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

徐擎; 凌瑞杰; 刘移民; 张华东; 李刚; 王如刚; 刘吉祥; 曾强; 李天来; 贾宁; 王忠旭

doi:10.16462/j.cnki.zhjbkz.2022.08.004

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

doi: 10.16462/j.cnki.zhjbkz.2022.08.004

徐擎¹,
凌瑞杰²,
刘移民³,
张华东⁴,
李刚⁵,
王如刚⁶,
刘吉祥⁷,
曾强⁸,
李天来⁹,
贾宁¹,
王忠旭^1, ,

1.
100050 北京，中国疾病预防控制中心职业卫生与中毒控制所职业防护与工效学研究室
2.
430015 武汉，湖北省新华医院
3.
510420 广州，广州市第十二人民医院
4.
400042 重庆，重庆市疾病预防控制中心
5.
110005 沈阳，辽宁省卫生健康服务中心
6.
100013 北京，北京市疾病预防控制中心
7.
550004 贵阳，贵州省疾病预防控制中心
8.
300011 西安，天津市疾病预防控制中心
9.
710054 西安，陕西省疾病预防控制中心

基金项目:

中国疾病预防控制中心职业卫生所职业健康风险评估与国家职业卫生标准制定 131031109000160004

详细信息

通讯作者:
王忠旭，E-mail：wangzx@niohp.chinacdc.cn

中图分类号: R135
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出版历程
- 收稿日期: 2022-03-25
- 修回日期: 2022-06-25
- 网络出版日期: 2022-08-23
- 刊出日期: 2022-08-10

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

1.
National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing 100050, China
2.
Xinhua Hospital of Hubei Province, Wuhan 430015, China
3.
Guangzhou 12th People's Hospital, Guangzhou 510420, China
4.
Chongqing Center for Disease Control and Prevention, Chongqing 400042, China
5.
Liaoning Provincial Health Supervision Center, Shenyang 110005, China
6.
Beijing Center for Disease Control and Prevention, Beijing 100013, China
7.
Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China
8.
Tianjin Center for Disease Control and Prevention; Tianjin 300011, China
9.
Shaanxi Provincial Center for Disease Control and Prevention, Xi'an 710054, China

Funds:

The Project of Occupational Health Risk Assessment and National Occupational Health Standard Formulation of National Institute of Occupational Health and Poison Control 131031109000160004

More Information

Corresponding author: WANG Zhong-xu, E-mail: wangzx@niohp.chinacdc.cn

摘要

摘要: 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6 854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。
- 工作相关肌肉骨骼疾患 /
- 不良工效学因素 /
- 潜类别分析 /
- 发生率 /
- logistic回归分析法
Abstract: 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 6 854 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.
- Work-related musculoskeletal disorder /
- Adverse ergonomic factor /
- Latent category analysis /
- Prevalence /
- Logistic regression analysis

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图 1 医疗行业主要工种发生WMSDs发生模式类别概率和条件概率分布

注：条件概率为各部位发生WMSDs的概率，类别概率为人群分类占比。

Figure 1. Classification probability and conditional probability distribution of WMSDs incidence pattern of main jobs in medical industry

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1a 医疗行业主要工种各部位WMSDs发生情况

1a. WMSD prevalence of main jobs in medical industry by different body part

工种	任一部位		颈		肩		上背		下背
工种	例数(n)	发生率(%)	例数(n)	发生率(%)	例数(n)	发生率(%)	例数(n)	发生率(%)	例数(n)	发生率(%)
保洁工(n=59)	15 ^a	25.42	3 ^a	5.08	7 ^a	11.86	3 ^a	5.08	5 ^a	8.47
护工(n=384)	196 ^{b, c}	51.04	119 ^b	30.99	91 ^a	23.7	66 ^{a, b}	17.19	78 ^{a, b}	20.31
护士(n=4 057)	2 380 ^c	58.66	1 677 ^c	41.34	1 342 ^b	33.08	932 ^b	22.97	1 120 ^b	27.61
技师(n=111)	60 ^{b, c}	54.05	42 ^{b, c}	37.84	35 ^{a, b}	31.53	15 ^{a, b}	13.51	15 ^a	13.51
技术管理人员(n=330)	158 ^b	47.88	123 ^{b, c}	37.27	98 ^{a, b}	29.7	63 ^{a, b}	19.09	60 ^a	18.18
其他辅助工种(n=10)	4 ^{a, b, c}	40.00	1 ^{a, b, c}	10.00	3 ^{a, b}	30.00	-	-	-	-
药师(n=33)	16 ^{a, b, c}	48.48	12 ^{b, c}	36.36	9 ^{a, b}	27.27	8 ^{a, b}	24.24	5 ^{a, b}	15.15
医生(n=1 782)	965 ^b	54.15	772 ^c	43.32	639 ^b	35.86	403 ^b	22.62	429 ^{a, b}	24.07
χ²值	51.286		65.831		37.866		29.129		51.082
P值	< 0.001		< 0.001		< 0.001		< 0.001		< 0.001
注：^{a，b，c，d}代表不同工种间WMSDs发生率两两比较结果。字母相同代表此两组间的差异无统计学意义，字母不同代表此两组间的差异有统计学意义。

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1b 医疗行业主要工种各部位WMSDs发生情况

1b. WMSD prevalence of main jobs in medical industry by different body part

工种	肘		腕/手		腿		膝		足踝
工种	例数(n)	发生率(%)	例数(n)	发生率(%)	例数(n)	发生率(%)	例数(n)	发生率(%)	例数(n)	发生率(%)
保洁工(n=59)	1 ^a	1.69	2 ^{a, b}	3.39	3 ^{a, b, c, d}	5.08	3 ^{a, b}	5.08	1 ^{a, b}	1.69
护工(n=384)	18 ^a	4.69	29 ^b	7.55	57 ^{c, d}	14.84	46 ^{a, b}	11.98	63 ^{b, c}	16.41
护士(n=4 057)	281 ^a	6.93	465 ^{a, b}	11.46	832 ^{b, d}	20.51	632 ^b	15.58	781 ^c	19.25
技师(n=111)	6 ^a	5.41	15 ^{a, b}	13.51	11 ^{a, b, c, d}	9.91	9 ^{a, b}	8.11	10 ^{a, b, c}	9.01
技术管理人员(n=330)	21 ^a	6.36	28 ^{a, b}	8.48	22 ^a	6.67	24 ^a	7.27	20 ^a	6.06
其他辅助工种(n=10)	-	-	-	-	2 ^{a, b, c, d}	20.00	-	-	1 ^{a, b, c}	10.00
药师(n=33)	2 ^a	6.06	4 ^{a, b}	12.12	2 ^{a, b, c, d}	6.06	5 ^{a, b}	15.15	5 ^{a, b, c}	15.15
医生(n=1 782)	133 ^a	7.46	239 ^a	13.41	197 ^{a, c}	11.05	203 ^a	11.39	191 ^a	10.72
χ²值	6.533		20.680		128.003		41.877		116.864
P值	0.435		0.003		< 0.001		< 0.001		< 0.001
注：^{a，b，c，d}代表不同工种间WMSDs发生率两两比较结果。字母相同代表此两组间的差异无统计学意义，字母不同代表此两组间的差异有统计学意义。

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表 2 医疗行业发生WMSDs科室分布情况

Table 2. Distribution of WMSDs in different departments in medical industry

工种	LCA分组	科室分布
医生	躯干型(22.8%)	口腔科、医学影像科、内科、门诊、检验科、妇产科、其他^a、职业病科、外科、急诊
	下背型(7.8%)	ICU、神经内科、外科、职业病科、内科
	全身型(7.4%)	手术室、心血管内科、儿科、妇产科、外科、内科
	足踝型(5.1%)	外科
	颈肩型(48.4%)	中医科、神经外科、神经内科、康复医学科、内科、心血管内科、骨外科、职业病科、口腔科、泌尿外科、医学影像科、耳鼻喉科、外科、其他^a、检验科、门诊、药房、妇产科、综合科、急诊、消化内科、妇科、体检科、儿科
	手足躯干型(8.9%)	ICU、急诊、妇产科、职业病科、医学影像科、外科、内科
护士	全身型(9.6%)	儿科、ICU、临床护理、急诊、手术室、内科、其他^b、外科、门诊、妇产科、口腔科
	躯干型(26.6%)	老年病科、职业病科、消化内科、急诊、综合科、口腔科、妇产科、神经内科、临床护理、麻醉科、ICU、外科、骨外科、内科、门诊、儿科、其他^b、体检科、心血管内科、康复医学科、医学影像科、神经外科、手术室
	颈肩型(35.5%)	眼科、口腔科、麻醉科、综合科、耳鼻喉科、消化内科、门诊、心血管内科、医学影像科、体检科、康复医学科、急诊、内科、临床护理、手术室、其他^b、神经内科、妇产科、外科、儿科、ICU、骨外科、神经外科
	轻微疼痛型(22.9%)	神经外科、神经内科、心血管内科、骨外科、内科、外科、康复医学科、其他^b、妇产科、急诊、ICU、手术室、医学影像科、口腔科、临床护理、门诊、儿科、体检科
	下背型(5.3%)	手术室、神经内科、ICU、外科、妇产科、门诊、内科、其他^b、急诊
护工	轻微疼痛型(36.9%)	消毒中心、内科、妇科、消化内科、临床护理、神经内科
	全身型(12.3%)	外科
	颈肩型(50.8%)	手术室、神经内科、外科、妇科、消化内科、临床护理、妇产科、门诊、物业公司
技师	颈肩型(90%)	内科、检验科、其他^c
	手足躯干型(10%)	医学影像科^d
药师	颈肩型(100%)	药房
注：^a其他医生范围：办公室、高压氧科、公卫科、全科医疗、医技科、医务科、预防保健科、住院部；^b其他护士范围：传染科、导管室、感染科、贵宾部、办公室、核医学科、慢病科、配液中心、全科医疗科、社区护士、仪器组、医技科室、医务科、预防保健科、住院部、总检室；^c其他技师范围：中医科、医技科、住院部；^d表示该科室参与调查的WMSDs发生数小于5例；排除小于(含)5例各科室类别模型发生数。按该类型病例占科室人员比例由大到小排列。

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表 3 医生、护士WMSDs主要发生模式影响因素的多因素logistic回归分析(N=1 782)

Table 3. Multifactorial logistic regression analysis of factors influencing the main incidence patterns of WMSDs among doctors and nurses (N=1 782)

WMSDs影响因素	选项	β值	s_x	Wald χ²值	OR (95% CI)值	P值
医生-颈肩型(n=467)
工作中是否长时间保持低头姿势	否/是	-0.560	0.176	10.165	0.571(0.405~0.806)	0.001
手腕是否需要长期处于弯曲状态	否/是	0.324	0.154	4.415	1.383(1.022~1.870)	0.036
坐位工作	经常/从不	0.698	0.315	4.905	2.009(1.084~3.727)	0.027
	很频繁/从不	0.746	0.320	5.434	2.110(1.126~3.952)	0.020
工作时使用振动工具	有时/从不	-0.443	0.183	5.876	0.642(0.449~0.919)	0.015
以不舒服的姿势工作	有时/从不	0.437	0.194	5.078	1.549(1.059~2.266)	0.024
	经常/从不	0.705	0.221	10.155	2.023(1.312~3.121)	0.001
医生-躯干型(n=217)
手腕是否需要长期处于弯曲状态	否/是	-0.398	0.192	4.305	0.672(0.461~0.978)	0.038
工作中是否能伸展或改变腿部姿势	否/是	0.346	0.172	4.038	1.413(1.009~1.980)	0.044
站立工作	经常/从不	-0.587	0.278	4.446	0.556(0.322~0.960)	0.035
	很频繁/从不	-0.796	0.340	5.472	0.451(0.231~0.879)	0.019
以不舒服的姿势工作	有时/从不	0.581	0.259	5.043	1.787(1.077~2.966)	0.025
	经常/从不	1.098	0.289	14.470	2.998(1.703~5.278)	< 0.001
	很频繁/从不	1.482	0.326	20.675	4.402(2.324~8.339)	< 0.001
护士-颈肩型(n=840)
工作中的颈部姿势	大幅前倾/直立	0.797	0.353	5.085	2.218(1.110~4.434)	0.024
工作中颈部是否长时间保持同一姿势	否/是	-0.225	0.107	4.405	0.799(0.648~0.985)	0.036
工作中是否需要用手捏/紧抓一些物品/工具	否/是	-0.269	0.112	5.803	0.764(0.614~0.951)	0.016
坐位工作	很频繁/从不	0.427	0.155	7.579	1.533(1.131~2.077)	0.006
长时间蹲或跪姿工作	很频繁/从不	-0.54	0.219	6.069	0.583(0.379~0.895)	0.014
护士-躯干型(n=634)
工作中是否经常弯腰同时转身	否/是	-0.279	0.140	3.999	0.757(0.576~0.994)	0.046
工作中颈部是否长时间保持同一姿势	偶尔/从不	-0.529	0.170	9.702	0.589(0.422~0.822)	0.002
长时间站立工作	偶尔/从不	-0.660	0.257	6.593	0.517(0.312~0.855)	0.010
坐位工作	偶尔/从不	0.275	0.138	3.963	1.317(1.004~1.727)	0.046
	经常/从不	0.796	0.167	22.755	2.216(1.598~3.072)	< 0.001
	很频繁/从不	0.633	0.196	10.445	1.883(1.283~2.765)	0.001
以不舒服的姿势工作	经常/从不	0.500	0.180	7.753	1.649(1.160~2.345)	0.005
	很频繁/从不	0.759	0.215	12.429	2.137(1.401~3.260)	< 0.001
注：选项中“/”后为参考项。

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