Y HOC Vl|T NAM THANG 9 - SO 2/2014
i r a C TINH GANH NANG BENH TAT VA THIET HAI KINH TE DO TAI NAN LAO D 6 N G TAI MOT CONG TRINH XAY DITNG
Nguyen Bich Diep*
S U M M A R Y
E S T I M A T I N G BURDEN OF DISEASE A N D E C O N O M I C LOSSES DUE TO OCCUPATIONAL I N J U R I E S I N CONSTRUCTION WORKERS A retrospective study was conducted on reconds of 95 occupational injuries happened among 2763 workers. The burden of disease and economic losses due to occupational and injuries were estimated by using DALY and cost analysis methods, respectively.
The results showed that among 95 occupational accidents, there were 71 mild cases (74.7%), 19 senous cases (20%) and 5 deaths (5.3%). The rate of occupational injury was 34.4 /1,000 workers, in whidi the fatal occupational injuries and non-fatai occupational injuries were 1.8 and 32.6/1,000 workers, respectively. Total inpatient and outpatient treatment days were 144 and 837 days, respectively, in which 2 1 % of inpatient treatment were less than 7 days and 67.8% of outpatient treatment were less than 3 days.
Total number of days off work and receiving salary was 975 days, in which majority were 3-7 days (74.4%). The average number of days losing work capacity was 10.8 days/worker. Total number of year's life lost in 95 injured workers was 150.3 DALY (or 158 DALY/100 workers), in which the burden of fatal occupational injuries was 148.9 DALY (constituted for 99.1% of totel DALY). The burden of occupational injuries was highest in workers under 30 years old (70.4% of total DALY) and in mine explosion workers (70% of total DALY). The estimated economic losses (direct costs) per year in construction workers were 937.633 million Vietnamese dong, in whidi economic losses in operators were the highest (442.307 million Vietnamese dong and accounted for 47.2% in total)
The findings of this study indicated the needs for continuing a study on occupational safety and healHi conditions, risk factors of occupational accidents and injuries as well as effective preventive measures in order to reduce burden of diseases and economic losses for employees, employers and society
Keywords: DALY, Construction Workers, Occupational Injuries
I. OAT V A N OE
Theo danh gia cua To chtTc lao dpng qudc \&.
(ILO), nganh xay dytig la mpt trong nhihig nganh cong nghiep dpc hai nhat cung vdi nganh nong nghiep va m d d ca cac nu'dc phat t r i ^ va dang phat trien. Trong nganh xay difng cd it nhSt T O M TAT
95 tri/dng hop tai nan lao dgng xay ra trong mot n3m trong tong so 2763 cong nhan lam viec t?i mot cong trinh xSy di/ng dUOc hoi ciiu. Chi so DAILY v^a cac phirong phap phan tfch chi phi du'dc ap dung d^ Udc tfnh ganh n^ng b^nh tat va cac ton that kinh te do tai nan lao dpng va chan thu'dng nghe nghiep gay ra.
K§t qua nghien cdU cho thay trong 95 trudng hdp tai nan lao dpng (TNLD) co 71 tru'dng hop nhe chigm 74,7%, 19 biidng hdp n|ng (chi&n 20%) va 5 tri/dng hpp iM tijf vong (chiem 5,3%). Ty le TNLD d cdng nhan xay dutig \h 34,4 /1,000 cong nhan, bong do ti" 1? tai nan lao dong gay tir vong la 1,8 va tai nan lao dpng kliong gay til" vong 32,6/1,000 cong nhan. Tong so ngiy dieu trj npi trii va ngoai trii ciia cong nhan bj chlfn thudng \i 144 ngay va 837 ngay vdi so ngSy dieu trj trung binh lan lui!?t la 1,5 ± 3,4 va 9,3 ± 11 ngSy, trong do dieu tri ngi trii chii yeu du'di 1 tuan (21%) va 67,8% dieu tri ngoai trii ft hdn va bang 3 ngay. Tong so ngay nghi vi$c duUc hu'dng luong cua cac tru'dng hop bj chan thu'dng la 975 ngay, trong do chii yeu nghi viec tif 3-7 ngay (diiem 74,4%). Thdi gian mat kha nang lao dpng tmng binh d mot cong nhan xay duhg la 10,8 ngay. Tong sd nam song mat dl ciia 95 fri/dng hpp tai nan lao dpng la 150,3 DALY (hoSc 158 DALY/100 cdng nhan), trong dd ganh nSng benh tat do tai nan lao d$ng gay tir vong ta 148,9 DALY (chi§m 99,1% tSng so DALY). Ganh nang benh tat cao nhat do TNLD d c6ng nhan dudi 30 tuoi (70,4% tdng so DALY) va d cdng nhan no min (70% tong so DALY).
U'dc tinh thi$t hai ve kinh te (chi phi tri/c tiep) do tai nan lao dpng mgt n3m d cong nh3n x3y di/ng la 937,633 trieu dong, trong do chi tra luUng, h5 trd va boi thudng cho cong nhan van hanh may xiic, may nghien da chi^m ty le cao nhat (442,307 trieu dong, chigm 47,2%)
Cac ket qua nghien ciiu da chi ra sU can thiet tiep tuc nghien ojTu sau hdn ve dieu kien an toan ve sinh lao dpng, cac yeu to nguy cd gay tai nan lao dpng va chan thuyng nghe nghiep d cong nhan xay di/hg cung nhu cac giai phap phong ngCra hieu qua de lam giam ganh nSng b|nh tat va thiet hai kinh te cho doanh nghiSp, ngu'di lao d$ng va xa hpi.
* Vien Sire kh6e nghe nghiep va Moi tru'dng Chju trach nhi^m chinh: N g u y i n B i c h D i § p Email: [email protected] E)t: 0904.155.008 Phan bi|n khoa hpc: PGS.TS Tran Th| Ngoc Lan Ngay nhan b i i : 22.7.2014
60
Y HOC VIET NAM THANG 9 - SO 2/2014
60.000 ngu'di bj tir vong tai cac cdng trinh xay duhg moi nSm va hang tram ngan ngu'di phai chju thUdng tat nghiem trpng va sii'c khoe yeu kem. Xay dung cung la mpt nganh cdng nghiep mui nhpn ciia Viet Nam, chiem ti trpng Idn trong thu nhap kinh te quoc dan (khoang 13,5%) va lUc lUdng lao dpng chiem khoang 10% trong tong so tUc lu'dng lao dpng. Day la mot trong nhilYig nganh cdng nghiep cd nhieu yeu to nguy hiem, nang nhpc, dpc hai va tai nan lao dpng (TNLD) cd chieu hu'dng gia tang. Theo so iieu thdng ke chu^ day du, nam 2000 xay ra 196 vu TNLD lam chet 52 ngu'di, thi den nam 2011 so vy tai n^n tang \in la 502 vu lam chet 117 ng\iif\ va l^m thut^ng n^ng 118 ngu'di [2]. Tai nan lao dpng va chan thu'dng nghe nghiep khdng chi la nguyen nhSn giy chit va tan tat hang dau cho ngu'di lao dpng, ma cdn la ^anli nang tai chinh Idn ddi vdi cac nen kinh te. Viec do lu'dng va danh gid ganh n^ng va thiet h^i kinh te do tai nan va chan thu'dng nghe nghiep cd y nghla het sii'c quan trpng ve mSt khoa hpc doi vdi cac nha hoach dinh chfnh sach, giup hp xay dutig chu'dng tririh rah thiep, chfnh sach va th^ che de bao dam an toan tai ndi l^m vl|c, phdng ngira benh t$t, tai nan chan thu'dng nghe nghiep va nang rao su'c khoe cho ngu'di lao dpng. Cac nghien ciiu d Vi?t Nam ve ganh nang benh tat noi chung va ganh nSng do tai nan lab ddrig va chan thu'dng nghS nghiep ndi rieng hau nhu* rat it va dSc bfdt ddi vdi nganh xay dutig chu^ cd nghien cihj nao. Do v$y, u'dc tfnh ganh nang benh tat va ton that kinh te do TNLD gay ra d cdng nhan xay dytig la van d l ran nghien cuti.
II. 06l TU'PNG vA PHU'aNG PHAP NGHIEN CUTJ 2.1. Odi tiring nghien cO'u
Cdng nhan xay dutig va cac sd lieu thong ke TNLO, chan thu'dng nghe nghiep (CTNN); ho sd tai nan lao ddng; so lieu thong ke ve nghi viec, chi phi y te,t^n thSt kinh te ciia doanh nghiep do tai nan chan thu'dng nghe nghiep, w trong 1 nSm tai mpt cdng trinh xay dutig
2.2. Phu'dng phcip nghien cu'u - Hoi cii\j ho sd TNLD va chan thu'dng nghe nc|hl^p cua cong nhan trong mpt nam: Thu tfiap rac thong tin thir cap bao gdm tai nan va chin thu%fng nghe nghiep tir so kham chij^ benh ciia bcim y te; thdng tin ve lu'dng, thu'dng, righi 6m do tai nan va chan thu'dng nghe nghiep tir Phong lao dong tien lu'dng. Phan loai TNLO theo Thdng Cu" lien tjch so 12/20IZ/TTLT-BLOTBXH-BYT ngay 21/5/2012 ve Hu'dng dan khai bao, dieu tra, :hdng ke, bao cao tai nan lao ddng.
• Danh gia ganh nSng do tai nan va chan thu'dng ighe nghiep bSng phu'dng phap tfnh chi so DALY: bnh so nam sdng mat dl do tan tat va
chan thu'dng (mat nhiitig nam sdng khoe) va sd nam song mat di do chet sdm. DALY la tong so nhu'ng nam sdng bj mat di do chet non (YLL-Year life lost) va so nam song ciing benh tat, tan tat (YLD-Year Life lived with disability) du'dc hieu chinh theo he sd benh tat: DALY = YLL + YLD (1 DAL Y dudc coi nhu" la tudng du'dng vdi viec mat dl 1 nam song khoe manh)
- Udc tfnh ton that kinh te do tai nan va chan thu'dng nghe nghiep bang phu'dng phap tinh toan cac thiet hai kinh te bao gom cac khoan: Phan thiet hai do chi phi den bu/ho trd cho cac tru'dng hdp bj tir vong, chan thu'dng va chi phi dieu trj {Chi phi cho y tecdsd: so tien mua thua:, bon^
bang, dung cu sd cap cult, Chi phi do bao hiem tra khi di kham hoac dieu tri d cac cd sd y tS)', Phan thiet hai ve kinh te ciia nha nu'dc {ngudilao dgng nghi viic do TNLD van du'dc an ludng (100% ludng): thiet hai nha nudc = so ngay nghi viec du'dc hu'dng ludng x Iddng/ngay);
III. Kfr QUA NGHIEN CU'U
3.1. Ket qua hoi cuti so liSu tai nan lao dpng Hoi ciru cac so lieu TNLO ghi nhan tgi Tram y te ciia mpt^cdng trinh xay dutig trong nam 2006 cho thay tong sd cong nhan bj TNLO cap ciTu tai Tram y te la 95 tru'dng hdp trong dd 71 TNLD nhe chiem da so (74,7%), tai nan nang cd 19 tru'dng hdp (chiem 20%) va cd 5 tru'dng hdp bj tu" vong (chiem 5,3%). Tong so cdng nhan lam viec tai thdi diem nay tren cdng tru'dng xay dutig la 2763 cdng nhan. Nhu' vay, ty le tai nan lao dpng chung ciia cdng nhan xay dutig la 3,4% (95 tru'dng hdp/2763 cdng nhan hay 34/1.000 lao dpng). Ty le TNLO gay tu' vong la 1,81/1.000 cdng nhan va TNLD khdng gay tii vong la 32,57/l.OOQ cdng nhan lam viec toan bp thdi gian tren cdng tru'dng. Cac cdng nhan bj TNLD cd tuoi ddi tir 19 den 51 tuoi, chii yeu la nam va vdi tuoi nghe trung binh 6,5 nam. Cd 5 tru'dng hdp cdng nhan nam bi tu" vong do TNLO bao gom 1 cdng nhan van hanh may xuc, 1 thd han va 3 thd no min. Tuoi cdng nhan bi tu' vong thap nhat la 19 va rao nhat la 51 tudi va tuoi nghe tii 1-28 nam. Cdng nhan bj TNLO chii yeu d lu^ tudi du'di 30, chiem 72,7% va ty le nay giam dan khi tuoi ddi cang rao. Tu'dng td, cdng nhan cd tudi nghe tir 1-5 nam bj TNLO niiieu nhat, chiem 67,4% va cung giam dan khi tudi nghe rao hdn. Cac TNLO chu yeu hay xay ra d cac cdng viec ciia thd gia cdng, be tdng va cot thep (chiem 58,9%) va thd khoan (17,9%). Cac nguyen nhan gay TNLO chCi yeu do cac vat, thanh sat, thep, da va dap va rdi (35,8%), cac vat sac nhpn (25,4%), w. Dac biet cd 3 nguyen nlian ^ay TNLD tir vong la do m^y xiic, dien giat va nd min. Cac vet thu'dng chii yeu la chan thu'dng phan mem (71,1%),
Y Hpc VigT NAM THANG 9 - SO 2/2014 Bing 1. So nqay dieu tri noi tru va ngoai tru
So ngay dieu trj So nqay dieu tri trunq binh Khonq dieu tri ngi trij
'U va ngoai tru So ngay dieu tri ndi tru
fn=an^*
(n=90);
\"-^"/
Sof lu'dng I Ty le "/o 1.5 ±3.4 (3-20)
igo?rSffn So ngay dieu trj n
[ n = ? p l _ _ _ sofltfang I t g e >
9.3 ±11 ( 3 j 5 ) _
Dieu tri <3 nqay 61 67.8
Dieu tri tu* 4-7 ngay Dieu trj tif 8-15 nqay Dieu trj tu' 16-30 nqay Dieu tri > 30 ngay
ITong so ngay dieu tr| 144 ngay 837 ng^y
Trong tong so 90 tru'dng hdp bi tai nan chan ngay dieu trj ngoai tru cua cac cong nhan xly thu'dng, co hdn 2/3 so tru'dng lidp ichong dieu tri duTig la 837 ngay. So ngay dieu trj trung binh li noi tru do cac vet thu'dng d miJc dp nhe. Tong so 9,3 ± 11 ngay, dao dong tif 3 den 55 ngay. Trong ngay dieu tri noi tru ciia cac cong nhan xay dirng do dieu trj ngoai trii it hdn va ban^ 3 ngay chlSii la 144 ngay.' S5 ngay dieu trj trung binh la 1,5 ± hdn 2/3 so tru'Sng hdp (67,8%) va tren 30 ngiy 3,4 ngay, dao dpng tir 1 den 20 ngay. Trpng dd co 6 tru'dng hdp chan thu'dng nang (Bang 1).
dieu trj npi tru du'di 1 tuan chiem 21%. Tong so Bing
TT 1 2 3 4 5
e
?. So ngay nghi du'dc hu'dnq lu'dng
So ng^y nglii du'^c hu'dng lu'dng | So lu'dng (n=901 Ty le °/o So ngay trung binh 13-60) ngay)Ll0.8 ± 13,5
Nghi 3 ngaY_
Nghi tir 4-7 nqay Nglii tir 8-15 ngay Nghi tir 16-30 ngay Tren 30 nqay
Tong s£ ng^y nghi
27 40 5 10 8 975
30,0 44,4 5,6 11,1 8,9
SSngay nghi viec trung binh dudc hWdng ludng ciia cong nhan bi TNLD la 10,8 ngiy. Nhd viy, thU gian mat khi ning lao dgng trung binh d mgt cdng nhin xay dufig bi tai nan chan thudng la gan li ngay. Tong so ngiy nghi viec du'dc hu'dng ludng cua 90 tru'dng hdp li 975 ngiy, trong dd nghi viic ^ 4-7ngay chiem 44,4%. Nghi viec 3 ngiy chiem 30% (Bang 2)
3.2. Udc tinh g^nh n$ng b$nh tat va ton that kinh t€ do TNLD
Bing 3. So nam song khoe manh bi mat di do TNLO d cac cong nhan xay dung theo nhom tuS va gidi
Thdi gian mSt kha nang lao dong TB do TNLP (nam) Gidi Nhdm
tuoi
So tru'dng hdpTNLS
H l l o TNLO trung binh
Tong so nam sdng khoe manh bi mat di
do bj TNLfl (DALY)
59
17,32 0,357
1,064 0,164
70,435 35,378
3,027 0,206 28,009
0,117 0,1 0,120
14,569 0,6 16,324
21-30 I
Tong sdDALY cua nam
I
0.0691S0,2S4 0,032 Tdng so DAL Y cua nit
Tong sd DALY
0,032 150,296 95 tru'dng^hdp TNLO bao gom 5 tru'dng hdp tiJ va^, ganh nang benh tat do~FTNL£) cua com vong CO tong sp nam song khoe manh bi niat di nhan xay dirng tai mpt cong trinh xav riirnn nam do TNLO la 150,3 DALY, trong dd so nam song 2006 la 158,2 DALY/100 cong nhan va tru™ hinh mSt di do TNLO gay tir vong (YLL) la 148,9 DALY, 1 nam cong nhan xay dirng mat di i 6 nam S chiem 99,1% va so nam s ^ g mat di dp mat kha khde manh/1 ngu'di (Bang 3). "™ ™"9 nang lap dpng do TNLO (YLD) chiem 0,9%. Nhy
Y HOC VigT NAM THAHG 9 • SO 2/2014
Bang 4. So nam sdng khoe manh bj mat di do TNLO theo cac loai chan thu'dng Cac loai Chan thUiffig
TNLO gay tir vong ( n ^ Vet thiTdnq phan mem (n=64) ~ Gay, ran xu'dng (n=12) Xu'dc giac mac (n=5)~^
Bdng (dien, tia hanj (n=3) Chan thu'dnq cot song (n=2) Put gan (n=l) Tham tim, barr^dap ^n=3)
Tong cpng
DALY(n=951 148,91
0,672 0,313
Ty le % 99,1
TT^LD gay tu" vong cd so nam song khoe manh mat di cao nhat (148,9 DAL Y) va chiem 99,1 % tong sd DALY. So nam song khoe manh mat di do vet thu'dng phan mem dufig thu' hai do sdlWdng cong nhan bichan thu'dng nay chiem hdn 2/3 tong so cong nhan bi TNLD (Bang 4).
Bleu do 1. Ganh nang benh tat do TNLO theo nhdm tudi DALY
8 0 1 70.4
m
>50 lu'JIXemxetginh nang benh tit theo Ilia tuoi cho thiy so DALY bl mat di nhieu nhatii dlila tuoi dwdl 20 tii$ (70,4 DALY vi chiem 46,8% tong so DALY). Tiep theo ta lia tuoi tir21 den 30 tuoi (35,4 DALY, chlim 23,6%) (Bleu do 1)
TT 1 2 3 4 5 6
Bangs. So nam spnq khoe manh bi mat di do TNLO theo chu'c danh nqhe Chij'c danh nghe
Thd gia conq, be tonq & cot thep (n=56) Thd khpan (n=17)
Thd thi cpng (n=7) Thd np min (n=6) Thd han (n=5)
Cpng nhan van hanh may (may xiic, may nqhien da) (n=4) Td'ng cdng
DALY (n=95) 0,43 0,24 0,13 104,96 27,78 44,27 150,2
Ty le % 0,3 0,2 0,1 69,9 18,5 29,5 100 Th^ no min co 3/6 cong nhan bi tiy vong do TNLD, co so nam song khde manh mat di cao nhat (104,96 DALY) va chiem 70% tong so DALY. Tiep theo la thd han va cong nhan lai may xuc co 1 tru&ng hdp tu" vong vachiem 18,5% va29,5% tong so DALY.
TT 1 2
j^:- A<
Bing ff/Thiet hai kinh te do TNLO d conq nhan xay duTiq Cic khoan chi
Tonq chi phi cho hoat dong ciia tram y te
Tdng chi phi ho trd ciia doanh nghiep cho cac tru'dng hdp bITNLO
Chi ciia bao hiem cho nhihig ngu'di di dieu trj npi tru va ngpai triJ (24 lu'dt noi tru va 90 lu'dt nqoai trii) Tong chi ciia doanh nghiep cho nhiiTig ngay nghi do
"TNLO va chSn thu'dnq nqhe nqhieo Tdng chi
tronq nam 2006 Sdti'en (trieu ddng)
60,0 498,0 337,269 42,364 937,633
Tyle (°/o) 6,4 53,1 36,0 4,5 100
Y HOC VI|T NAM THANG 9 - SO 2/2014 Con SO U'dc tinh ve thiet hai kinh te d cong
nhan xay dirng do TNLD va chan thiTdng nghe nghiep bao gom tong chi phi cho hoat dpng cua Tram y te trong nam 2006 (chi phE cho cap ciTu, di^u tri, kham chu'a benh cho cac cong nhan xay dutig cua ddn vj), tong chi phi ho trd ciia doanh nghiep cho dieu tri TNLD va chan thuWng nghe nghiep va den bu cho cac tru'dng hdp tir vong, chi ciia bao hiem cho nhiTng ngirdl di dieu trj npi tru va ngoai tru va chi tra li/dng cho nhifng ngay nghi bi TNLD va chan thu'dng nghe nghiep cho cong nhan la khoang 937,633 trieu dong, trong do chi phi ho trd ciia doanh nghiep cho cac tru'dng hdp TI^LO chiem 53,1% (Bang 6).
IV. BAN LUi^N
Tong so nam song khoe manh bi mat di do TNLO la 150,3 DALY, trong dd so nam song mat di do TNLO gay tir vong (YLL) la 148,9 DALY, chiem 99,1%. Nhu'vay, ganh nang benh tat do bj TNLD ciia cong lihan xay dirng la 158,2 DALY/100 cong nhan. So vdi ket qua ciia mpt sp nghien ciru trpng nu'dc khac nhu' ket qua nghien ciTu ciia Nguyen Bich Diep va cs. (2010) tai mpt Nha may ddng tau (2,8 DALY/100 cong nhan) [4], nghien ciTu ganh nang benh tat ciia cong nhan ciia Nha may xe life Gia Lam (Vu Y te du' phong, Bp Y te, 2002) (6,5 DALY/100 c6ng nhan) [3], vv tlii ket qua cua nghien ciru nay cao hdn rat nhieu mac dBu sd tru'dng hdp tai nan thu'dng tich ft hdn, nhu'ng lai bao gom cac tai nan lap dpng gay tiJ vpng. Tu'dng tiT, sd sanh vdi kit qua nghien cull ciia Le Vu Anh va CS (2004) tai quan the vdi 10.375 ngu'di cp 45 tru'dng hdp tiT vong, tong ganh nang benh tat tai quan the (DALY) la 1.945 nam bang 18.754 nam/100.000 dan; trong dp SP nam spng bj mat dp tiT vpng (YLL) chiem 35% tPng ganh nang benh tat va bang 685 nam, tu'dng du'dng vdi 6.605 nam/100.000 dan, sp nam spng bj mat dp tan tat (YLD) la 1.260,45 nam, tu'dng du'dng vdi 12.149 nam/100.000 dan, thi ket qua nghien ciru ciia chiing tci cung cap hdn rat nhieu; tong ganh nang benh tat la 158.200 nam/100.000 cong nlian, trong dd so nam song mat di do TNLD gay tir vong (YLL) la 148,9 DALY, tu'dng du'dng 156.737/100.000 Cdng nhan va so nam song bj mat do tan tat (YLD) la 1,4 nam, tu'dng du'dng vdi 1.474 nam/100.000 cong nhan. Kh\l vay, ganh nang benh tat do cac yeu to nghe nghiep gay ra cap hdn rat nhieu so vdi ganh nang benh tat ciia cpng dong dan cu'.
Con so u'dc tinh ve thiet liai kinh te ciia cong nhan xay dutig do TNLO trong nghien ciru nay la khoang 937,633 trieu dong bao gom tong chi phi chp hpat dpng ciia Tram y te trong mpt nam cho
cap ciru, dieu tri, kham chu'a benh cho ^'^""^
nhan ciia dan vi, tong chi phi ho trd cua ooann nghiep cho dieu tri chan thu'dng va den pu cjo cac tru'dng hdp tu'' vong, chi cua bao hiem cho nhii'ng ngu'di di dieu tri noi tru va ngoai tru, chi tra liTdng cho nhiTng ngay nghi viec va_ khong bao gom cac chi phi cd hoi ciia cong nhan phai tir chi tra khi bi TNLD. Tong chi phi thiet h?i kinli te CLia cong nhan xay dutig do bj TNLO u'dc tinh cao hdn tong chi phi thijt hai kinh te ciia mpt so nghien ciru khac nhu' nghien cull ciia Nguyen Bich Diep (2010) d cong nhan ddng tau (4|1 trieu ddng) [4], nghien ciiu ciia Vu Y te d}
phdng va Dai hpc Y Ha Npi d Nha may Xe lira Gia Lam (2002) (302 trieu dpng) [3] dp trpng nghien ciru nay bap gpm ca chi phi bci thu'dng 5 tru'dng hdp TNLD gay tir vpng.
TNLD va chan thu'dng nghe nghiep khcng clii la nguyen nhan gay chet va tan tat hang dau cho ngu'di lap dpng, ma ccn la ganh nang tai chinh Idn doi vdi cac nen kinh te. Tai Viet Nam, theo so lieu bad cap ciia Bp Lap dprig, Thu'dng binh va X§ hpi, chi phi dp tai nan lap dpng xay ra trang nam 2012 (chi phi' tien thuoc, mai tang, tien IMI thu'dng cho gia dinh ngu'di diet va nhihig ngirfii bj thu'dng,...) la 82,6 ty dong, thiet hai ve tai san la 11 ty dong, tong so ngay nghi (ke ca nghi;Che dp) do TNLO la 85.683 ngay[2]. Theo u'dciili ciia To' chirc Lao dpng Qudc te, hang namltB khpang 2,3 trieu ngu'di lao dpng tuT vong doltai nan lao dong va benh nghe nghiep (BNN). llcfc tinh 4% GDP toan cau (khoang 1.25 ti USlSfbl tham hut dd chi phi tru'c tiep hdac gian tiep cho TNLO va BNN (nhu' ton that gid iam, bol thu'dng cho ngu'di lap dpng, san xuat gian doan va chi phi y te) [6]. Trong cac nghien ciiu do Cue An tpan lap dpng Australia cpng bp, chi phi u'dc tinh chi tra dp thu'dng tich va benh lien quan iJIn nghe nghiep nam 2005-2006 la 57,5 ti do-la Australia (chiem 5,9% GDP), va 60,6 ti (chieni 4.8% GDP) chp nam 2008-2009. Chan thuang chiem tdi 30,7 trieu de-la tren tSng chi phi kinh te (51%). Cac ca nhan va xa hdi ganh phan Icj) chi phi nay (95%) [1]. Geetha M. Waehrer etal.
(2007) da u'dc tinh chi phi cac chan thu'dng nghe nghiep gay tir vong va khong gay tir vong trong nganh Xay duhg d Hoa ky 2002 la 11,5 ty USDvi bang 15% tong chi phi ciia tat ca cac nganh conj nghiep tu' nhan. Chi phi cho mpt tru'dng hdp chSi) thiTdng nghe nghiep gay tir vpng hoac khdng gay tir vong la 27.000 USD trong nganh Xay dutij gan gap 2 lan cho mpt tryirng hdp chan thiidnj ciia tat ca cac nganh cpng nghiep nam 2002' 15.000 USD [5]. Hptwitz and McCall (2004) u'dc tinh chi phi bpi thu'dng trung binh cdnq nhan x3«
dung d Oregon tir 1990 den 1997 la 10.084 USD
Y HOC Vier NAM THANG 9 - SO 2/2014 va thd sat, thep cd chi phi trung btnh cho moi boi
thudng cao nhat (16.472 USD) [7].
V. KET LUiBiN VA KHUYEN NGHj
1. Cac Icet qua cua nghien c^u cho thay tai nan lao ddng va chan thu'dng nghe nghiep xay ra d cac cdng nhan xay diTng tai mdt cdng trinh da gay ganh nang benh t | t va thiet hai kinh te Idn cho ca ngu'di lao ijong, doanh nghidp va xa hoi;
Sd nam sdng khde manh mat di do tai nan lao dpng la 158 DALY/lOO cdng nhan/nam hay 1,6 DALY/1 cdng nhan/nam. Sd nam sdng khde manh mat di cao nhat d tai nan lao ddng gay tir vo'n^ (148,9 DALY, chiem 99,1% tong sd DALY), d cong nhan xay di/ng du'di 20 tudi (70,4 DALY va, chiem 46,8%) ya d thd nd min (104,96 DALY va chiem 70%). Tdng thiet hai kinh te cua cdng nhan xay duYig do tai nan lao dpng va chan thudng nghS' nghiep la 937,633 trieii dong, trong dd chi trS cho cdng nhan van hanh may xuc, may nghiin da chi§m ty le cao nhat (442,307 trieu d5ng, chi§m 47,2%)
2. C3n tiep tuc nghien ciiu sau hdn ve dieu kien an toan ve sinh lao ddng, cac yeu td nguy cd gay tai n?n lao ddng va chan thu'dng nghe nghl$p d cdng nhan xay dyVig cung nhu* cac Qiai phdp phdng ngiia hieu qua de lam glam ganh nang va thiet hai kinh te cho doanh nghiep, ngudi lao ddng va xa hpi. Ngoai ra, cdng tac thdng tin, tuyen truyen giao due ve cac tac hai ndi lam viec, cac npuy cd gay tai nan lao ddng via cac bien phap phdng ngu^ cho cdng nhan xay duTig cung ran du'dc day manh.
TAI LIEU THAM KHAO
1. Australia Safety ad Compensation Council (2009 and 2012). The Cost of Work-related injury and Illness for Australian Employers, Workers and the ajmmunity: 2005-06 and 2008-09. Retrieved from ttie Safe Work Astralia website:
http://safeworkau5tralia.gov.au/AboutSafeWorkAu stralia/WhatWeDo/Publications/Pages/
SR200903InjurvAndIllness2005To2006.aspx and /cost-injurY-illness-2008-09.aspx
2. Bo Lao dong, Thu'dng binh va Xa hpi (2000- 2012). Bao cao tinh hinh tai nan lao dong tu"
nam 2000 den 2012. http://antoahlaodong'.gov.vn 3. Bo Y t e , Vu Y te dy" phdng (2003). '•'Nghien
cuU thu" nghiem phudng phap udc tinh ganh nang benh tat va thiet hai kinh t€do benh tat va tai nan d Nha may xe iui Gia Lam nSm 2002". Bao c i o khoa hoc. Hoi thao ve Ganh nSng benh tat tai Ha Npi, Thang 10 nam 2003
4. NguySn Bich Di^p (2010). Ganh nang tai nan chin thu'dng nghi nghiep tai mot doanh nghiep CO khf dong tau. Tap chi Sinh ly hoc so 14 (4), trang 23-29
5. Geetha M. Waehrer, Xluwen S. Dong, Ted Miller Elizabeth Haile, Yurong Men (2007).
Costs of occupational injuries in construction in the United States. Journal of Accident Analysis &
Prevention, Volume 39, Issue 6, November 2007, Pages 1258-1266
6. ILO (2009). World Day for Safety and Health at Work 'Facts on safety and health at work' 7. Horwitz I B , McCall BP (2004) Disabling and
Mai occupational claim rates, nsks, and co^ in die Oregon construction industry 1990-1997. J Occup Environ Hyg. 2004 Oct;l(10):688-98
KET QOA PHAU THUAT DIEU TRI S6l TRONG GAN
(NHAN 186 TRU-aNG HQ-p)
T 6 M TAT
Mijc <nch: md ta dSc diem benh ly va ket qua sdm sau mo sdi bong gan. Ddi tu'dng va phu'dng phap nghien diu: nghien cuU tien CLTU mo ta tir thdng 1 den thdng 12 nSm 2013, tai benh vien hiiU nghi Vjet Out d cac benh nhan ^ N ) du'dc chan doan va phau thu|t vi soi trong gan ve cac d k diem lam sang, c3n lam sdng, phudng phdp md va ket qua dieu tri
* Bd mdn Ngogl-OHY Hd Ndi
* * BV HN Viet Dure
Chju trach nhiem chinh; T r a n Bao L o n g Email: [email protected] Dt: 0986.695.825 Phan bien khoa hoc: PGS.TS Trinh Van Tuan Ngay nhan bai: 11.8.2014
Tran Bao Long*, Do Manh Hung**
Ket qua va ban l u | n : 189 6N thuoc dol tu'dng nghien culi (nam 112, nu* 74), tudi trung binh: 50'08
± 15,23 (thap nhat 17, cao nhat 86). 50 BN (26,9%) cd tam chuYig Charcot. 1 BN bi viem phuc mac mat, 4 BN bi viem tuy cap. 177 BN w d c mo lay soi dan' lutJ Kehr. Sdi sdt chiem 37,9%. 3 BN (1,61%) bi nhiem khuan vet mo, 2 BN (1,07%) bi ro m?t khoi sau dieu trj noi khoa, 2 BN nang gia dinh xin ve, khdng cd tu' vong. Thdi gian n^m vien trung binh 8,75 ± 3,3 ngay (dao dong 4 -27 ngay),
Ket Tuan: soi trong gan thu'dng bl benh keo ddi hay mo nhieu lan, lam sdpg thu'dng khong dien hinh, md ong mat chu lay sdi dan lull Kenr Id pnu'Ong phap dieu tri pho bien nhat, phdi hop tan sdi dien thuy luc cho ty le sach sdi cao.
Sot sdi chiem 37,9% chu yeu d mdc do ha phan thuy,sdi trong gan ddn thuan sdt nhieu hdn soi phdi hop ca trong va ngoai gan (P<0,05).