CHUYEN PE: HOI NGHj KHOA HOC NGANH Y TE TJNH KHANH HOA - L^N THLT II
DANH GIA DIEU KIEN MOI TRU0NG KHONG KHJ TAI CAC COT SOT SAN XUAT CO SUT DUNG DIEU HOA NHIET DO DOI vAl SUfC KHOE NGlTon LAO DONG Cf KHANH HOA
Vien Chinh Chien*, Trinh Thi Bich Thuy**
T O M TAT:
Tien h^nh NC c m ngang tai 9 DN co he thong DHKK, do 1478 chi tieu moi truong va kham 1571 nguoi kgt qua cho thay Ty le m l u kh6ng dat TCCP ve vSt ly, h6a hoc va vi sinh vat lan lugt la 14,3%, 9.8% vS 9,9%. Ty I? bj SBS 1^ 28,9% vS ty le bi cac tri$u chO-ng SBS don le la 64,4% Ty le b\ SBS a nO cao hon nam, trong phong lanh cao han ben ngo^i va nhSn vien vSn phbng c6 nguy c o bj SBS cao n h l t S u gia tSng nong dO S O j ho^c NOx trong kh6ng khi c6 liSn quan den s y tSng ly le SBS 9 1 % c6c DN he thong BHKK khong dat yeu cau ve chat l u o n g .
S U M M A R Y
ASSESSMENT OF A I R - E N V I R O N ME NT I N SOME INTERPRISES W H I C H HAS A I R - C O N D I T I O N CENTRAL SYSTEM AND I T ' S
IMPACT TO HEALTH OF WORKERS I N KHANH HOA PROVINCE Across-section study had been carried-out in 9 enterprises which had air-condition central system. 1478 enviromental factors were measured and 1571 workers were examined health enclosing. The result showed: the rate of environmental physical factors, chemical factors and microorganise polluted in air over OELs (occupational exposure limits) were 14.3%; 9.8%
and 9.9% respectively. The rate of SBS was 28.9% and at least one of SBS's symtoms Vi'as 64.4%. Female had been SBS higher than male;
workers in air-condltion room had been SBS higher than workers out side with p<0.05. The officers workers in air-condition had rale of SBS highest The increasing SOa or NOx content in air closed-relative the increasing of rate SBS in workers with p<0.05. 9 1 % air-condition systems in enterprises were no good.
* Vi4n ve sinh Dich te Tdy Nguyen
** Vien Pasteur Nha Trang 2 1 0 "
I. O A T V A N O E :
SBS (Sick Buiding Syndrom) la tinh trang r6i loan sue khoe cua nhung nguoi song va lam viec trong phong kin co sir dung diSu hoa khong khi (DHKK). Cac nghien ciiu vh SBS tren the gioi ngay cang nhieu, SBS that su da tro thanh mpt van de siic khoe quan trpng dugc dac biet quan tam a cac nuoc phat trien [4].
Tai Viet Nam, chua co nhieu nghien ciiu vh hpi chimg nay, chu yeu la cac tai lieu dich de giang day va khuyen cao. Tai Khanh Hoa, ca nguoi sir dung Ian cac nha quan ly h§
thong DHKK deu rat it quan tam den tac hai nay. Tuy nhien qua ket qua theo doi so bo cua chung toi trong nhieu nam cho thay su 6 nhilm do ir dpng khi thai cung nhu nhiing hihu hien cua SBS a nhiJng nguoi lam viec trong phong dieu hoa khong khi la co that va la mpt van de can quan tam giai quyet nham bao ve sire khoe. Do la Iy do chinh de chiing toi de xuat nghien cuu nay.
II. MUC TIEU NGHIEN CCfU:
- Xac dinh dugc chat lugng moi trucmg va anh hucmg doi voi SK nguai lao dpng.
- Bh xuit bien phap khic phuc.
III. PHUdNG PHAP NGHIEN C^U:
Thik kh nghien ciiu mo ta ckt ngang. Do 1478 chi tieu moi truong khong khi cua 9 doanh nghiep (chia lam 02 nhom nganh: che bi^n thuy san 03 DN va nhom nganh khac 06 DN) CO DHKK trung tam. Kham sire khoe 1571 nguai lao dpng tai cac DN do.
Y HQC VIET NAM THANG 5 • SO BAC BlgT/2012
IV. KET QUA NGHIEN COU:
1. Ket qua ve do moi triroTig tai cac doanh nghiep:
/./. Ket qua to cdc yeu to vat ly:
ll\ 0 yeu to vat ly co 6 nhilm, cao nhSt la cucmg do anh sang (61,7%) roi ddn do Im
(25,3%). Ty le chung vl cac chi tieu vat ly Ithong dat TCCP la 14,3%, kha thip trong dieu kien cua nuoc ta hien nay. Ty le 6 nhiem cac ylu t6 vat ly trong nhom cac nghanh nghe khac chi co 12,55%, thip hon nganh chS biSn thuy san (CBTS) 25,6%.
Biku S 1: J-j le % cac chi tieu vat ly trong khong faii khong dat TCCP 1.2. Ket qua do cdc yeu to hoa hgc:
Chi CO 3/8 ylu t6 hoa hpc co mlu do vuot TCCP, cao nhlt la nong do khi CO2 (43,2%) roi den nong do CL2 (14,3%); n6ng do nicotine cung rit cao (44,4% nhung mang tinh cue bg).
Ty le chung vd vuot TCCP cua chi tieu hoa hoc la 9,79 %.
Bieu do 2: Ty Ie % cac chi tieu hoa hoc trong khong khi khong d^t TCCP 1.3. Kit qud dinh iirffng cdc yiu t6 vi sinh vat:
9,88% tong so mau bi nhiem cau khuan tan mau co nghTa la chac chan nhiem ban. Gia tri trung binh cua cac chi so vi sinh qua NC la: Cau khuan tan mau: 14,9 khuan lac W ; Vi nim 854,7/m^; Tong vi khuan hieu khi; 1682,2 W . So sanh 02 nhom doanh nghiep tiii ca ty le nhiem va gia tri trung binh ve cac chi tieu vi sinh vat trong nhom nganh khac thap hon so voi nganh CBTS, sir khac biet co y nghia thong ke voi p<0.05.
CHUYEN PE: HOI NGHj KHOA HOC NGANH Y TETJNH KHANH HOA • LAN THLf II
2. Ket qua dieu tra hoi chiing SBS trong cong nhan:
Ty le CO hpi chimg SBS qua ket qua dieu tra;
Biiu dd 3: Ty le co hpi chiing SBS tong hgp qua ket qua dieu tra
Ty le CO hpi chiing SBS theo tieu chuan cua WHO trong nghien cuu nay la 28,9% con ty Ie CO mpt trong cac trieu chimg cua SBS la 64,4%. Ty le nay thap hem rat nhieu so vcd k^t qua tai Nhat la 37,2% [6] song ^ai cao horn tai Singapo 19,6% [5] hay My 20% [3].
N6u xet theo ty Ie xuat hien trieu chiing don le thi ket qua ciia nghien ciiu nay chi la 64,4% thAp han kk qua tai Anh 80-90% [2]
hay a mien Bac 80% [1]. Trong nganh CBTS, nhom lam phong dieu hoa ty le mac SBS cao gap 3,6 lan nhom lam cong viec ben ngoai (p<0,05). Xet theo giai, ty Ie hi SBS cua nij cao gap 1,7 Ian nam voi p.<0,002 phii hgp voi hau het cac ket qua NC tren tren the gioi [2]. Co su khac biet ro rang ve ty le bi SBS giii'a cac nhom chiic danh nghe va che dp lao dpng voi p.<0,05. Nhom chiic danh nghe de hi nhat la nhom Iam cong tac hanh chinh hoac ky thuat. Ket qua nay ciing trimg khop voi cac NC tai chau Au [2].
3. Phan tich cac yeu to nguy ctf lien quan giua moi tnrcmg va SBS:
Hau het cac yeu to moi truong nhu nhiet dp, do am, van toe gio, nong dp khi CO2, CO, NH3, cau khuan tan mau... deu co ty le bi SBS kha cao khi gia tang nong dp song khi kiem dinh thong ke chua ghi nhan sir khac biet vai p.>0,05. Chi co 02 chi so la nong dp SO2 va nong dp NOx khi tang cao la co moi
lien quan kha ro rang vai ty le mac SBS voi p <0,002.
4. Ket qua dieu tra h^ thong dieu hoa khong khi cua cac doanh nghiep:
8/9 doanh nghiep he thdng diSu hoa lip dat khong diing qui each, khong co he thong khu trimg khong khi, khong lam v$ sinh t&n loc thuang xuyen. Da so cac nai thiet kh he thong khong du tai nen phai dong kin cua thi mai dii lanh. Nhiet do cac van phong thuong khoang 25-28 C nhung dp am rat cao tren 80%. Nhin chung chat lugng cua he thong dieu hoa tai cac DN dugc khao sat chua t6t.
V. KET LUAN VA KIEN NGHh
Ket qua nghien ciiu cho thay ty le 6 nhiem cac yeu to moi truong khong cao (tir 9,9% -25,6%), co 8/21 ylu t6 moi truong t5t ca cac mau do deu nam trong TCCP. Ty le hi SBS la 28,9% va ty le bj cac trieu chiing SBS don le la 64,4%. Ty le bi SBS a nir cao han nam, trong phong lanh cao hon ben ngoai va nhan vien van phong co nguy co bi SBS cao nhat. Su gia tang ndng dp SO2 hoac NOx trong khong khi co lien quan din su tang ty Ie SBS. 91% cac DN he thSng DHKK khong dat yeu cdu vh chk lugng.
Kiln nghi ciin tang cuong cac giai phap vh hanh chinh, ky thuat va y th dh cai thien moi truong, han chh nguy co bi SBS khi lam viec trong moi truong DHKK.
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Y HQC VigT NAM THANG 5 - S6' PAC BIET/2012
TAI LIEU THAM KHAO
1. Nguyin Trinh Hirffng, Budc ddu ddnh gid khd ndng gdy hgi chung benh nhd kin tgi cdc vdn phdng ldm vi^c d Viet Nam, BCKH tai hpi nghi APOSHO 18, Ha Npi, thang 10/2002, trang 281.
2. London Hazards Centre, Interchange Studios, Sick Building Syndrome: Causes, Effects and Control, Chapter 1 -3, 1990.
3. Craner J, Alderman S, Willits N.
Epidemiological Investigation of a Moid- Contaminated "Sick" Building. In Johanning E (Ed.), Bioaerosols, Fungi, Bacteria, Mycotoxins and Human Health. Fungal Research Group Foundation, Albany, NY, 2005.
CA Erdmann, KC Steiner, and MG Apte
"Indoor Carbon dioxide concentrations and Sick building syndrome symptoms in the base study revisited: analyses of the 100 building dataset", hidoor Air 2002, pp. 4 4 3 ^ 7 Goi P.L.,Goh K.T., Pboon M.H., Foo S.C.,
Yap H.M., Epidemiology of sick building syndrome and its associated risk factors in Singapore, Occup Environ Medicine 1998;
55;p 188-193.
Saijo Y, Reiko K et all, Symptoms of sick house syndrome and contributory factors;
study of general dwellings in Hokkaido, Nippon Koshu Eisei Zasshi, 2002 Nov;49(ll):l 169-83.
KET QUA DIEU TRj PHAU THUAT MOT SO TRimNG HOP U MANG NAO LOTN TAI BENH VIEN DA KHOA TINH KHANH HOA
T 6 M TAT
Myc ti§u: DSnh gid ket qua v^ n6u mgt s6 nti^n x6t qua cdc tru6'ng hap u mdng ndo Ion dugc di^u trj phdu thu^t tai b^nh vi6n Khdnh H6a. S6 ll#u- phiFong phap: hoi ciru 6 truing hgp u mSng nao c6 kich thudc 16'n dipgc dieu tn phlu thulit tgi b^nh vi$n Kh^nh H6a trong 2 nim (2010 - 2012). Khao sdt cdc dau hipu Idm sdng khi b$nh nhdn nh$p vi$n. SO- dung CT Scan co cSn quang vd MRI c6 can tO" de chan dodn. Cdt u vti-i kinh vi phiu Id phuong phdp dugc lya chpn.
MifC dO l^y u dugc ddnh gid theo phdn loai cua Simpson. Tat ca cdc tru6'ng hgp deu du'gc Idm giai ph§u b^nh 1;?. Tinh trgng b?nh nhdn truac vd sau m6 dugc ddnh gid dya tren chi so chu-c ndng s6ng Karnofsky ( KPS) K i t qua: Tuoi tre nh^t: 24 vd 16'n nhat' 67. Tit ca cSc tru'6'ng hgp
* Khoa Ngogi Than Kinh - B4nh vien da khoa tinh Khdnh Hoa
Tran Quoc Hien*
deu c6 bieu hi$n ciia mOt tinh trang tSng dp luc nOi sp vd 4 tru&ng hgp Id co bieu hi$n ci)a diu hi0u thin kinh khu trCi. Vj tr( u deu ndm tr6n leu.
Kich thudc cua u" 5-6cm id ba tru'dng hgp, trSn 6cm vdi hai trudng hap va tr^n 7cm Id mgt trudng hgp. Mirc dfl clt u: Simpson I : 04, Simpson II: 01, Simpson IV: 01 Ket qua Giai phdu b^nh: loai hgp bdo 5 trudng hgp, Iggi tdn sinh mgch la 1 trudng hgp. Thdi gian phdu thudt vd lugng mdu truyln doi vdi loai u mach cd sy khdc bipt so vdi cSc loai khdc. Bien chiing sau mo: 01 trudng hgp bj phCi ndo. Sau m6 cit u tat ca cdc trudng hgp diu cd cai thi$n v l chipc nang song. Kit luan: Doi vdi nhUng khii u Idn sif dung cdc phuong ti0n hd trg nhu kinh vi phdu vd dung cu elm mdu Id cin thiet, giiip tranh ton thuong nhiing cau trOc quan trgng cua nag, elm
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