心理因素及物理负荷对职业性肌肉骨骼疾患的影响分析

The interactive effect of job task and psychosocial factors on work-related musculoskeletal disorders

目的探讨心理因素与物理负荷的交互作用及其对职业性肌肉骨骼疾患（WMSDs）的影响。方法选取653名来源于电子行业流水线作业、缝纫行业、制造行业的工人及行政管理人员作为调查对象。采用改良的北欧国家肌肉骨骼疾患标准调查表调查肌肉骨骼疾患情况，心理社会状况调查采用工作内容量表（JCQ），进行流行病学横断面调查，并应用快速暴露检查法（QEC）问卷对其进行工效学的物理负荷评价。结果不同暴露等级下，肩部、上背、下背、手，腕的肌肉骨骼疾患的年患病率的差异有统计学意义（P〈0．05或P〈0．01），同时暴露在高的物理和心理负荷时，工作人员各部位的年患病率明显高于暴露在其他等级时的肌肉骨骼疾患的患病率。调整工龄、年龄、性别后，用logistics回归分析结果表明，在肩部、上背、下背和手／腕部的WMSDs影响中可能存在物理负荷和心理负荷的交互作用（P〈0．05）。结论高物理负荷下，不良心理因素对工人WMSDs的发生造成的影响远大于工人处于低物理负荷工作时，实施工效学干预不仅要从过度负荷，不良姿势，静态负荷等物理因素方面进行干预来降低wMsD的发生。也要关注心理因素方面的干预。

Objective To investigate the interactive effect of job task and psychosocial factors on the outcomes of museuloskeletal disorders. Methods 653 workers from different type of manufacturing industries and administration office recruited in a cross-sectional epidemiological survey. The Quick Exposure Check （QEC） was applied to assess the ergonomic load of job task, Job Content Questionnaire （jCQ） for identifying psychological characteristics, and Nordic Standardized Questionnaire for investigating outcomes of WMSDs. Results The prevalence of WMSD in shoulder, upper back, lower back and hand/wrist were significantly different under a variety of combined job task and psychosocial characteristics （P〈0.05 or P〈0.01）. The more physical and psychological loads, the higher prevalence of WMSDs were revealed. By using multivariate analyses, a potential interactive effect was found in terms of the WMSDs symptoms in hand/wrist, shoulder, upper back and lower back after adjusted by work year, age, and gender. Conclusions Higher physical load and greater psychosocial risk are more frequent self-reported symptoms of WMSDs than those of lower exposures. Ergonomic intervention strategies aimed at reducing the incidence of WMSDs should not only be focused on control of physical work factors but also psychosocial risks of relevance.