【作者】 葛华；

【导师】 张晨； 刘继文；

【作者基本信息】 新疆医科大学 ， 劳动卫生与环境卫生学， 2018， 博士

【摘要】 目的:通过现场职业卫生调查,了解铜镍矿工暴露的职业有害因素种类及水平,采用问卷调查评价铜镍矿工的职业紧张水平、职业健康状况、工作能力、职业生命质量和不安全行为的现状及其影响因素。通过结构方程模型探索影响铜镍矿工不安全行为的因素,以期为改善铜镍矿工的工作环境、提高其职业生命质量及干预措施的制定和实施奠定基础。方法:（1）对铜镍矿的58个工种通过工作分析了解其职业紧张因素。（2）通过对该铜镍矿职业有害因素的识别,依据国家相关标准规范采样及检测,了解铜镍矿作业场所化学性和物理性职业有害因素的水平。（3）通过分层整群抽样,抽取工龄>1a的全部铜镍矿工为研究对象进行问卷调查。采用付出-回报失衡问卷、中文版工作倦怠量表、社会支持量表、北欧肌肉骨骼疾患量表和在岗期间职业健康体检了解铜镍矿工职业健康状况;通过工作能力指数量表和健康调查量表了解铜镍矿工的工作能力和职业生命质量。（4）采用不安全行为结构问卷进行调查,了解铜镍矿工的不安全行为现状,并通过结构方程模型探索影响其不安全行为的因素。结果:（1）采矿单元23个工种最终聚为2类,分别包含10个工种共32个职业紧张因素和13个工种共64个职业紧张因素;95个采样点中,3个噪声采样点不合格,余均未超标。（2）选矿单元13个工种最终聚为2类,分别包含11个工种共51个职业紧张因素和2个工种共81个职业紧张因素;86个采样点中,总粉尘浓度超标点10个、CS₂浓度超标点1个、噪声超标点7个,余均未超标。（3）冶炼单元22个工种最终聚为2类,分别包含20个工种共47个职业紧张因素和2个工种共81个职业紧张因素;123个采样点中,噪声超标点12个、照度未达标点1个,余均未超标。（4）此次共调查铜镍矿工1857人,问卷回收有效率92.9%;（5）不同性别间男性职业紧张程度高于女性（P<0.01）;大专学历组、月收入小于2500元组职业紧张程度较高（P<0.01）;冶炼单元铜镍矿工的职业紧张水平较高（P<0.05）。（6）男性中度倦怠的铜镍矿工检出率较高,女性轻度倦怠检出率较高,且男性铜镍矿工职业倦怠程度高于女性铜镍矿工（P<0.01）;年龄在35岁^组、高中学历组、月收入小于2500元的铜镍矿工职业倦怠感最强（P<0.01）;冶炼单元的铜镍矿工职业倦怠感最强（P<0.01）;职业紧张程度较高的铜镍矿工职业倦怠感也较强（P<0.01）。（7）女性获得支持度高于男性（P<0.01）;年龄在30岁^组、本科及以上学历组、离婚组和月收入4000元^组的铜镍矿工获得的支持相对较多（P<0.01）;选矿单元铜镍矿工获得支持程度最高,采矿单元得到客观支持及对支持的利用程度最多（P<0.01）;职业紧张程度越高获得的社会支持越少（P<0.01）。（8）铜镍矿工幽门螺杆菌阳性、血脂增高和脂肪肝是检出率较高的生理健康问题;女性肌肉骨骼损伤检出率高于男性（P<0.05）;年龄在35岁^组、本科及以上学历组、离婚组和月收入在2500元以下的铜镍矿工其肌肉骨骼损伤较严重（P<0.01）;冶炼单元铜镍矿工肌肉骨骼损伤较严重（P<0.01）;铜镍矿工颈部肌肉骨骼损伤检出率较高（P<0.01）;高职业紧张水平的铜镍矿工肌肉骨骼损伤更严重（P<0.01）。（9）年龄<25岁组、工龄<5a组、本科及以上学历组、离独组和月收入4000元^组的铜镍矿工工作能力较强（P<0.01）;选矿单元铜镍矿工的工作能力较高（P<0.01）;职业紧张水平越高的铜镍矿工工作能力越低（P<0.01）。（10）年龄在45岁^组的铜镍矿工职业生命质量较好（P<0.05）;本科及以上学历组的铜镍矿工职业生命质量最好（P<0.01）;月收入越高,其职业生命质量越好（P<0.01）;采矿单元铜镍矿职业生命质量较好（P<0.01）;职业紧张组的铜镍矿工职业生命质量低于非职业紧张组（P<0.01）。（11）年龄、文化程度、月收入、职业生命质量和社会支持与职业倦怠成负相关。婚姻状况、职业紧张和肌肉骨骼的损伤与职业倦怠成正相关。年龄、文化程度、婚姻状况、月收入、职业生命质量、工作能力与社会支持成正相关。文化程度、职业生命质量和职业倦怠对肌肉骨骼损伤是保护性因素,而职业紧张是铜镍矿工肌肉骨骼损伤的危险因素;社会支持水平越高、职业生命质量越好的铜镍矿工其工作能力越好;职业紧张、职业倦怠、肌肉骨骼损伤与职业生命质量成负相关。（12）不安全行为结构问卷在铜镍矿工中测量的信度和效度经检验均满足测量要求;随年龄和工龄的增长,个人安全意识有所下降;大专学历组的铜镍矿工其安全行为意识最高;离婚组的铜镍矿工不安全行为危险性最高;采矿单元铜镍矿工不安全行为发生的可能性较大（P<0.01）;不同作业环境中倦怠程度水平较高的铜镍矿工行为越不安全;未出现肌肉骨骼损伤的铜镍矿工行为较安全（P<0.01）;（13）经适配系数的检验,所建立的结构方程模型可接受,职业紧张水平影响铜镍矿工的不安全行为。结论:（1）选矿单元铜镍矿工职业紧张因素较多。铜镍矿工所暴露化学性、物理性职业有害因素主要有:生产性粉尘、NH₃、NO₂、NO、SO₂、SO₃、H₂S、H₂SO₄、CO、Cu、Ni、NaOH、噪声、高温和工频电磁场。（2）采矿单元职业有害因素监测合格率达96.8%,选矿单元检测合格率达79.1%,冶炼单元检测合格率达89.4%。42.08%的铜镍矿工存在不同程度的职业紧张;81.7%的铜镍矿工具有不同程度的职业倦怠。职业紧张组的铜镍矿工职业倦怠水平高于非职业紧张组。非职业紧张组的社会支持水平高于职业紧张组。铜镍矿工的颈部、肩部、膝部肌肉骨骼损伤较其他部位多见,职业紧张组的肌肉骨骼损伤较非职业紧张组高。职业紧张组的铜镍矿工工作能力和职业生命质量均低于非职业紧张组。（3）铜镍矿工对个人安全素质不高引起不安全行为发生的认识较高,但缺乏实际工作中对劳动任务、劳动对象和作业环境不安全行为的识别。职业倦怠水平较高的铜镍矿工行为越不安全,肌肉骨骼系统损伤的铜镍矿工存在不安全行为的危险性。职业紧张水平越高的铜镍矿工,其发生不安全行为的可能性越大。更多还原

【Abstract】 Objective:To understand the occupational hazards and levels exposed by copper-nickel miners through occupational health survey,a questionnaire survey was conducted to evaluate the status of occupational stress,occupational health status,working ability,occupational quality of life and unsafe behaviors of copper-nickel miners and their influencing factors.To explore the factors through SEM that affect the unsafe behaviors of copper-nickel miners,to improve the working environment,the quality of life and the intervention measures of the copper-nickel miners.Methods:（1）Fifty-eight types of copper-nickel ore were analyzed through AET,to understand their occupational stress factors.（2）Based on the identification of the occupational hazards in the copper-nickel mine,the level of chemical and physical occupational hazards in the copper-nickel mines were understood according to the national standard sampling and testing.（3）All the copper-nickel miners with length of service>1a were selected as the research object for the questionnaire survey by using stratified cluster sampling.To understand the occupational health status of copper-nickel miners by using ERI,CMBI,social support scale,Nordic Musculoskeletal Scale and occupational health examination.To understand the working ability and professional life quality of copper-nickel miners by using WAI and SF-36.（4）To investigate the unsafe behaviors of copper-nickel miners by using the questionnaire of unsafe behaviors structure,to explore the factors that influence their unsafe behaviors through SEM.Results:（1）Twenty-three types of work in the mining unit were finally clustered into 2 categories,including 32 occupational stress factors in 10types of work,and 64 occupational stress factors in the 13 types of work.Among the 95sampling points,3 noise sampling points were unqualified,and others were not exceeded.（2）Thirteen types of mineral processing units were eventually clustered into 2categories,which included 51 occupational stress factors in 11 types of work and 81occupational stress factors in 2 types of work.Among the 86 sampling points,there were10 samples with excessive dust concentration,1 sampling point CS₂ with excessive concentration and 7 samples with excessive noise,and others were not exceeded.（3）Twenty-two types of smelting units were eventually grouped into 2 categories,which consisted of 47 occupational stress factors in 20 types of work and 81 occupational stress factors in 2 types of work.Among the 123 sampling points,there were 12 excess noise points and 1 illuminance point,and others were not exceeded.（4）One thousand eight hundred and fifty-seven people of copper-nickel miners were investigated,and the effective recovery rate of the questionnaire was 92.9%.（5）Male occupational stress was higher than famale in different genders（P<0.01）;college education group,and the group whose monthly income was less than 2500 yuan,their occupational stress was higher（P<0.01）;occupational stress level of copper-nickel miners in smelting unit was higher（P<0.05）.（6）Male copper-nickel miners had the highest detection rate of moderate burnout,famle copper-nickel miners had the highest rate of mild burnout,the degree of occupational burnout of male copper-nickel miners was higher than that of female（P<0.01）;the burnout of copper-nickel miners who aged 35^years old group,high school education group,a monthly income of less than 2500 yuan were the highest（P<0.01）;the burnout of the copper-nickel miners in the smelter was the highest（P<0.01）;the copper-nickel miners with high levels of occupational stress also had higher burnout levels.（7）The famale got more support than male（P<0.01）;the age group at 30^years old,undergraduate and above qualifications group,divorced copper-nickel miners,monthly income more than 4000 yuan group received the highest relative support（P<0.01）;the copper-nickel miners in the concentrator received the highest support;the copper-nickel miners in the mine received the most objective support and the most supportive use（P<0.01）;the higher the occupational stress was,the less social support they had got（P<0.01）.（8）The positive rate of Helicobacter pylori,hyperlipidemia and fatty liver in the copper-nickel miners were the mainly physiological health problem with high detection rate;the detection rate of female musculoskeletal injury was higher than that of male（P<0.05）;the musculoskeletal injuries in the 35-year-old group,undergraduate education group,divorce group,and copper-nickel miners with a monthly income less than 2500 yuan were more serious（P<0.01）;the musculoskeletal injuries of the copper-nickel miners in the smelter were serious（P<0.01）;the copper-nickel miners had a higher detection rate of cervical musculoskeletal injuries（P<0.01）;musculoskeletal injury was more severe in copper-nickel miners with high occupational stress level（P<0.01）.（9）The copper-nickel miners with age<25 years old group,working age<5a group,bachelor degree or above,divorce group and monthly income 4000^yuan group had better working ability（P<0.01）;the working ability of copper-nickel miners in the concentrator was higher（P<0.01）;the higher the occupational stress level was,the lower the copper-nickel miner’s working ability they had（P<0.01）.（10）The occupational quality of life of copper-nickel miners who aged 45 years was better（P<0.05）;copper-nickel miners with bachelor degree or above had the best professional life quality（P<0.01）;the higher the monthly income was,the higher occupational quality of life they had（P<0.01）;the occupational life quality of the mining unit copper-nickel was better（P<0.01）;the occupational quality of life of the occupational stress group copper-nickel miners was lower than that of the non-occupational stress group.（P<0.01）.（11）Age,education,monthly income,occupational quality of life,and social support were negatively correlated with job burnout;marital status,occupational stress,and musculoskeletal injuries were positively correlated with job burnout;age,education level,marital status,monthly income,occupational quality of life,work ability and social support were positively related;the degree of education,occupational quality of life and job burnout were protective factors for musculoskeletal injuries;occupational stress was a risk factor for musculoskeletal injuries in copper-nickel miners;the higher the level of social support and the better the quality of occupational life was,the better the working ability of copper-nickel miners they had got;the occupational stress,job burnout,musculoskeletal injury and occupational quality of life were negatively correlated.（12）The reliability and validity of the unsafe behaviors structure questionnaire measured in the copper-nickel miners were all satisfied with the measurement requirements;with the growth of age and seniority,personal safe awareness had declined;the copper-nickel miners of the college group had the highest awareness of their safe behaviors;the unsafe behaviors of the copper-nickel miners in the divorce group was the most dangerous;the possibility of unsafe behaviors of copper-nickel miners in mining unit was greater（P<0.01）;the behaviors of copper-nickel miners with higher level of job burnout was less safe;the behaviors of copper-nickel miners without musculoskeletal injury was safer（P<0.01）.（13）Through the test of the adaptation coefficient,the established structural equation model was acceptable,and the level of occupational stress affected the unsafe behaviors of copper-nickel miners.Conclusion:（1）There are many occupational stress factors for the copper-nickel miner in the beneficiation unit.Copper-nickel miners were exposed to chemical and physical occupational hazards include:productive dust,NH₃,NO₂,NO,SO₂,SO₃,H₂S,H₂SO₄,CO,Cu,Ni,NaOH,noise,high temperature and power frequency electromagnetic fields.（2）The qualified rate of detection of occupational hazards in mining units reaches 96.8%,the qualified rate of mineral processing units is 79.1%,and the qualified rate of smelting units is 89.4%;42.08%of copper-nickel miners have varying degrees of occupational stress;81.7%of copper-nickel ore tools have varying degrees of burnout;the burnout level of copper-nickel miners in the occupational stress group is higher than that in the non-occupational stress group;the level of social support in the non-professional tension group is higher than that in the occupational stress group;the musculoskeletal injuries in the neck,shoulders,and knees of the copper-nickel miners are more common than those in other sites,and the musculoskeletal injuries in the occupational stress group are higher than those in the non-occupational stress group;the occupational stress group’s copper-nickel miners’work ability and occupational life quality are lower than those of the non-professional stress group.（3）Copper-nickel miners have a relatively high awareness of the unsafe behaviors caused by the low personal safety quality,but they lack the identification of labor tasks,labor objects,and unsafe behaviors in the work environment.The more unsafe copper-nickel miners with higher burnout levels is,the more dangerous the unsafe behaviors of copper-nickel miners with musculoskeletal system injuries that would be.Copper-nickel miners with higher occupational stress levels are more likely to experience unsafe behaviors.更多还原