TINH HINH SQC KHOE CUA NHAN VIEN BQC XA TAI 4 LOAI HINH CO sd s(i DUNG NGUON
PHONG XA TRONG SAN X U A T
BS. VIJ VAN LlJC, TS. VU MANH HUNG, PGS.TS. NGUYEN DlTC HONG
Vien N/c KHKT Bao ho Lao dong
TS. NGUYfeN H A O Q U A N G V A C T V
Cue An toan Bde xa va Hat nhan
Tom tat: Qua phong van va hoi ciru ho sa kham sire khoe ban dau, kham sire khoe dinh ky tai 04 loai hinh casasir dung cac nguon phong xa cho thay: chua thay cac benh va cac trieu chiing benh lien quan den phong xa a nhan vien thuoc cac co sa co sir dung nguon phong xa. Ty le cac benh ma nhan vien bite xa mac khong chenh lech nhieu so vdi tinh hinh benh tap trung trong cong nhan theo bao cao cua Bo Y te '''; nhan vien phong xa dirge dieu tra co sire khoe kha tot, loai II chiem t'} le cao nhat (59,84%), tiep den la sire khoe loai I (23,62%), loai III (14,17%), va rat it c6 sire khoe thuoc loai V (2,36%) I".
Abstract: Through interviews the workers and research the initial physical examination records, periodic health examination records at the basis of the following four types of radioactive sources used for that: (1) Not that the disease and symptoms related to radiation workers in establishments that use radioactive sources. That the proportion of illness from radiation workers not much different than the common ailments among workers as reported by the Ministry of Health. (2) Employees of radiation have been investigated fairly good health, type II accounted for the highest percentage (59.84%), followed by health type I (23.62%), grade III (14.17 %), and few have health category V (2.36%).
I. DAT VAN DE do dac thu cdng viec lien quan vdi ngudn phdng xa, cd thd nhu'ng ngudi lam viec true tiep it nhieu eung bj anh hudng.
Sir phat trien manh me eua khoa hgc va cdng nghe, oieu tra tinh hinh sire khde, benh tat va edng tac du phdng trong dd cd khoa hgc va cdng nghe hat nhan da lam thay cua nhan vidn tiep xue true tiep vdi phdng xa tai cdc ca sd ddi mgi mat cua ddi sdng xa hdi tren todn the gidi. Ky thuat cd sir dung phdng xa nham de xua't cdc giai phap dam bao hat nhan dugc ap dung trong hau het cac ITnh vuc nhu sUe khde eho nhan vien phdng xa la mdt nhu cau bUc thiet.
cdng nghiep, ndng nghiep, y te, nghien cUu dao tao, tham
dd dja chat v.v... vdi tdc do phat trien ngay cang nhanh II. DO! TirOTNG VA PHI/ONG PHAP NGHIEN CUU Tuy nhien, song song vdi nhUng Igi feh to Idn ma vide ap 1. Doi tifcrng va dja ban nghien culi
dung ky thuat hat nhan dem lai, thi nd cdn tiem a'n nhUng - Ddi tugng chfnh la tat ea nhan vien dang lam viec tai nguy eo gay mat an toan bUc xa, anh hudng den sUc khoe 20 co so thude 4 loai hinh cdng nghiep cd sir dung ngudn ciJa nhOng ngudi true tiep lam viec vdi bUc xa (ggi tat la phdng xa trong qua trinh SX la: cd sd chieu xa edng nghiep nhan yien bCc xa). (ON); cosd sir dung thiet bj do, dieu khien hat nhan (DKHN);
6 nudc ta, cung vdi xu hudng phat trien cua the gidi, co sd sir dung ngudn phdng xa, thiet bj bifc xa (TBBX) cac ky thuat nhu: ehieu xa cdng nghiep, ky thuat do hat trong tham dd gieng khoan; co so chup anh phdng xa nhan, ky thuat sir dung ngudn phdng xa trong tham dd, ky (CAPX) cdng nghiep d ca 3 mien dat nudc. Tdng sd 135 thuat chup anh phdng xa dugc Ung dung trong thdi gian nhan vien phdng xa da dugc phdng van.
qua da mang lai nhUng Igi ich vd ciing to Idn. Tuy nhien, - Hd sd kham sire khde tuyen dung, kham sire khde
/ r\r\AA Tap chi
4/2011 BAO HO LAO DONG 11
KHOA H O C , CONG NGHE - CHUYEN GIAO
djnh ky
2. Phi/crng phap nghien culi, ky thuat ap dung - Nghien cUu md ta eat ngang
- Ky thuat ap dung:
+ Phdng van true tiep NLD dua vao bd cau hdi da dugc thiet ke sin.
+ Hdi cUu hd so khdm sUe khde ban dau khi tuyen dung, khdm sire khde djnh ky cua NLD.
- Sd lieu dugc xir ly, phan tfch bang cac phan mem Epi-lnfo 2002 va SPSS 16.0.
III. KET QUA NGHIEN CUU VA BAN LUAN
- Cac nhan vien lam viec tai cac ca sa phdng xa duac phong van nhQng thong tin ve sire khoe va mot so thong
Bang 1: Phan bo nhan vien theo gidi
\ ^ Ccjsd GidiMN.
NLD \ . ^ Nam
Ncr
Cong n
%
Co sd chieu xaCN
41 10 51 37,78
Cosd DKHN
9 1 10 7,41
Co sd sir dung TBBX
8 0 8 5,93
Cosd CAPX
66 0 66 48,89
Tong n 124
11 135
% 91,85
8,15
100,00 Bang 2: Phan bo nhan vien theo so nam lam viec hien tai
\ c c f s d
Sd n a m \
<5 5 - 9 10-20
>20
Co sd chieu xa CN n = 51 n
22 10 14 5
% 43,14 19,61 27,45 9,80
CosdDKHN n = 10 n
3 3 4 0
% 30,00 30,00 40,00 0,00
Co sd sir dung TBBX
n = 8 n
4 2 1 1
% 50,00 25,00 12,50 12,50
Co sd CAPX n = 66 n
55 11 0 0
% 83,33 16,67 0,00 0,00
Tong n = 135 n
84 26 19 6
% 62,22 19,26 14,07 4,44
fin ve DKLV co lien quan. Ket qua khao sat duac trinh bay trong cac Bang 1-^2.
Qua Bang 1 cho thay, nhan vien lam viee tai cac eo sd ed sir dung ngudn phdng xa chii yeu la nam gidi (91,85%), phu nU ehl chiem 8,15%. Dieu nay dugc ly giai do cdng viee tiep xiic vdi ngudn phdng xa la cdng viee thude loai rat ddc hai, cam phu nU lam viec theo quy djnh ciia Nha nude. NhUng nhan vien nff ma chiing tdi dieu tra chii yeu lam cac edng viee gian tiep, khdng tiep xue true tiep vdi phdng xa, nhu ke toan, bao ve hay nhUng edng viec hanh chfnh khae.
Qua Bang 2 eho thay, da sd nhan vien dugc phdng van cd tudi nghe dudi 5 nam (chiem 62,22%) va mdt sd it cd tudi nghe tren 20 nam (4,44%). Cd the thay nhan vien lam viec tiep xiic vdi phdng xa ed thdi gian lam viec tuong ddi dai, nhdm cd sd nam lam viec tu 10 nam trd len chiem tj' l§
kha cao (18,51%), trong dd ed mdt sd ft nhan vi&n da Idm vide tren 20 nam.
- Ve nguon phong xa tiep XUC ma cac nhan vien duac phong van co tiep xue, duac trinh bay trong Bang 3.
Qua Bang 3 cho thay, nhan vien lam viee trong cac cd sd cd sir dung ngudn phdng xa chii yeu tiep xue vdi tia gama (94,07%). Mdt sd nhan vidn phdng xa edn tiep xue vdi cac ngudn phdng xa khae: eo sd sir dung cac thiet bj do, DKHN cd nhdn vien tiep xue vdi ca 2 tia gama va notron; eo sd sir dung cdc TBBX trong tham dd Bang 3.: Nguon phong xa tiep
^ " ^ - • ^ Cosd
Ngudn tiS'p xue ^ " ^ \ Gama
Beta Anpha Gama va Notron Gama, Beta va Anpha
TiaX
XUC Co sd chieu xa CN
n = 51 n
51 0 0 0 0 0
% 100,00
0,00 0,00 0,00 0,00 0,00
CosdDKHN n = 10 n
9 0 0 1 0 0
% 90,00
0,00 0,00 10,00 0,00 0,00
Co sd sir dung TBBX n = 8 n
4 0 0 0 4 0
% 50,00
0,00 0,00 0,00 50,00 0,00
• -1 • '
Co sd CAPX n = 66 n
63 0 0 0 0 3
% 95,45
0,00 0,00 0,00 0,00 4,55
Tong so n = 135 n 127 0 0 1 4 3
% 94,07
0,00 0,00 0,74 2,96 2,22
.g » Tap chi Inr\AA
12 BAO HO LAO DONG 4/2011
gieng khoan nhan vien dugc phdng van tiep xiic vdi ca 3 tia gama, beta va anpha; cd sd CAPX, ngoai tia gama cdn ed nhan vien tiep xiic vdi ca tia X, tuy khdng nhieu. Khdng ed nhan vien nao dugc phdng van tiep xiic rieng re vdi tia beta va anpha.
- Ket qua phong van ve cong tac dao tao, huan luyen ATBX, theo doi lieu ca nhan, hudng dan ve quy tac, quy trinh lam viec tiep xiic vdi nguon phong xa ciia nhan vien cac ca sa co sir dung phong xa, duac trinh bay trong Bang 4.
Qua Bang 4 cho thay, viec trang bj kien thUc cho nhan vien ve ATBX dugc eae cd sd rat quan tam. Ty le nhan vien dugc dao tao, huan luyen vd ATBX trudc khi lam viec tiep xue vdi phdng xa chiem tdi 94,07%, nhan vien ed chirng chf dao tao, huan luy§n vd ATBX la 88,15%, 89,63% nhan vien dugc theo ddi lidu ca nhan va 97,78% dugc hudng dan ve cac quy tae, quy trinh lam viec tiep xue vdi ngudn PX. Tuy nhi§n, tai cd sd sir dung cac thiet bj do, dieu khien hat nhan , chi cd 50% nhan vien dugc dao tao, huan luyen ve ATBX trudc khi lam vi&c tiep xue vgi phdng xa. Cung tai cdc CO sd nay, ehi cd 40% nhan vien cd chirng chi dao tao, huan luyen ve ATBX, 30% nhan vien dugc theo ddi lieu ea nhan.
- Tinh hinh kiem tra mire do nhiem ban phong xa sau khi lam viec tiep xue vdi nguon phong xa dugc trinh bay
trong Bang 5.
Qua Bang 5 cho thay, viec thue hien kiem tra mUc dd nhidm ba'n phdng xa sau khi lam viec tiep xue vdi ngudn phdng xa chua dugc tdt. Cdn 38,52% nhan vien dugc phdng van khdng dugc kiem tra mUc do nhidm ba'n phdng xa sau khi lam vide tiep xue vdi ngudn phdng xa va 14,07%
thinh thoang dugc kiem tra. T^ le nhan vien thUa nhan thudng xuyen dugc kiem tra ehi' chiem 47,41%. Nhu vay, cac CO sd eung chua that su chu y den viec kiem tra mUc dd nhidm ba'n PX ciia nhan vien sau khi lam viee tiep xue vdi phdng xa.
- Tinh hinh kham site khoe nhan vien dugc trinh bay trong Bang 6.
Viec kham sUc khde ban dau giup phat hien nhUng nhan vi§n mac benh trudc khi vao lam viec tiep xue vdi PX, qua do danh gia dugc benh ed phai liSn quan den yeu td tiep xue vdi phdng xa hay khdng va tuyen chgn nhUng ngudi cd sUc khde phii hgp.
Kham sUc khde djnh ky hang nam giup phat hien nhUng benh mdi mac, mdi phat sinh trong qud trinh lam viec. Benh cd the' do anh hudng cua phdng xa, cung cd the khdng, nhung qua dd se ed nhUng can thiep kjp thdi nham han che tdi da nhUng anh hudng den sire khde nhan vien.
Qua Bang 6 cho thay: ve co ban, cac co sd da quan tam den viec kham sire khde ban dau trudc khi vao lam
Bang 4: Cong tac dao tao, hua'n luyen veA TBX, theo doi lieu
^"^•^^^^^^ Cosd Chi tieu ^""~~--^,^^^
Dugc dao tao, huan luyen ve ATBX trudc khi lam viec tiep XLic vdi nguon PX
Co chirng chi dao tao, huan luyen ve ATBX
Dugc theo doi lieu ca nhan Dugc hudng dan v6 cac quy tac, quy trinh ISm vi6c tiep xue vdi nguon PX
Co sd chieu xa CN n = 51 n 50 44 44 48
% 98,04
86,27 86,27 94,12
CosdDKHN n = 10 n 5 4 3 10
% 50,00
40,00 30,00 100,0
ca nhan
Co sd sir dung TBBX n = 8 n 8 7 8 8
% 100,0
87,50 100,0 100,0
CosdCAPX n = 66 n 64 64 66 66
% 96,97
96,97 100,0 100,0
Tdng sd n = 135 n 127 119 121 132
% 94,07
88,15 89,63 97,78
Bang 5: Kiem tra mi/c dp nhiem ban PXsau khi lam viec tli'p xiic vdiPX
\ . Cosd Tan s u a t ^ ^ ^
kiem tra ^ \ Khdng
Thinh thoang Thudng xuy6n
Co sd chi^u xa CN n = 51 ' n
13 7 31
% 25,49 13,73 60,78
Cosd DKHN n = 10 n
9 1 0
% 90,00 10,00 0,00
Co sd sir dung TBBX n = 8 n
2 0 6
% 25,00
0,00 75,00
Co sd NOT n = 66 n
28 11 27
% 42,42 16,67 40,91
Tdng sd n = 135 n
52 19 64
% 38,52 14,07 47,41
4/2011 BAO HO LAO DQNG 13
KHOA H O C , CONG NGHE - CHUYEN GIAO
Bang 6: Tinh trang kham si/c khde nhan vien
^ \ , ^ ^ ^ Cosd Loai hinh k h a r n \ ^ Kham SK ban dau Kham SK dinh ky
Co sd chieu xa CN n = 51 ' n
49 51
% 96,08 100,00
CosdDKHN n = 10 n
4 7
% 40,00 70,00
Co sd sir dung TBBX n = 8 n
7 8
% 87,50 100,00
Co sd CAPX n = 66 n
66 66
% 100.00 100,00
Tong sd n = 135 n
126 132
% 93,33 97,78
viec tai cac co sd cd tiep xiic vdi phdng xa va kham sUe khde djnh ky hang nam eho nhan vien. 93,33% sd nhan vien dugc kham sUc khde ban dau va 97,78% nhan vien dugc kham sUc khde djnh ky hang nam. Cd co sd 100%
nhan vien dugc kham sue khde ban dau va kham sUc khde djnh ky, nhu co sd CAPX. Tuy nhien, ty le nhan vien lam viec tai cac co sd DKHN duoe kham sUc khde ban dau
14,17 0 2
59,84
Bieu do I:
35
Phan loai 23,62
sire khoe
a SK loai 1
• SKIoai II DSK loai III n SKIoai IV
• SKIoai V
(
B$nh ung 1111/
B?nhTK, noitiit U lanh tlnh
Da lilu Benh mau Benh truyen nhilm
Benh tim maeh Benh cot s6ng Benh tieu hoa B$nhmat
) 1 2 3 4 5 6 1 1.84
1 1.84 J 2.^2
. ,.-=*^i.-^2.96 13.7
|4,44
| 5 . i y 1 5,93 15.93
Bieu do 2: Tinh hinh mdc benh 1
|6.67 8
va kham sUc khde dinh ky cdn thap (40% va 70%).
- Ket qua kham sUc khoe dinh ky gan nhat cua nhan vien phong xa tai cac ca sa khao sat dugc trinh bay trong Bieu do 1.
Qua Bieu dd 1 cho thay, nhin ehung, hau het nhan vien lam viec tai cac co sd cd sir dung phdng xa cd sUc khde thude loai tdt va trung binh (loai I den loai III chiem 97,64%). Sd nhan vien ed sUe khde rat yeu (loai V) chiem ty le thap, dd la nhirng nhan vien mac benh man tinh nhu benh tim maeh, benh ung thu, benh khdi u.
- Ca cau nhom benh ciia so nhan vien dugc phong van, trinh bay trong Bieu do 2.
Qua Bieu dd 2 eho thay, benh ve mat chiem ty Id cao nhat (6,67%), sau dd den benh tieu hda (5,93%), benh cdt sdng (5,93%), benh tim maeh (5,19%), benh truyen nhiem (4,44%), benh mau (3,70%). Dac biet, ed ca nhan vien mac benh khdi u (2,22%) va benh ung thu (1,84%),
Theo bao cao tdng ket ve tinh hinh benh tat chung trong cdng nhan eiia Bd Y te thi ty le mac benh ve mat la 6,7%, benh co xuong khdp chiem 3,55%, benh ve da chiem 2,53%, benh tim maeh 2,33%. Nhu vay, ty le mac benh cua nhan vien bUe xa trong nghien ciru nay chenh lech khdng nhieu, chua thay xua't hien cac benh lien quan den yeu td tiep xue vdi ngudn phdng xa trong nhan vien bUe xa d cac cd sd dugc dieu tra..
- Cac trieu chirng thu dugc thong qua phong van true tiep nhan vien dugc trinh bay trong Bang 7.
Qua Bang 7 ta thay, trong sd nhan vien dugc phdng van, eae trieu chirng thudng xuyen xua't hien ndi Chung thap, chi dudi 5%, 14 BAO HO LAO DONG 4/2011
Bang 7: Bieu hien trieu chi/nci
^^^-^^^ Tan suat
^"^^^---...jaiat hien Loai trieu ctiUng ^ ^ ^ - - . , . ^ Met mdi
Nhirc dau Mat ngu Tang tiet mo hdi NgUa
Xanh tim dau chi Kho da
Nirt ne da Rung toe
Hoa mat, cam giac ruoi bay Giam thi luc
Say thai (hoac vg say thai) De non (hoac vg de non) Con di dang
Sinh hoat tinh due giam
Thudng xuyen n
2 1 6 6 1 0 0 0 1 1 0 0 0 0 3
% 1,48 0,74 4,44 4,44 0,74 0,00 0,00 0,00 0,74 0,74 0,00 0,00 0,00 0,00 2,22
Thinh thoang n
28 22 20 7 10 0 2 2 6 12 17 1 0 0 9
% 20,74 16,30 14,81 5,19 7,41 0,00 1,48 1,48 4,44 8,89 12,59
0,74 0,00 0,00 6,67
Khong n
105 112 109 122 124 135 133 133 128 122 118 134 135 135 123
bleu hien
% 77,78 82,96 80,74 90,37 91,85 100,00
98,52 98,52 94,81 90,37 87,41 99,26 100,00 100,00 91,11
Tong n 135 135 135 135 135 135 135 135 135 135 135 135 135 135 135
% 100,00 100,00 100,00 100,00 100,00 100,00 100,00 100,00 100,00 100,00 100,00 100,00 100,00 100,00 100,00
nhieu nha't la trieu ehUng thudng xuyen mat ngii va tang tiet md hdi cung chi chiem 4,4% sd ngudi dugc phdng van.
Cac trieu chUng thinh thoang xua't hien thi gap nhieu hdn, nhu met mdi (20,7%), nhUe dau (16,3%), mat ngQ (14,8%), giam thj lue (12,6%). Dac biet, cac trieu chirng cd the ed lien quan den viec tiep xiic vdi phdng xa nhu de non, con di dang khdng gap trudng hgp nao va chi 0,7%
say thai.
IV. KET LUAN VA KHUYEN NGHj 1. Ket luan:
- Thdng qua phdng van vd hdi cUu hd sd kham sire khde eho thay: hau het cac cd sd cd sir dung ngudn phdng xa rat quan tam den van de kham sUe khde cho nhan vien, ke ea viee kham sUe khde tuyen dung vd kham sUc khde djnh ky hang nam.
- Ket qua kham cho thay, chua phat hien nhan vien mac cac bdnh vd phdng xa, mdt sd nhan vidn mac bfnh b cac chuyen khoa khae nhau va cd bieu hien cdc trieu chirng khde thudng khi lam vide. Tuy nhien, tj- le mac benh cung nhu tridu chirng ndi ehung thap, khdng khae bi^t so vdi ty If mac trong cdng nhan edng nghiep ndi ehung.
- Cac hd Sd dugc quan ly va luu giU day dii, dam bao tinh lien tue va ke thUa trong edng tae an toan bUe xa.
2. Khuyen nghj:
De dam bao an toan bUc xa eho nhan vi6n lam vifc tai cac Cd sd cd sir dung ngudn phdng xa, ddn vj can thue hien tdt mdt sd viee sau:
- Lidn tue dao tao, dao tao lai cho nhan vien vd van dd ATBX va dugc theo ddi lieu ea nhan theo dung quy djnh.
- cac CO sd can thudng xuyen thuc hidn kidm tra mire dd nhiem ba'n phdng xa sau khi lam vide tiep xue vdi ngudn phdng xa.
- Td chirc tdt vide kham sire khoe tuyen dung, kham sifc khoe djnh ky, kidm sodt chat che tinh hinh benh tat nhan vien hire xa, phat hien sdm, kjp thdi eae benh mdi mac.
Tai Neu tham khao
LBoYte (2008), "Bao ciio tinh hinh benh tat chung trong cong nhan".
2. Nguyen Thi Hong Tii (2005), "Toan cau hda va anh hudng den sire khoe NLD".Q
4/2011 BAO HO LAO DONG 15