上海市某医院护理人员肌肉骨骼疾患调查及其危险因素的分析

Prevalence of musculoskeletal disorders and associated risk factors of healthcare workers in a hospital of Shanghai

[目的]调查上海市某医院护理人员肌肉骨骼疾患(MSDs)的患病现状,探究患病的相关影响因素。[方法]采用横断面调查方法,应用中文版肌肉骨骼疾患调查表,于2016年1月对上海市某三级乙等医院全院护理人员进行问卷调查,调查内容包括:个体信息、各部位MSDs的患病情况及其严重程度及相关职业危险因素等,采用卡方检验、logistic回归以及敏感性分析识别MSDs患病的影响因素。[结果]共发放问卷464份,收集有效问卷423份,有效应答率91.2%。护理人群在过去一年肌肉骨骼疾患的患病率达91.4%,其中患病率最高为腰部(80.5%),其次为颈部(73.2%)、肩部(64.8%)。经logistic分析,颈部疼痛与长时间站立(OR=1.91,95%CI:1.23~2.95)、颈部不良姿势(OR=2.57,95%CI:1.38~4.77)、人员短缺(OR=1.73,95%CI:1.00~2.99)存在统计学关联,另外体力感觉累的人员更易出现颈部疼痛;腰部疼痛与搬抬患者(OR=2.15,95%CI:1.03~4.47)、人员短缺(OR=2.03,95%CI:1.14~3.62)存在统计学关联。体感累的错分比例超过3%时,体累感与腰痛的关联统计学意义消失;图形分析显示加班与搬动病人,以及用力与重复动作间有交互作用,但未呈现统计学意义。[结论]护理人群中肌肉骨骼疾患的患病率较高,其中腰部的患病率高于其他部位,可能的危险因素包括长时间站立、不良姿势、人员短缺以及搬抬患者等,亟需相应的政策和措施来降低护理人员肌肉骨骼疾患的患病率,提高护理人员的健康水平。

[Objective] To survey the prevalence of musculoskeletal disorders（MSDs） and identify associated risk factors in healthcare workers in a hospital of Shanghai. [Methods] A cross-sectional study was conducted using the Chinese Musculoskeletal Disorders Questionnaire in January 2016 in a tertiary grade 2 hospital in Shanghai. The questionnaire covered personal information, prevalence and severity of MSDs in various body parts, and related occupational risk factors. Chi-square test, logistic regression model, and sensitivity analysis were used to assess the factors affecting the prevalence of MSDs.[Results] A total of 464 questionnaires were distributed, and 423 valid questionnaires were returned with a valid response rate of 91.2%. The overall prevalence rate of MSDs in the selected healthcare workers was 91.4% over the past 12 months, and the highest MSDs prevalence rate was reported in low back（80.5%）, followed by neck（73.2%） and shoulder（64.8%）. After adjustedby selected confounders, the results of logistic regression analysis showed that long-time standing（OR=1.91, 95%CI： 1.23-2.95）, awkward neck postures（OR=2.57, 95%CI： 1.38-4.77）, staff shortage（OR=1.73, 95%CI： 1.00-2.99）, and being exhausted after work were significantly associated with neck pain, whereas moving patients（OR=2.15, 95%CI： 1.03-4.47） and staff shortage（OR=2.03, 95%CI： 1.14-3.62） were associated with low back pain. When the proportion of misclassification on self-reported physical exhaustion was over 3%, the statistical association between physical exhaustion and low back pain disappeared. Interactions between working overtime moving patient and between exertion repetitive operation were identified by graph analysis; however, those effects did not reach statistical significance. [Conclusion] A high prevalence of MSDs is identified in the healthcare workers in the selected hospital, especially in low back. Long-time standing, awkward postures, staff shortage, and moving patients are the possible risk factors. It urges multi-dimensional policies and solutions to control MSDs in healthcare workers and promote their health.