for knee MSDs were age, years of service, working in uncomfortable postures, prolonged standing, lifting with single hand, Slipping or falling during work, coldness, carrying out the same work almost every day, working hours per week. Conclusions (1) Lifting very heavy loads(more than20kg) had a closer relationship with MSDs of low back than with that of neck or knee, while lifting relatively light loads(more than5kg) had no significant impact on neck and knee.(2) prolonged standing increased the risk of MSDs of neck, low back and knee, while only the "always" category for squatting and kneeling imposed a significant influence on knee.(3) Work organization had an important impact on the occurrence of MSDs; adding personnel and increasing breaks at work should be considered to decrease the prevalence of MSDs.(4)repetitive movements, carrying the same task every day significantly increase the risk of MSDs.(5) Ergonomic environmental factors have important influences on MSDs, and more attention should be imposed on it.更多还原