某车辆段职业性噪声聋检出情况的两个诊断标准一致性比较

A comparison of the consistency between two standards for detection on occupational noise-induced deafness in the train maintenance personnel

目的比较GBZ 49-2007《职业性噪声聋诊断标准》和GBZ 49-2014《职业性噪声聋的诊断》在实际运用中的优缺点。方法收集昆明铁路局车辆段2015年噪声从业人员职业健康检查中的208例听力检测结果。通过职业健康检查表和病史询问、耳部检查和纯音气导听阈测试收集受检者基本信息及听力损失情况。分别采用GBZ 49-2007和GBZ 49-2014进行职业性噪声聋的诊断及诊断分级,运用Kappa分析和符合率对两个标准的评价结果进行一致性检验。结果采用GBZ 49-2007对208例听力检测结果进行评价,高频听力损失检出率为12.02%;其中:观察对象13人检出率为6.25%;轻度噪声聋2人,中度噪声聋9人,重度噪声聋1人,职业性噪声聋诊断率为5.77%。采用GBZ 49-2014对208例听力检测结果进行评价,高频损失率为13.94%。诊断:轻度噪声聋6人,中度噪声聋9人,重度噪声聋1人,职业性噪声聋诊断率为7.69%。比较两个标准的听力损失情况,Kappa值为0.867符合率为95.67%。对208例听力检测结果的评价进行一致性检验,Kappa值为0.850,符合率为96.63%。对GBZ 49-2014中诊断听力异常的16例诊断病例用GBZ 49-2007评价,符合率为75%。结论这两个标准对听力检测结果的评价是一致的。GBZ 49-2014取消了"观察对象",但通过将4 000Hz听阈值纳入到诊断分级中,进行加权计算,其中一部分人能够诊断为轻度噪声聋。这一修订国标2014在诊断上更为科学合理,并保护劳动者的权益。但由于2014版标准中取消了"观察对象",对于部分出现高频听损且达到原标准"观察对象"的劳动者,尚需采取一定补救措施。

Objective To compare advantages and disadvantages in the practical application between《Diagnostic criteria of occupational noise-induced deafness》（GBZ 49-2007）and 《Diagnosis of occupational noise-induced deafness》（GBZ 49-2014）.Methods hearing test Results of 208 workers exposed to noise were collected from occupational health examination in Kunming Railway Bureau in 2015.Basic information was collected from the occupational health examination forms and medical history,hearing information was collected from ear examination and hearing test,using the national standard GB 2007 and 2014diagnosis and classification of occupational noise deafness diagnosis,The consistency of the Results of two standard＇s evaluation was tested by using Kappa analysis and consistency rate.Results Based on hearing test Results of the 208 worker by using GBZ 49-2007,the high frequency loss rate was 12.02%.13 observed object were detected,2cases wity slight hearing loss（6.25%）,9cases with moderate hearing loss,one person with severe hearing loss.The rate of occupational noise-induced deafness was 5.77%.Based on the hearing test Results of the 208 workers by using GBZ 49-2014,the high frequency loss rate was 13.94%,6cases with slight hearing loss,9cases with moderate hearing loss,one person with severe hearing loss.The rate of occupational noise-induced deafness was 7.69%.On hearing loss consistency test,Kappa value was 0.867 and the consistency rate was 95.67%.On consistency test of the evaluation of the hearing test Results fro 208 workers,Kappa value was 0.850,the consistency rate was96.63%.16 cases diagnosed with hearing loss by GBZ 49-2014 were tested by using GBZ 49-2007,and the consistency rate was 75%.Conclusions Good consistency of the Results of two standard＇s evaluation was found.Since GBZ 49-2014 cancels diagnosis of observed object,but includes 4000 Hz hearing threshold into diagnostic classification and combines weight,cases with slight hearing loss has increased.It showed that GBZ49-2014 standards for the occupational diagnosis of hearing loss is more scientific and reasonable in practice and more emphasis on the rights of workers.