OitU KIEN MOI TRU-QNG LAO DONG VA TJNH TRANG SLTC K H 6 E CONG NHAN KHAI THAC VANG TAI T I N H Q U A N G NAM
Tran Thj Ngoc Lan, Vien Chinh Chien*
Cue Qudn ly Moi tru&ng, Bp Yti, Hd Npi
* Vien Vi sinh Dich ti Tay Nguyin
TOM TAT
Oilu tra cat ngang thuc trgng mdi tru-dng lao dOng va su-c khoe ngu-di lao dpng khai thac vdng tai huyen Thang Binh, tinh Quang Nam nSm 2009, kit qua cho thay: - Moi tardng lao dOng bi 6 nhilm n|ng nl, hdm lupng Si02 trong bgi ti> 87,2 - 97,3% ; ning Qi> bui tai cac vi tri lao dong tCr 0,61 - 149,7mg/m3 co tdi 80% mlu do bui vupt TCCR - Trong ting so dilu tra (92 ca), ty l# c6 bilu hien lam sang la 78,2% ; co rli loan chUc nSng phii Id 52,2%. Ty le bi benh bgi phoi Silic d p tinh Id 18,48% ; bi Silico-Lao la 18.48%, bi Lao Id 7,6% vd nghi Lao Id 30,4% - ting cOng cac ca b$nh vd nghi benh Id 47 ngu-di co 75%. - 47 ca trong nhdm bi b$nh vd nghi b$nh theo doi dupe sau 4 thang - co 2,1% bi tir vong (byi phii Silic thi C);
27,5% c6 bilu hi#n tang ngng b^nh d cdc ca bui phii silic va silicose-lao; 6,4% co giam ton thuong diu Id cdc ca bi Lao. Ddy Id kit qua ddng bdo dOng v l nguy co benh tdt cho nhOng ngu-di Idm nghi khai thac vdng tu do tai Vi$t Nam.
I. DAT VAN DE
(5 Viet Nam, benh byi phoi silic chilm ty le cao nhat trong sd cac benh nghi nghiep dugc bao hiem. Sd lieu cgng ddn cho thiy din nam 2010 cd 26.972 ngudi lao dgng dugc cip sd bao hiem vl benh nghi nghiep, trong dd ban 75% cdng nhan mic benh bui phdi-silie [1-3].
Tir thang 2/2009 din thang 4/2009 d Viet Nam xuat hien rit nhilu bai bao, thdng tin tren mang vl 'benh la' tren ngudi dan dao vang tu do d Quang Nam lam chet ban 10 ngudi trong vdng 6 thang vdi chan doan khdng rd rang gay xdn xao du luan [4-9]. Kit qua chin doan tir cac benh vien Lao va benh Phdi tai Ha Ngi va thanh phd Ho Chi Minh hudng nhieu tdi benh viem phdi ke chua rd nguyen nhan hoac benh bui phdi Silic. Vi vay.
nghien ciru dieu tra thuc trang benh bui phoi silic nghe nghiep tren cdng nhan dao vang dugc tiln hanh nham lam rd van de nay
Muc tieu nghien ciru:
2.1. Danh gia dieu kien lam viec va mdi trudng lao dgng tai md khai thac vang Thang Binh- Quang Nam.
2.2. Tim hieu thuc trang siic khde ciia cdng nhan khai thac vang sdng tai 2 xa Binh Djnh va Binh Trj thugc huyen Thang Binh.
Tren eo sd ket qua nghien ciru, dl xuit cac giai phap ve An toan ve sinh lao ddng phii hgp ap dung cho ddi tugng nghien ciru.
II. PHU-ONG PHAP NGHIEN CUtJ Ddi tugng nghien ciiu la 92 ngudi lao dgng lam nghe khai thac vang tu do 02 xa Binh Tac gia: Trin Thj Nggc Lan
Dja chi: Cue quan ly mdi trudng, Bd Y tl Di?n thoai: 0945969889
Email: [email protected]
Djnh va Binh Trj cua huyen Thang Binh, tinh Quang Nam. Nghien ciiru dugc tiln hanh trong thdi gian tir thang 4/2009 din thang 12/2009 vdi phuong phap nghien ciiru cit ngang kit hgp hdi ciru cac trudng hgp nghi ngd "benh la"
Ngi dung nghien ciiru la khao sat danh gia dieu kien mdi trudng lao dgng cua ddi tugng nghien ciiu tai khu vyc khai thac vang d huyen Thang Binh; td chiic phdng van, kham siic khde va chup X-quang phdi cho tat ca 92 ddi tugng trong nhdm nghien cu'u [10].
Xir ly sd lieu bang phan mem EPI Info 6.04 va Excel va cac thuat toan thdng ke dimg trong y hgc.
IIL K E T QUA
3.1. Danh gia dieu kien moi trvdng lao dong tai ham khai thac vang
Quan sat va phdng van cac ddi tugng nghien ciiu cho thay cdng nhan khai thac vang lam viec trong dieu kien khdng dam bao An toan Ve sinh lao dgng. Mdi ham md cd chieu ngang hay ban kinh khoang dudi 1 m, chi dii de chui Igt 1 ngudi va chieu sau khoang 15-20m, khdng cd thdng khi nen khdng khi trong ham Id het sire nggt ngat vdi bui day dac. Cdng nhan khdng dimg khau trang do do am ket hgp vdi nhiet do cao trong ham Id gay khd thd. Ket qua do ndng do bui toan phan va ham lugng silic tu do trong bui va mau da lay tai khu vyc ham Id dugc trinh bay tai Bang 1:
Bang 1. Kit qua do ndng do byi toan phin va Silic ty do trong khdng khi mdi trudng lao dpng.
TT 1.
2.
3.
4.
5.
1.
2.
3
Vj tri do
Vi tri cdng nhan dai vang (cgnh may xay da dang boat dpng) Vi tri mdy xay da
Tren cu-a ham khai thac vang
Ben trong ham khai thac vang (each cii-a him 15m) Ben trong h i m khai thac vang, vj tri cdng nhan khoan da
TCCR
Trpng luong bui (mg/m3) 57,0
107,0 0,6 92,0 149,7
1 mg/m3 Ham l u ^ n g Silic t y do
Miu da trang Mlu bgi da Mlu da xanh
97,3%
87,2%
61,7%
Ket qua khao sat cho thay tai tat ca cac silic ty do trong cac mau bui do dugc rat cao vj tri lao dgng trong khu vyc ham vang cd ndng tir 61,7-97,3%.
do bui cao gap 57-150 lan TCCP ; Ndng do
198
Tap chi Y hpc dy phong. Tap XXI, sd 3 (121)Bang 2. Kit qud do nOng d$ hoi khi ddo trong khdng khi mdi trudng lao dpng him vang (mg/m3)
Vi tri do
TCCP
C02 S02 1 Canh may xay da
2 Vj tri m^y xay dd
3 Tren cira ham khai thdc vang
4 Ben trong h i m khai thac vang (each cu-a him 3m) 5 Ben trong ham khai thac vang, vj tri cdng nhan khoan da
1042 1,31 1044 1,31 1128 1,81 1224 1,81 1350 1,81 1800 10
Ndng do hoi khi dgc CO^ va SO^trong khdng khi mdi trudng lao ddng tai cac vj tri do nim trong kholng TCCP. Cac loai hoi khi dgc khac nhu H,S, HC, NO,, CI, khdng phat hien dugc trong cac mau khdng do.
3.2. Ket qua kham va chan doan benh
3.2.1. Thong tin chung ve doi tuffng nghien ciru
Bang 3. Phdn bd ddi tuQ'ng nghien cuu theo dja du, tudi ddi v i tham ni§n nghi nghiep khai thac vang
Thdng sd Sd lu-Q'ng (n) Ty 1$ (%)
Phdn bd theo dja du - Xa Binh Djnh - xa Binh Trj
67 25
72,8 27,2 PhSn bd theo tudi ddi
- < =30 tuoi Tir 30-40 tuoi Tir 40 - 50 tuoi Tr§n 50 tuoi
20 50 15 7
21,7 54,4 16,3 7,6 Phan bl theo tudi nghi
- Dudi 3 nSm - 3-5 n§m - > 5 nam
42 42 8
45,7 45,7 8,6
Tdng s6 92
Ddi tugng nghien ciiru gdm 92 ngudi, sdng tap trung tai 2 xa Binh Trj va Binh Djnh, trong dd nhieu nhit cac ddi tugng d xa Binh Trj (noi cd md vang) chilm 72,8%; Nhdm tudi ddi dudi 30 tudi chiem 21,7%; Cao nhit la d nhdm tudi 30-40, 3.2.2. Ket qua kham lam sang
chilm 54,4%. Tudi nghi cua ddi tugng nghien ciru chu ylu la dudi 5 nam (91,4%), trong dd mgt nira la dudi 3 nam lam nghe khai thac vang. So ddi tugng lam viec khai thac vang ed tham nien tren 5 nam chiem 8,6%.
T y le % 90.00 80.00 70.00 60.00 • 50.00 • 40.00 • 30.00 • 20.00
10.00 0.00
68.48
4.f.48 30.43
i , • • - ' _ . .
'c
' '53.26
•^ ^
7H.2(^
Ho Turc ngirc Kho iha Dau ngi,rc Khac d a m Tong chung Trieu chvng
Bilu dd 1 Ty le cac trif u chu-ng lam sang ghi nh^n qua kham benh.
Ket qua kham lam sang cho thay phan Idn cac ddi tugng nghien ciru thudng bj cung luc 2-3 trieu chirng ve dudng hd hap, chu yeu la ho kem khac ddm, khd thd hoac dau turc ngye.
Cd 72 ca (chiem ty le 78,3%) cd bieu hien lam sang ve hd hap nhu ho, tuc nguc , khd thd khi gang sire.
Phan tich theo phan bd do tudi cho thay 3.2.3. Ket qua chup phim X-quang phoi.
Ty I? •/.
80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00
ty le xuat hien cac trieu chirng lam sang ed xu hudng tang dan theo tudi ddi va tudi nghe. Dac biet tat ca 100% cac ddi tugng lam viec khgai thac vang tren 5 nam deu cd trieu chirng lam sang ve dudng hd hap; Nhdm ddi tugng nghien ciru ed tudi ddi tren tren 30 nam thi tren 80%
deu cd trieu chiirng lam sang.
1K.4K IK.4K
7.61
3 0 4 3
' '-K ;
Silico Silicu-Lau Lau Nghi nga (lau) Chung Chan doan d ^ tren phim XQ
Bilu dd 2. Ty l# cac lo^i bf nh theo kit qui chyp phim
200
Tap chi Y hpc dy phong. Tap XXI, sd 3 (121)Tir Bieu dd 2 cho thiy, theo kit qua chin doan bang hinh anh tir phim chup X-quang phdi dua theo bang phan loai benh bui phdi nam 2000 cua Td chirc lao ddng quoc tl cho thiy trong nhdm ddi tugng nghien ciru (72 ngudi
cd trieu chiing lam sang he hd hip), t> le mic benh bui phdi Silic don thuin va Silicosis kit hgp Lao phdi rat cao, chilm tdi 37% tong sd ea dieu tra. Dac biet cd 4 ca ed hinh anh benh bui phdi silic the the khdi.
Te It- 7.00 - 6.00 - 5.00 • 4.00 • 3.00 • 2.00 • 1.00 • 0.00
%
1 5.43
'/
'heo/ 1 1
5.43
"he 1 0
(i S2
Hic 1/
0.00
2.17
'
1 The 1 '2 The 2/2
1.09
T h c K h Cl
The benh theo ILO
Bilu dd 3. Phan lo^i t h i b#nh bui phoi silic trong ddi tu-<;mg nghien ciru
Tir kit qua cua Bieu dd 4 cho thay, trong nhdm ddi tugng mac benh bui phdi-silic cd 6,52% d t h i 1/1; 5,43% thi 1/0; 2,17% thi 2/2. Dac biet ed 4 ca cd hinh anh benh bui phdi silic thi the khdi, trong dd 3 ca thi B va 01 ca thi C, chilm 1,09%) sd phim chup. Trong 4 ca
cd hinh anh silicosis the khdi. cd 2 ca the khdi B d do tudi 30-40: 01 the khoi C a do tuoi 40- 50 va 01 ca the khdi B d dp tudi tren 50. Tat ca 4 ca benh bui phoi silic the khdi deu nam trong nhdm cd dudi 3 nam tudi nghe.
3.2.4. Kit qud do chirc nang ho hdp.
Bang 4. Phan bd cac ca bilti ddi CNIHH theo tuoi ddi va tuoi nghi trong sd tru-dng hop cd bilu hien lam sang (n=72)
Thdng sd So ca cd rdi loan CNHH
Ty le %
H^n che Tac nghen Phan bd theo tudi ddi
< =30 tuoi Tir 30-<40 tuoi Tir 40 - < 50 tuoi Tren 50 tuoi
7 19
9 3
35,0 58,0 53,3 42,9
6,7
Phan bd theo tuoi nghi Dudi 3 nam
3- 5 nam
> 5 nam
10 23 5
47,6 54,7
50,0 12,5
Tong sd 38 52,1%
Ket qua do chiirc nang hd hap cua 72 ddi tugng nghien ciru cd bieu hien lam sang hd hap cho thay tdng sd cd 52,1 % ca cd rdi loan chirc nang hd hap. Trong 17 ca mac benh bui phdi silic cd 14 ca ed hgi chirng han ehe-chiem ty le 82,4%; Trong 17 ea bj Silicosis va Lao phdi hgp, cd 16 ea ed RL CNHH, chiem ty le 94,1%.
Phan tich theo phan bd tudi ddi va tuoi nghe cho thay ty le cd rdi loan chirc nang hd hap cd xu hudng tang dan theo tudi ddi va tudi nghi rd ret. Nhdm tudi 30-40 cd ti le RL CNHH chiem 58%; nhdm 40-50-chilm 53,3%. Nhdm cd tudi nghe dudi 3, 3-5 va >5 nam cd ti le ddi tugng cd RL CNHH chilm lin lugt 47,6; 54,7 va 62,5%.
3.6. Ket qua theo doi chuyen bien tren phim X-quang sau 4 thang :
Sau 4 thang chiing tdi da tien hanh theo ddi chup lai 63 ddi tugng trong dd cd 47 ddi
tugng benh ly d lan 1, vdi tdng cdng 91 phim.
ket qua cd 12/ 47 ddi tugng cd bieu hien tang nang cac tdn thuong tren phim X-quang phdi (chiem 27,5%) cu the:
- 4 trudng hgp the khdi (2A va 2B, trong dd 2 trudng hgp nghi ngd the A chup phim lan 1 da phat trien rd tdn thuong rd ret dang the khdi A) deu cd tdn thuong lan rgng hon lan 1. Cd 1 trudng hgp tir the B chuyen sang the C.
2 trudng hgp tir the 1/1 p/q va q/p dang ed xu hudng chuyen thanh the khdi A (chiem 4,3%>). 4 trudng hgp cd xu hudng tang ve mat do (til' 0/1 len 1/0; 1/0 len 1/1 va 2/2 len 2/3) chiem 8,7% va 02 trudng hgp cd xu hudng tang ve kich thudc (tir p/p len p/q) chilm 4,3%.
- Cd 03 trudng hgp ed giam tdn thuong tren phim X-quang deu la cac ca lao phdi don thuan. Ngoai ra trong 4 thang theo ddi, cd them
1 trudng hgp tiir vong (ca thi C cua lin 1).
202
Tap chi Y hpc dy phdng. Tap XXI, sd 3 (121)V. KET LUAN
Dieu kien mdi trudng lao dgng eiia cdng nhan khai thac vang tai 2 xa Binh Djnh va Binh Trj, tinh Quang Nam khdng dam bao an toan ve sinh lao ddng do tiep xiic vdi bui d ndng do cao gap 65-150 lin TCCP. Ham lugng silic ty do trong mau bui va da tai cac vj tri lao ddng la rit cao: 61,9-97%.
Do tiep xiic vdi ham lugng bui cao va cd ndng do silic tu do trong bui khdng khi mdi trudng lao ddng rit Idn, kit hgp vdi dilu kien lao ddng dac biet nang nhgc dgc hai nen cdng nhan khai thac vang trai phep bj mic benh bui phdi silic cap tinh cd tien trien nhanh va mire do benh rat nang. Ddng thdi day cung la dieu kien thuan lgi cho benh lao phdi ket hgp vdi benh bui phdi-silic phat trien trong nhdm ddi tugng nghien ciiu.
Ty le bj benh bui phdi nghe nghiep trong ddi tugng nghien ciru qua dieu tra rat cao, tdi 75% cac ddi tugng dugc dieu tra nam trong dien cd benh va nghi benh, trong dd benh bui phdi silic chilm 18,48%;Silicosis-lao: 18,48%;
Benh lao phdi chilm 7,6% va sd trudng hgp nghi ngd mic Lao len tdi 30,4%). Cd tdi 78,2%
doi tugng dilu tra cd bieu hien lam sang va 52,2% cd rdi loan chiire nang hd hip.
Tiln triln cua cac ea benh theo mat do va kich thudc cac dam md hoac not xo hda hinh tron diu tren phdi ciia cac ddi tugng mac benh bui phdi-silic don thuan hoac silicosi-lao phdi hgp sau 4 thang theo ddi tang rit nhanh.
KIEN NGHI.
Tir kit qua dilu tra ca benh cac trudng hgp byi phdi Silic cip tinh tai Thang Binh Quang Nam cho thiy hifn nay vln tdn tai nhii-ng hilm hga cue ky nguy hai cho sire khde cgng ddng va ngudi lao dgng tu do song hg hoan toan khdng nhan bilt dugc va chua cd kiln thiirc vl b?nh nay (kl ca y te co sd tuyIn
xa, thdn). Do vay can sdm xay dung mgt md hinh phdng chdng benh bui phdi Silic cip tinh cho cdng ddng lao dgng tu do.
TAI LIEU THAM KHAO
1. Nguyen Duy Bao, Nguyin Kim Giao, Nguyen Bach Nggc va cs, Nghien ciiu benh bui phdi Silic trong cdng nhan khai thac da va thu nghiem phdng chdng bui bang khau trang cd hieu suat Igc bui cao, Bao cao tai hdi nghj qudc te ve Y hgc Lao ddng va Ve sinh Mdi trudng lin thiir hai, thang 11-2005, trang 114-115.
2. Ta Tuyet Binh, Le Trung. Pham Nggc Quy.
Nghien ciiu ve rdi loan thdng khi phdi va phan tich khi mau d cdng nhan tiep xiic nghe nghiep vdi bui Silic, Bao cao tai hgi nghj qudc te ve Y hgc Lao ddng va Ve sinh Mdi trudng lan thiir nhat , thang 11-2003, trang 49-50.
3. Vien Chinh Chiln, Phiing Thj Thanh Tu, Nguyen Thj Hdng Tii va cs, Ket qua dieu tra giam sat diem tinh hinh benh bui phdi silic d miln Trung Viet Nam, Bao cao tai hgi nghj thudng nien lan thir 18 cua td chirc An toan - Ve sinh lao dgng khu vuc chau A -Thai Binh Duong (APOSH018), Ha Ngi 10/2002, trang 374-379.
4. Dd Ham, Nguyin Nggc Anh, Nguyen Thj Thu Ha, Benh bui phdi silic trong cdng nhan mgt sd nganh nghe d Thai Nguyen, Bao cao tai hdi nghj qudc te ve Y hgc Lao ddng va Ve sinh Mdi trudng lin thir nhat, thang 11- 2003, trang 130
5. Le Trung , benh bui phdi silic, Benh nghi nghiep , nha xuit ban Y hgc, 1994 , trang 295-353
6. Vien YHLD &, VSMT, Benh bui phdi silic nghi nghiep. Ha Ngi nam 2002, Uang 53-83.
7. XDC, weekly, July 18,2008/57(28); 771-775 8. Cherniack M. The Hawks' Nest incident:
America's worst industrial disaster. New Haven, CT: Yale University Press; 1986.
9. National Institute for Occupational Safety and Health. NIOSH hazard review. Health eflfeets of occupational exposure to respira- ble crystalline silica. Washington, DC: US Department of Health and Human Services,
CDC, National Institute for Occupational Safety and Health; 2002.
10. Wise RP. Livengood JR, Berkelman RL, Goodman RA. Methodological alternatives for measuring premature mortality. Am J PrevMed 1988;4:268-73.
WORKING ENVIRONMENT CONDITION AND HEALTH STATUS OF GOLD MINERS AT QUANG NAM PROVINCE
Tran Thi Ngoc Lan, Vien Chinh Chien*.
Health Environment Management Agency, Ministry of Health, Hanoi
*Institute of Hygiene Epidemiology of Tay Nguyen In 2009, according the report from some
lung hospitals in Quang Nam province and HCM city, there were some cases of "strainge lung disease" found in patients who live in two communes and work in a short time and in the same gold mining in Quang Nam province. In order to clairily this information, a case study on investigation of pneumoconiosis diseasis among gold mining workers have been caried with Objectives: i)To investigate work condi- tion and environment in gold mine in Thang Binh- district, Quang Nam province, and ii) To evaluate a health status of gold miners living in two communes Binh Dinh anh Binh Tri, Thang Binh district
Methods: Using cross-sectional and forlow-up study in short time. Epidemiology investigation and health examination for all il- legal gold miners working at Dong Gia gold mine, living in Binh Dinh & Binh tri com- munes in Thang Binh district, Quang Nam province. Measure dust concentration in work- place and analyzing Si02 concentration in re- spirable dust. The data analysis by rate % ac- cording to some epidemiological characteristic (hazadous factors in workplace, age group, and work time) and clinical findings (symptoms, chest-radiograph signs).
Resuh: work condition and environment in of gold mine causes a high risk for health of workers. The average concentration of dust in work sites is 63.04mg/m3 of air. Concentration of free silica in dust takes 87.3-97.3%; Among 92 investigated workers, 78.2% suffer from respiratory symptoms such as cough, sputum, chest pain, breathness and 52.2% had respi- ratory disfunction. Diagnosis of lung diseases based on chest radiograph shows that there are 11.96% of workers suffered from Silicosis;
18.48%) workers have chest x-ray image as Silico-Tuberculosis; Simple tuberculosis takes 7.6%, There were 4 eases with massive silicosis (category B and C by ILO 2000 classification of pneumoconiosis), contributed 4.4%. After 4 months flow-up by X-ray, there were 27.5%
cases increasing Silicosis (more seriously than before), one case C level was died.
Conclusion: Illegal gold miners working at Donggia gold mine had worked in very bad environmental that eaus e take high illness and many person die by pneumoconiosis (acute Silicosis and Silico-Tuberculosis). We will need carry out emergency activities to preven- tive new cases and reduce damage patients.
Keywords: Silicosis, Tuberculosis, Sili- co-Tuberculosis, free silica dust (Si02), respi- ratory function.
