手持工件打磨作业致职业性手臂振动病流行病学调查  

Epidemiological investigation of occupational hand-arm vibration disease caused by handheld workpiece polishing

作　　者：潘思玉 严茂胜[2] 肖斌[2] 贾艳霞[3] 郑浛君 蒋雍建 林瀚生 王梅 PAN Siyu;YAN Maosheng;XIAO Bin;JIA Yanxia;ZHENG Hanjun;JIANG Yongjian;LIN Hansheng;WANG Mei(School of Public Health,Guangdong Pharmaceutical University,Guangzhou,Guangdong 510310,China;不详)

机构地区：[1]广东药科大学公共卫生学院,广东广州510310 [2]广东省职业病防治院,广东广州510300 [3]山西医科大学公共卫生学院,山西太原030001 [4]广州医科大学公共卫生学院,广东广州511436

出　　处：《中国职业医学》2024年第1期65-69,共5页China Occupational Medicine

基　　金：国家临床重点专科建设项目(2011-09);广东省医学科学技术研究基金(A2021485,A2022127);广州市科学技术局生物医药产业创新补助。

摘　　要：目的探讨手持工件打磨作业致职业性手臂振动病(OHAVD)的影响因素。方法采用方便抽样法,选择某运动器材生产企业的222例OHAVD患者(病例组)、275名手传振动作业工人(接触组)和同企业不从事手传振动作业的243名健康工人(对照组)为研究对象。对3组人群进行现场职业卫生调查,采用人体振动测量仪检测手传振动的接触水平,计算8 h等能量频率计权振动加速度[A(8)]和累积振动暴露水平(CVEL)。结果接触组和病例组人群手指发冷、麻木、刺痛和振动性白指的检出率均高于对照组(P值均<0.05);病例组人群上述手部症状检出率均高于接触组(P值均<0.05)。病例组人群A(8)和CVEL均高于接触组(P值均<0.05)。二分类logistic回归分析结果显示,年龄和CVEL均是OHAVD的影响因素(P值均<0.05)。限制性立方样条模型显示,接触手传振动人群CVEL水平与罹患OHAVD的风险存在正向非线性的剂量-反应关系(总趋势P<0.01,非线性P<0.01),随着CVEL的增加,罹患OHAVD的发病风险呈递增趋势。结论接触手传振动是OHAVD的危险因素;应及早对接触手传振动人群进行干预,降低振动接触水平,控制振动接触时间。Objective To explore the influencing factors of occupational hand-arm vibration disease(OHAVD)caused by handheld workpiece polishing.Methods A total of 222 OHAVD patients(case group),275 hand-transmitted vibrationexposed workers(exposed group)and 243 healthy workers without hand-transmitted vibration exposure(control group)in a sports equipment manufacturing enterprise were selected as the study subjects using the convenience sampling method.Worksite survey of occupational health was conducted on these three groups,and the human vibration measurement equipment was used to measure the vibration exposure level of handheld vibration among the study subjects.The 8-hour energy equivalent frequencyweighted vibrating acceleration[A(8)]and cumulative vibration exposure level(CVEL)were calculated.Results The prevalence of coldness,numbness,tingling fingers,and vibration-induced white finger was higher in the exposed group and the case group compared with the control group(all P<0.05).The prevalence of the above-mentioned hand symptoms was higher in the case group compared with the exposed group(all P<0.05).The A(8)and CVEL levels of the study subjects in the case group were higher than those in the exposed group(all P<0.05).Binary logistic analysis result showed that age and CVEL were both influencing factors of OHAVD(all P<0.05).According to the restricted cubic spline models,CVEL of the study subjects in the exposed group had a positive nonlinear dose-response relationship with the risk of OHAVD(overall trend P<0.01,nonlinear P<0.01),indicating an increasing risk of OHAVD with increasing CVEL.Conclusion Hand-transmitted vibration exposure is a risk factor for OHAVD.Early intervention should be carried out for hand-transmitted vibration-exposed individuals to reduce vibrationexposed levels and control vibration exposure time.

关 键 词：手臂振动病 手传振动 累积振动暴露水平 影响因素 剂量-反应关系 

分 类 号：R135.4[医药卫生—劳动卫生]