中国医疗行业工作相关肌肉骨骼疾患发生模式及其影响因素分析

Incidence patterns and risk factors of work-related musculoskeletal disorders in medical industry in China

目的调查中国医疗行业工作相关肌肉骨骼疾患(work-related musculoskeletal disorders,WMSDs)发生情况,探究不同岗位不良工效学职业危害因素及WMSDs发生模式。方法通过《北欧肌肉骨骼疾患问卷(修改版)》电子问卷系统对中国6854名医疗行业从业人员进行横断面调查。根据美国国家职业安全卫生研究所(National Institute for Occupational Safety and Health,NIOSH)判定WMSDs方法进行发生结果统计分析。应用潜类别分析(latent class analysis,LCA)对主要工种WMSDs多部位发生模式进行分析,利用logistic回归分析法确定不良工效学因素。结果调查样本中,不计部位的总体WMSDs发生率为56.1%。其中,医生为54.15%、护士为58.66%、护工为51.04%、技师为54.05%、药师为48.48%。根据LCA分类结果,医生与护士WMSDs发生模式主要有颈肩型和躯干型;技师主要为颈肩型;药师为颈肩型;护工主要为颈肩型和轻微疼痛型。多因素logistic回归分析结果显示,颈肩型医生发生危险主要来自手腕长期弯曲(OR=1.383,P=0.036),频繁坐位工作(OR=2.110,P=0.020),工作姿势经常不舒服(OR=2.023,P=0.001);躯干型医生发生危险主要有腿部姿势受限(OR=1.413,P=0.044),频繁不舒适工作姿势(OR=4.402,P<0.001);颈肩型护士发生危险主要来自颈部大幅度前倾(OR=2.218,P=0.024),长时间频繁坐位工作(OR=1.533,P=0.006);躯干型护士发生危险有长时间频繁坐位工作(OR=1.883,P<0.001),频繁不舒适工作姿势(OR=2.137,P<0.001)。结论中国医疗行业WMSDs发生率同世界主流国家地区相比处于中等水平。但行业总体不良工效学危害水平较高,不良作业姿势普遍存在。其中颈部、肩部、上背部、下背部的工效学负荷水平较高,主要与颈部工作中长时间保持不变、长时间低头、颈部大幅度前倾、手腕长期弯曲、长时间保持转身、腿部空间受限、长时间坐姿、作业姿势不舒服等职业因素有关。应通过加强宣教培训、增加辅助助力设施、改善工作组织模式等方式,降低肌肉骨骼损伤危险。

Objective This study aimed to investigate the prevalence of work-related musculoskeletal disorders(WMSDs)in China's medical industry and explore the occupational hazard factors of adverse ergonomics and the incidence pattern of WMSDs in different jobs.Methods A cross-sectional survey of 6854 employees from the medical industry in China was conducted.Statistical analysis of disease results was carried out according to the American NIOSH method.Latent class analysis(LCA)was used to analyze the multi-site incidence patterns of WMSDs in major jobs,and logistic regression was used to determine the adverse ergonomic factors.Results The overall prevalence of WMSDs was 56.1%,of which 54.15%were doctors,58.66%were nurses,51.04%were nurses,54.05%were technicians,and 48.48%were pharmacists.According to LCA results,the main incidence modes of WMSDs in doctors and nurses were torso type and neck-shoulder type;Technicians and pharmacists were neck-shoulder types;Nursing workers were mild pain type and neck-shoulder type.Multivariate logistic regression results showed that the risk of neck-shoulder typed doctors mainly came from long-term wrist bending(OR=1.383,P=0.036),and frequent sitting(OR=2.110,P=0.020),and frequent uncomfortable working posture(OR=2.023,P=0.001).The main risks of torso typed doctors were limited leg posture(OR=1.413,P=0.044)and frequent uncomfortable working posture(OR=4.402,P<0.001).The risk of neck-shoulder typed nurses mainly came from neck tilt(OR=2.218,P=0.024)and long and frequent sitting work(OR=1.533,P=0.006).Torso typed nurses have the risk of frequent sitting positions for a long time(OR=1.883,P<0.001),and frequent uncomfortable working positions(OR=2.137,P<0.001).Conclusions Compared with mainstream countries and regions in the world,the prevalence of WMSDs in China's medical industry is at a moderate level.However,ergonomic hazards and awkward working posture in the industry are relatively high.Besides,the ergonomic level of the neck,shoulder,upper and lower back is higher,which is mainly related to occupational factors such as keeping neck posture unchanged and lowering the head for a long time during work;tilting the neck forward greatly;bending wrists,sitting,keeping turn-back frequently;limited leg space;and uncomfortable working posture.The risk of musculoskeletal injury should be reduced by strengthening education and training,increasing auxiliary assistance facilities and improving work organization mode.