RULA和PLIBEL对消化内镜护理操作不良工效学因素的识别与评估

Application of PLIBEL and RULA in the identification and assessment of adverse ergonomic factors in gastrointestinal endoscopy care operations

目的探讨消化内镜护士发生工作相关肌肉骨骼疾患(WMSDs)的工效学因素,为预防和控制WMSDs发生提供依据。方法采用瑞典工效学危害识别法(PLIBEL)分析消化内镜护理操作过程中的不良工效学因素,并使用快速上肢评估工具(RULA)进行接触评估。结果消化内镜护理操作RULA得分为2~7分,根据RULA划分标准,所对应的分数等级为1~4级,其中Ⅰ级操作1个、Ⅱ级操作14个、Ⅲ级操作5个、Ⅳ级操作1个。肩、颈和上背部及肘、前臂和手部两个区域存在较多的不良工效学因素,其次为下背部,所有操作均存在足部、膝和臀部无座和支撑的站姿作业这一不良工效学因素。结肠镜腹部加压及内镜下逆行胰胆管造影术(ERCP)插管、放置治疗器械、交换治疗器械、交换盘绕附件、注射造影剂等操作为Ⅲ级中风险;ERCP术后搬移病人为Ⅳ级高风险操作,易罹患WMSDs。结论消化内镜护理操作过程以肩、颈和上背部,肘、前臂和手部,下背部WMSDs风险较为突出;应重视对不良工效学因素的管理与控制,以预防消化内镜护士WMSDs的发生。

Objective To investigate the ergonomic factors of work-related musculoskeletal disorders(WMSDs)in gastrointestinal endoscopy nurses and to provide a basis for the prevention and control of WMSDs.Methods The adverse ergonomic factors during gastrointestinal endoscopy care operations were analyzed using the Swedish ergonomic hazard identification method(PLIBEL)and exposure assessment using the rapid upper limb assessment(RULA).Results The RULA scores for digestive endoscopy care operations ranged from 2—7,with the corresponding score scale being 1—4 according to the RULA classification criteria,with 1 operation in classⅠ,14 in classⅡ,5 in classⅢand 1 in classⅣ.There were more adverse ergonomics factors in 2 areas that are respectively the shoulder,neck,upper back,and the elbow,forearm and arm,followed by the lower back.All the operations had adverse ergonomics factors in the standing position with no seat and support for the feet,knees and hips.Colonoscopic abdominal compression,ERCP-related operations including intubation,placement of therapeutic devices,exchange of therapeutic instruments,injection of contrast agent were regarded as gradeⅢintermediate risk,and postoperative transfer of ERCP patients were regarded as gradeⅣhigh risk of WMSDs.Conclusion There were higher risk of WMSDs in the shoulder,neck,upper back,elbow,forearm,arm,and lower back in gastrointestinal endoscopic care operations;and more attention should be paid to the management and control of adverse ergonomic factors to prevent the occurrence of digestive endoscopic care associated WMSDs.