Y HQC VI$T NAM T H A N G 8 - S 6 1/2012 NGHI£N C|)U DAC D I ^ M B | N H BUI PHOI S I U C or CdNG NHAN DONG TAU HA LONG N A M 2010
P h ? m TCing L S m * , P h ^ m N g p c C h f t u * * , T r a n VSn T u S n * *
T6M rkr
Nghien ctjfu dm?c tien hanh tren 751 cdng nhSn nh^ miy dong t^u H^ Long. ChSn doan b§nh bgi ph6l- silic bSng X quang phdi theo tl§u chuSn cua ILO (2000). K§t qud nghien cdU cho thSy ty 1^ nghl ngd vh mSc BBPSi Id 5,8%. Trong dd cd 1,9% \h chSn dodn di3c ch3n mSc BBPSi ( t h l 1/0 p trd l#n) vi 3,9% Id nghi ngd m k BBPSi (thg 0/1 p). PhSn xudng vo tdu co ty I? nghi ngd va mSc BBPSi cao nhSt (10,0%), Oep a§n id nhdm phdn xudng Ldm sgch vd sdn (3,4%).
NhiJng nghe nghi?p cd ty If nghi ngd mSc vd mSc BBPSI cao la phun hat mdi, go ri, phun cdt, xuc hgt mai, hdn, sdn (5,2% vd 2,8%) vd gia cdng v6, ldp rdp vo tdu, cStJidi, cdt mdy (1,9% vd 0,4%). Nh6m cdng nhan cd tuoi nghe >10 n5m cd t^ I? nghi ngd mSc vd mdc BBPSi (13,8% vd 6,7%) cao hdn so vdi nhdm <10 ndm (0,4% vd 0,2%), si; khac bi?t cd y nghTa ttidng ke vdi p<0,001.
SUMMARY:
THE STUDY ON CHARACTERISTICS OF SIUCA- DUST LUNG DISEASE OF HALONG SHIPMENT'S
WORKERS I N THE YEAR 2010 The study was conducted on 751 workers of Ha Long shipment factory. To diagnose silica-dust lung disease by lung X-ray acconjing to the ILO standards (2000). Study result shows that the rate of doubts and contract BBPSi was 5.8%. Of which 1.9% is certainly getting BBPSi diagnosis (type 1/0 p or higher) and 3.9% were suspected contract BBPSi (type 0/1 p). The Ship sheil factory has the highest rate of suspicion and contract BBPSi (10.0%), followed by Oean and paint fectory (3.4%). Occupations have high rate of suspected infection and contracting BBPSi is abrasive blasting, type rust, sand blasting, abrasive contact, welding, painting (5.2% and 2.8%) and processing of shell, ship shell assembly, vapor cutting, machinery cutbng (1.9% and 0.4%). Worter group with working age > 10 years with suspected infecbon rate and getting BBPSi (13.8% and 6.7%) is higher compared with those <10 years (0.4% and 0.2%), the differences were statistically significance with p <0.001.
I. D^J V A ' N O E
Viet Nam nam ben bd bien Ddng vdi hang nghin ki Id met bd bien va them luc dja. Viec xay
di/ng vh phdt trl^n n g i n h cdng nghlip ddng tSu IGI mdt trong nhutig nhiSm vg cd tfnh chat chien luidc trong s i / nghl|p p h k trien kinh ti cung nhU cCing CO an ninh- qudc phdng. Trong c^c phSn xudng cua nhci mciy ddng thu, c^ng nhan phcil t r y t ti§p ho$c gidn tiep tiep xdc vdl c^c yeu t d bat ldi cua mdi tru'dng lao ddng: ndng ^ m , bgi, tieng on, hdi khi dpc, sdn, xSng... [ 3 ] , [ 5 ] , [ 6 ] .
Nha mdy ddng tdu H^ Long la mpt ddn vj thdnh vi§n cua tap doan cdng nghiep tiiu thuy ViSt Nam (VINASHIN). Hang nSm, ddn v! da duy tri v i ^ kiem tra mdi tru'dng lao ddng, kham sdc khde djnh ky va kham benh n g h i nghidp kha dSu ddn. Mdi tru'dng lao dpng cung da du'dc cai thi?n dang ke. Tuy nhien, do ddc diem lao ddng nen mpt sd yeu t d nguy cd cua mdi tru'dng lao dpng cd the dan den cac benh nghe nghiep va nhieu benh ly cd ti'nh chat nghe nghiep khac. Trong dd hai benh ly cd nguy cd cao la bui phdi- silic (BBPSi) va d i & nghe nghiep [ 6 ] , [ 7 ] .
Xuat phat tiT thu'c te d d , chung tdi tien hanh nghien curu de tai nhSm muc tieu: Mo ta dSc diem benh bui phoi slllc & cdng nhan nha miy dong tau Ha Long, nam 2010.
II. o o ' l T l i p N G VA PHUONG P H A P NGHIEN CCTU 2 . 1 . O d ! t u ' d n g n g h i e n cuTu: Gdm 751 cdng nhan nha may ddng tau Ha Long.
2.2. Phu'dng p h ^ p n g h i e n ci?u
* Thiet ke nghien cuti vi cffmau:
Thiet ke nghien ciili: md ta cdt ngang cd phan tich.
- Cd mau: theo cdng thiTc djch te hpc md ta, u'dc tinh la 380 ngu'di, thu'c te da nghien culj 751 ngu'di.
* Phu'dng phip chin doan benh byi phoi- silic bing X quang phoi.
Tien hanh chyp X quang phdi cho 751 cdng nhan nha may ddng tau Ha Long bang may XQ ca sdng VISITOR AR 30 cua UALIA.
- Chup phim XQ phdi va danh gia theo ILO 2000: chup tu' the sau - tru'dc, phim 30 x 40cm l<hi benh nhan dang d thi hit vao gang su'c.
* ; Cue Yte, Bg Glao diong van tai, **:_ Hoc vien Quan y Phin biSn khoa hpc: PGS.TS. Nguyin Titng Linh
•f HQC VIJT NAM T M A N Q 6 • Stf 1f2012
• S i n h g i i cic t h l BBPSI nghS nghl$p:
+ M^t d^i 4 lo«l.
. Lo«l 0: kh&ng c6 cic nSt mA nhd hojjc cA It hdn gidl h;n, dudi lo^l 1.
. Cic lo^l 1, 2 v i 3: t h l hl$n m$t d4 t i n g dSn cic nSt md nhd ( x i e d|nh bing cich so vdl cic phim m l u tuQng ijlig).
+ D6I vdl cic h?t md trdn nhd, k^ hl^u cua 3 kich thu>>c khic nhau: p (dudng k(nh khang q u i 1,S mm), q (dudng kinh khoing 1,5 • 3 mm) v i r (dudng kinh khoing 3 - 1 0 mm).
+ 061 vdl cic sdi md nhd khdng dSu, ky hl^u cua 3 kich thudc khic nhau l i s (chlSu rdng III. K C T Q U A N G H I I N cijru
khSng q u i 1,5 mm); t (chlSu rdng tir 1,5 - 3 mm) v i u (chlSu li^ng tCr 3 - 1 0 mm).
+ Vdl c i c d i m md Idn t i * i 1 cm du'dng kM cic t h l b$nh dudc xie djnh theo kich thudc ri chia l i m 3 lo^l A, B v i C.
Phim do Hpl dSng a<jc phim cua Trung tin Bio v^ Slit khde lao ddng v i Moi trudng GTWoi mdi chuyin gia, H^l d8ng Glim d|nh Y kta GTVT thg'c hl|n. O9C theo phuOng phip m ^ Sn, h$l chin cic chuyin gia, so sinh vdl phim mau cCia ILO.
> Xiy / y tff llfu: theo phudng phip ttiS^
k l y sinh hijc bing phin m i m SPSS 131
Phin xudng
V6tJu U m sach v i son Thiet b|, Ong tiu, Sl^n tiu, Trends
T6nqs5
n
301 325 125 751 P
Nghl ngd ( t h « 0 / l p ) S6 lu'dng
19 8 2 29
T y l *
(%)
6,3 2,5 1,6 3,9
<0, Mic ( t l i e >
S«
luidng 11 3 0 M 001
bfnh I / P E L
T y l * { % ) 3,7 0,9 0 1,9
T5ng s5 So IUdng
30 11 2 43
Tyll
(%)
10,0 3.4 1,6 5.8 Cac so lieu d bang 1 cho thay ty le nghl ngd va mic BBPSi d cdng nhin n h i m i y ddng tau H;
Long la 5,8%. Trong do cd 14/751 tru'dng hop (1,9%) chan doin chSc diSn mSc BBPSI ( t h l 1/0 pirt len) va 29/751 tru'dng hdp (3,9%) nghl ngd mSc BBPSI (the 0/1 p). Phin xuOng vd tau co ty le nghl ngd v i mic BBPSI cao nhat (10,0%), tiep den l i nhdm phan xuftig L i m sach v i sdn (3,4%), it iiiiS la cac phan xUdng Thiet bj, Ong t i u , Dien tau va Trien da ( 1 , 6 % ) , stf khic bi|t od y nghia dwng l i vdi p<0,001.
KSt q u i PhSn loal ti«n phim XO Loai 1/0 p Loal 1/1 p Loai 2/1 po Loai 2/2 00
SSIuWns 9
Ty le (%) 64,3 3 1 21.4
1 7,1 1 1 7,1
Qua bang 2 thay trong so cdng nhan ddng tau mSc BBPSi thi da so la the I p (1/0 p la 64,3% va 1/1 p la 21,4%), chi cd 2 tru'dng hdp lo?l 2 (14,2%).
Bing 3. Tv le BBPSi theo chu'c danh nahe nahieo ir\
Nghe nghl$p Gia cong vo, l3p rip v6 t i u , cSt hoi, cit mdy
Phun hat mii, go ri, phun cit, xiic hat mil, hin, son
Phong dang, trien da, ong t i u , giin dao, dien, mav
n
262 462 27
=751).
Nghl ngd (the 0 / l D ) SS luidng
5 24 0
T * l« ( % ) 1,9 5,2 0
M i c benh ( t h e > l / O p ) _ SoluVng
1 13 0
TV l e t * ) . 0,4 2,8 0 p<0,05
Y HQC VI$T NAM T H A N G 8 - S 6 1/2012
Qua b i n g 3 t h i y nhom nghe nghidp phun hat m i l , go ri, phun cat, xijc hat m i l , h i n , sdn c6 ty* 1^
nghi ngd va m i c benh BBPSi cao n h i t ( 5 , 2 % v i 2,8%), t i l p den l i nhdm gia cdng vd, l i p r i p vd t i u , c i t hdi, c i t may ( 1 , 9 % v i 0,4%).
Bing 4. Ty le mSc BBPSI theo qidi b'nh (n= 751).
BBPSI Nghi nqd (the O/lo) Mlcbenh(t)ie21/0p) P
n
29 14
Gidl tinh N a m ( i i
SS IUdng 19 12
= 606) T * l « ( % )
3,1 2,0
NO' ( n = 145) SS IUdng
10 2
T l > l « ( % ) 6,9 1,4 p>0,05
KS qua d bang 4 cho t h i y ty I I nghl ngd m i c v i m i c BBPSI khdng khic bUt theo gkSi d'nh (p>0,05), Bing 5. Ty le m i c BBPSI theo tudi ddi ( n = 751).
TuSi ddi
<35 tuoi (n=: 538) So ludng T y i f c y - )
£ 3 5 tuSi ( n = 213) S d l u d n g T v W ( % )
Nghi ngd (die 0/lp) 27 12,7
Mic benh (the al/Opi 14 6,6
< 0,001
K ^ qua d bang 5 cho thay nhdm cdng n h i n i 3 5 tuoi cd ty le nghi ngd m i c v i m i c BBPSi (12,7% va 6,6%) cao hdn so vdi nhdm <35 tudi (0,4% v i 0%), sU khic bet o6 y nghla thdng ke vdi p<0,001.
Bing 6. Ty le BBPSi theo tuoi nghe (n= 751).
< 1 0 n a m ( n = 5 5 6 ) Tuoi nghie
SS IUdng T v l l ( % l So IUdng T y l e O d l
>10 n i m ( n = 195)
Nghi ngd (the 0/lpl 0,4 27 13,8
l ^ k benh (the >l/Op) 14 0,2 13 6,7
E 1 < 0,001 I Qua bang 6 thay nhdm cdng n h i n cd tuoi nghe >10 n i m cd ty le nghi ngd m i c v i m i c BBPSi
(13,8% v i 6,7%) cao hdn so vdi nhdm <10 n i m ( 0 , 4 % va 0,2%), sU khac biet cd y nghla thong ke vdi p<0,001.
IV. BAN LUAN
Mdi tru'dng lao ddng ciia cdng nhan ddng tau bi 6 nhiem bdi nhieu yeu t d bat ldi, d i e biet l i nong dp bui cd ham IUdng silic tU do cao la nguyen nhan dan den BBPSi nghe nghiep. Hien nay, he thong phan loai hinh i n h XQ ciia To chu'c Lao ddng quoc te (ILO) (2000) dUdc sir dung rong rai nhat.
DuS tren phan loai ciia ILO-2000 chung tdi nhan thay co 14/751 tru'dng hdp (1,9%) chan d o i n chac chan mac BBPSi (the 1/0 p t r d len) va 29/751 trudng hdp (3,9%) nghi ngd mac BBPSi (the 0/1 p).
Neu so vdi c i c cd sd s i n xuat khac thi ty le mac BBPSi d cdng nhan nha may ddng tau Ha Long d mirc thap (bang 7).
Bing 7, Ty le mac BBPSi cua cdng nhan nha m i y ddng tau Ha Long so vdi mot so ket qua dieu Nganh nghS, dUn vj
Xi nghiep Lien hiep Ba Son 111,
Nha mav Luyen gang- cong ty Gang thep Thai Nguyen f l l .
Mot so CO sd san xuat cd khi, dong tau, san xuat xi m3ng is Hai Phong 131.
Cong tv Phan lan nung chav Van Dien 121 Cong tv dong tau Hong Ha 161 Cong tv ddng tau Ha Long (nghi ngd va mic)
Nam 2000 2000 2001 2002 2005 2010
Tv le m i c 15,0%
12,1%
36,1%
6,02%
1,4%
5,8%
NhCJhg nghien ciJu ve BBPSi cho thay da sd sd 161 benh nhan mac BBPSi dieu tri tai benh cac benh nhan cd hinh anh X quang the nhe (loai vien Hai Ba Tru'ng thi cd tdi 81,9% tru'dng hdp d p) va d giai doan sdm cua benh (ioai 1). t r o n g the nhe (the p) [ 4 ] .
45
Y HQC VI$T NAM THANQ 8 • 86 1/2012 NghUn cdu cda Pham Thilu Hoa [4] d cdng
nhdn sin xult phin lln nung chiy cQng cho thiy da s i cdng nhin mic BBPSI t h l 1/0 p (81,82%), chi cd 4/18 nguidl (18,18%) mic BBPSI t h l 1/lp.
Nghiin cihj ciia Ludng Minh Tuin [6] d cdng ty ddng tiu HSng Hi cho thiy od 14 trudng hdp (20%) nghl ngd mic BBPSI v i mic BBPSI thl cd 18,6% t h u ^ t h l 0/lp v i 1,4% t h u ^ t h l 1/0 p v i khdng cd trudng hdP nio l i t h l 1/1 p. Trong nghiin cilli ciia chung tdi cung cho thiy 14 truidng hdp mic BBPSi thl hiu hit l i t h l Ip (1/0 p l i 64,3% v i 1/1 p l i 21,4%), chi cd 2 truidng hdp loai 2 (14,2%).
Ttieo m$t s5 nghiin culi [2], [4] thl BBPSi ting theo thdi glan tilp xuc vdl bui. Sau nhllu nim nghUn cdu BBPSI Le Trung [5] nhin thiy ty l | BBPSi l i 3,2% d cdng nhin cd thim nlln 6 + 10 nim v i 53,2% d cdng nhin cd thim niln tilp xuc bgi 11+ 20 nim. Theo ddi 161 b^nh nhin BBPSi dieu trj tai Khoa Benh nghe nghl|p, b|nh vl|n Hai Bi trung, Hoing Xuan Thio [4] nhin thiy tren 70% so b|nh nhin cd tudi ddi tir 31+
50 va tuoi nghS tif 11 den 25 nim. Nghien cilU cua Dudng Thj Hu'dng [3] tai mpt sd cd sd sin xuat thugc cac nganh cd khi, ddng tiu, sin xult xi ming d thinh phd Hal Phdng cung cho thiy ty le ngu'di mic BBPSI cao (36,1%) v i ty 1^ mic benh ting theo tuoi nghe: 41,2% trudng hpp cd tuoi nghe >25 nim; 35,0% trudng hpp cd tuoi nghe tir 15+ 24 nim v i 37,5% trudng hdp cd tudi nghe tir 5+ 14 nim.
Nghien cuU cua Lu'dng Minh Tuan [6] d cdng nhin ddng tau cong ty Hong Hi cung cho ttiay tuoi nghe cing cao thi ty le mic v i nghl ngd mic BBPSI cing cao: ting tir 8,3% d nhdm cd tuoi nghe <10 nim ting len 18,8% d nhdm cd tudi nghe 11-15 nim v i ting tdi 23,8% d nhdm cd tuoi nghe >15 nim. Day la moi tu'dng quan thuan vdl he so tu'dng quan r= 0,78 (p<0,01).
Qua nghien cirU (bing 6) thay nhdm cong nhan cd tudi nghe >10 nim cd ty le nghi ngd mic va mic BBPSI (13,8% v i 6,7%) cao hdn so vdl nhdm <10 nim (0,4% v i 0,2%), sU khic biet cd y nghTa thdng ke vdi p<0,001. Chung tdi cho ring viec phat sinh BBPSi cdn phu thuoc vao die diem ciia ca the vi ti'nh chat lao ddng. NhOtig cdng viec ning nhgc, thudng xuyen phai tiep xuc vdi bui cd ham IUdng silic td do cao thi cd nguy cd mac BBPSi nhieu hdn. Ket qua nghien ciru cua chimg tdi cho thay nhdm nghe nghiep phun hat mil, go ri, phun cit, xuc hat mai, hin, sdn cd ty le nghi ngd va mic benh BBPSi cao nhat (5,2%
46
v i 2,8%), tilp din l i nhdm gia cong vd, lip rip vd t i u , cit hdi, cit miy (1,9% va 0,4%).
V. K^T LUAN
