三级医院护士下背和下肢工作相关肌肉骨骼疾患及其影响因素分析

刘飞; 凌瑞杰; 贾宁; 刘爽; 孙敬智; 李刚; 刘移民; 杨燕; 张华东; 王如刚; 刘吉祥; 王忠旭; 殷红

doi:10.16369/j.oher.issn.1007-1326.2024.02.005

三级医院护士下背和下肢工作相关肌肉骨骼疾患及其影响因素分析

Analysis of work-related musculoskeletal disorders of lower back and lower limbs and influencing factors in nurses at tertiary hospitals

摘要

摘要:
目的调查三级医院护士下背部和下肢不同部位工作相关肌肉骨骼疾患（work-related musculoskeletal disorders，WMSDs）的患病情况，分析工效学危险因素与护士下背部和下肢各部位WMSDs患病风险之间的关联。
方法 2018—2020年，采用分层整群抽样，以15家三级医院3 060名护士为研究对象，使用《中文版肌肉骨骼疾患调查表》电子问卷系统收集医院护士WMSDs患病及相关危险因素的信息，采用logistic回归模型分析工效学危险因素与护士下背部及下肢不同部位WMSDs患病风险之间的关系。
结果护士下背部WMSDs患病率最高，为29.1%；腿部、足或踝部WMSDs患病率分别为21.6%和19.6%；膝部WMSDs患病率最低，为15.3%。多因素logistic回归分析结果显示，每周工作时长超过40 h、总工龄≥ 10年、长时间屈膝、搬运重物、以不舒服的姿势工作、多次的重复性操作工作、在同一场所完成工作、大学本科及以上学历会增加护士下背部WMSDs患病风险（OR = 1.20 ~ 2.26，P＜0.05），体育锻炼会降低护士下背部WMSDs患病风险（OR = 0.64 ~ 0.75，P＜0.05）；周工作时长超过40 h、长时间屈膝工作、经常和患者进行沟通会增加护士下肢各部位WMSDs患病风险（OR = 1.30 ~ 2.36，P＜0.05）；长时间站立、以不舒服的姿势工作、每天从事同样的工作会增加护士腿部WMSDs患病风险（OR = 1.82 ~ 2.05，P＜0.05）；搬运重物、以不舒服的姿势工作、每天从事同样的工作会增加护士足或踝部WMSDs患病风险（OR = 1.35 ~ 1.90，P＜0.05）；年龄≥ 30岁、搬运重物会增加护士膝部WMSDs患病风险（OR = 1.36、1.36，P＜0.05）；长时间坐位工作可以降低护士腿部、膝部和足或踝部WMSDs的患病风险（OR = 0.60 ~ 0.70，P＜0.05）。
结论三级医院护士下背部及下肢各部位均有不同程度的WMSDs患病风险，应通过加强教育培训、制定相关制度以及提供适宜的操作工具来改善。

Abstract:
Objective To investigate the prevalence of work-related musculoskeletal disorders (WMSDs) in different parts of the lower back and lower limbs among nurses in tertiary hospitals and to analyze the association between ergonomics risk factors and the risk of WMSDs in these body parts.
Methods Using stratified cluster sampling, 3 060 nurses from 15 tertiary hospitals were selected as the research subjects from 2018 to 2020. The electronic questionnaire system of the Chinese Version Musculoskeletal Disorders Questionnaire was used to collect information on the prevalence of WMSDs and related risk factors among these nurses. Logistic regression models were employed to analyze the association between ergonomic risk factors and the risk of WMSDs in different parts of the lower back and lower limbs.
Results The prevalence of lower back WMSDs was the highest among nurses, at 29.1%; the prevalence of leg, foot, or ankle WMSDs was 21.6% and 19.6%, respectively; and the prevalence of knee WMSDs was the lowest, at 15.3%. Multifactorial logistic regression analysis revealed that working more than 40 hours per week, having a total working time of more than 10 years, working with long bent knees, manual handling of heavy loads, working in uncomfortable postures, repetitive operations, completing tasks in the same location, and having a bachelor's degree or higher increased the risk of lower back WMSDs (OR=1.20-2.26, P < 0.05). Physical exercise reduced the risk (OR=0.64-0.75, P < 0.05). Working more than 40 hours per week, working with long bent knees, and having frequent communication with patients increased the risk of WMSDs in various parts of the lower limbs (OR=1.30-2.36, P < 0.05). Prolonged standing, working in uncomfortable postures, and performing the same tasks daily increased the risk of leg WMSDs (OR=1.82-2.05, P < 0.05). Manual handling of heavy loads, working in uncomfortable postures, and performing the same tasks daily increased the risk of foot or ankle WMSDs (OR=1.35-1.90, P < 0.05). Being aged ≥ 30 years and manual handling of heavy loads increased the risk of knee WMSDs (OR=1.36, 1.36, P < 0.05). Prolonged seated work reduced the risk of leg, knee, and foot or ankle WMSDs (OR=0.60-0.70, P < 0.05).
Conclusions Nurses in tertiary hospitals had different degrees of risk for WMSDs in different parts of the lower back and lower limbs. Improvements can be made through enhanced education and training, the establishment of relevant systems, and the provision of appropriate operational tools.

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