用转换系数调整脉冲噪声所致高频听力损失剂量-反应关系的探索  

Adjustment of dose-response relationship of industrial impulse noise induced high frequency hearing loss with different exchange rate

作　　者：赵一鸣[1] 陈山松[2] 成小如[1] 李玉秦[2] 

机构地区：[1]北京大学第三医院临床流行病学研究中心,100083 [2]郑州市疾病预防控制中心

出　　处：《中华医学杂志》2006年第1期48-51,共4页National Medical Journal of China

基　　金：卫生部科研基金资助项目(98-1-270);中国科学院声学研究所声场声信息国家重点实验室客座课题基金资助项目;NIHFogarty资助项目(SA1873JB)

摘　　要：目的 用不同转换系数调整脉冲噪声所致工人高频听力损失剂量-反应关系曲线。方法 以32名接触脉冲噪声的机械制造工人和163名接触稳态噪声的纺织工人为观察对象，用个体计量仪采集工人8h工作期间的噪声暴露数据，计算8h等效声级（LAeq.8h），并按不同转换系数（ER）将LAeq.8h和噪声作业工龄合并为累积噪声暴露量（CNE）。用常规方法测量工人左右耳气导听阈，按GBZ49-2002对听阈作年龄性别校正，并诊断是否为高频听力损失。结果 用ER=3计算，脉冲噪声组的CNE[（103．2±4．2）dB（A）·年]明显低于稳态噪声组[110．6±6．0dB（A）·年]，P〈0．01。增大ER值，脉冲噪声组的CNE升高，当ER=5．5时脉冲噪声组的CNE与稳态噪声组的CNE（ER=3）相似[110．3dB（A）·年VS110．6dB（A）·年]。脉冲噪声噪声组高频听力损失患病率（68．8％）与稳态噪声组（65．0％）相似，P〉0．05。两组CNE与高频听力损失患病率间均存在典型的剂量-反应关系，均P〈0．01。用ER=3计算，脉冲噪声100～109dB（A）·年组的高频听力损失患病率（76．9％，90．9％）明显高于稳态噪声组（30．4％，50．0％，P〈0．05）；脉冲噪声组用ER=5．5计算CNE时，各组间高频听力损失患病率与稳态噪声组（ER=3）相比（0％VS11．1％．33．3％VS30．4％．70．0％vs50．0％，62．5％VS79．5％，100．0％VS90．4％）差异均无统计学意义（P〉0．05）。Logistic回归模型显示，ER=3时脉冲噪声组CNE与高频听力损失患病率的剂量-反应关系曲线与稳态噪声组相比出现曲线左移，斜率增大；增大ER值，脉冲噪声组曲线右移，斜率减小，当ER=6时脉冲噪声组的剂量-反应关系曲线与稳态噪声组（ER=3）的曲线基本重合。结论脉冲噪声所致高频听力损失的危害在能量相同的情况下大于稳态噪声。增大ER值可以使脉冲噪声组的剂量-反应关系曲�Objective To explore a new method to evaluate the dose-response relationship between the noise exposure and prevalence of noise induced high frequency hearing loss. Methods Physical examination and questionnaire survey were conducted among 32 mechanical workers, 12 males and 20 females, aged 35. 1±7.2, exposed to industrial impulse noise （ impulse noise group）, and 163 textile workers, 82 males and 81 females, aged 31.5 ± 8.7, exposed continuous noise （continuous noise group）. SH-126 dosimeter was used to measure the A weighted equal sound level in continuous eight working hours （LA,q.sh） SO as to evaluate the individual noise exposure. Cumulative noise exposure （CNE） was calculated with the values of LAeq.8h and noise working year adjusted by different exchange rates （ERs） for each worker. Hearing threshold was measured by audiometer with routine method and adjusted by age and gender according to GBZ49-2002. High frequency hearing, loss was diagnosed based on the GBZ49-2002 for each worker. Results According to the equal energy rule , with the ER = 3 the CNE of the impulse noise group was [ 103.2 dB （A）·year ± 4.2dB （A）·year] , significantly lower than that of the continuous noise group [ 110.6±6.0dB （A）· year, P 〈 0.05 ]. With the ER=5.5, the CNE of the impulse noise group was 110.3 ± 6.6 dB （A）· year, not significantly different from that of the continuous noise group [ 110.6 ± 6. OdB （A） · year]. The high frequency hearing loss prevalence of the impulse noise group was 68.8% ,not significantly different that of the continuous noise group （65%, P 〉 0. 05 ）. Trend chi square test showed significant differences in the relationship between CNE and hearing loss prevalence among the impulse noise group with the ER = 3, the impulse noise group with the ER = 5.5, and continuous noise group （ all P 〈 0.01 ）. With the ER = 3, the high frequency hearing loss prevalence of the impulse noise group with the CNE of 100-104 dB （A）· year was 76.9% , signifi

关 键 词：听觉丧失 噪声性 听觉丧失 高频 听觉障碍 噪声 职业性 

分 类 号：R764[医药卫生—耳鼻咽喉科]