噪声与甲苯、二甲苯联合暴露作业人员听力损失特征及其影响因素

Characteristics and influencing factors of hearing loss caused by combined exposure to noise with toluene and xylene

目的 探索噪声与甲苯、二甲苯联合暴露导致的作业人员听力损失特征及其影响因素,为制定有针对性的防控策略与措施提供科学依据。方法 选择石油加工业、化学制品制造业、印刷业各1家大型企业,将2020—2021年作业人员分为噪声与甲苯、二甲苯联合暴露组(以下简称“联合暴露组”)和单纯噪声暴露组(以下简称“噪声组”);两组均开展职业健康体检、问卷调查及作业岗位甲苯、二甲苯及噪声危害因素检测,共计纳入研究对象1 144名。使用EpiData 3.1软件录入问卷,使用R 3.6.1软件包进行χ~2检验、t检验,Logistic回归分析研究对象听力损失特征和影响因素。结果 1 144名研究对象中,检出高频听力损失236人,听力损失总检出率为20.63%,联合暴露组高频听力损失率高于噪声组(P<0.05),高频听力损失者接噪工龄[(10.87±6.32)年]短于噪声组[(13.16±8.42)年](P<0.05)。现场监测显示,联合暴露岗位噪声声级水平和甲苯、二甲苯浓度水平均未超过国家职业接触限值。多因素Logistic回归分析显示,工龄、吸烟、经常使用耳机、高血压、高血糖、高胆固醇血症、低密度脂蛋白胆固醇浓度升高以及甲苯、二甲苯暴露为噪声作业人员高频听力损失的危险因素(P<0.05),文化程度高、A和AB血型(较O型)、高密度脂蛋白胆固醇浓度升高为噪声作业人员高频听力损害的保护因素(P<0.05)。结论 噪声作业人员高频听力损失是多种影响因素共同作用的结果,在制定相应防控措施和工作场所职业病危害因素接触限值时应考虑此类因素的协同作用。

Objective To explore the characteristics and influencing factors of hearing loss in workers caused by combined occupational exposure to noise with toluene and xylene, thereby provide scientific basis for formulating targeted prevention and control strategies and measures.Methods A total of 1 144 workers from petroleum processing industry, chemical product manufacturing industry and printing industry were selected as survey subjects, who were divided into two groups: one was exposed to noise, toluene and xylene simultaneously(combined exposed group), the other was exposed to noise only(noise exposure group), both groups carried out occupational health examination, questionnaire survey and related hazards detection such as toluene, xylene and noise hazard factors in operation posts. The softwares EpiData 3.1 and R 3.6.1 were used for data logging, chi-square test and t-test, respectively;and the Logistic regression was used as well for multi-factor analysis on analysis of the characteristics and influencing factors of hearing loss.Results The results suggested that 236 workers were found high frequency hearing loss among 1 144 subjects, the total detection rate of hearing loss was 20.63%, the high frequency hearing loss rate in combined exposure group was higher than that of noise exposed group(P<0.05), and the length of noise exposure in workers with high frequency(10.87±6.32 years) was shorter than that of the workers only exposed to noise(13.16±8.42 years).The on-site monitoring showed that both noise exposure levels(dB) and the exposed levels of toluene and xylene(mg/m~3) in combined exposure posts were all did not exceed the national occupational exposure limit recommended by GBZ 2.1. In addition, that working age, smoking, frequency of earphone using, hypertension, hyperglycemia, hypercholesteremia, LDL-C and exposure to toluene or xylene were the risk factors of high frequency hearing loss(P<0.05), while the education level, type A and AB blood groups(compared to type O), and HDL-C were the protective factors for high-frequency hearing impairment(P<0.05).Conclusion The results suggested that high-frequency hearing loss was the results multiple influencing factors, the synergy of these factors should be taken into account when formulating corresponding prevention and control measures and occupational exposure limits of these hazards in workplace.