【作者】 方锦斌；

【导师】 夏昭林；

【作者基本信息】 复旦大学 ， 公共卫生（专业学位）， 2012， 硕士

【摘要】 铅(Pb)是一种重金属元素,主要用于蓄电池的生产,在全世界有大量的职业接触人群。IARC将铅列入人类可疑致癌物,在较高剂量的暴露下,铅对神经系统、肾脏、血液系统和生殖系统都具有毒性作用。多年来,随着对铅毒性认识的加深,各国都在严格控制工作场所空气中铅的浓度,但其危害始终存在,特别是在蓄电池行业,各个工艺环节均存在铅的污染,到目前为止,其危害仍没有得到有效地解决。本研究对上海市蓄电池生产、回收企业进行职业卫生调查,分析铅接触人群的外剂量、血铅、尿铅等生化指标的影响,研究职业接触铅人群健康影响效应。在检测蓄电池企业工作场所空气中铅烟、铅尘浓度的基础上,评价铅危害程度及防护措施的防护效果,对于采取更好的举措保护铅作业工人的健康具有重要的意义,为蓄电池行业职业卫生监管工作提供科学依据。本研究分为三步,第一步,采用流行病学调查方法对上海市13家蓄电池生产、组装和回收企业进行职业卫生现状调查,了解其生产工艺流程、设备的密闭化程度、企业采取的防护设施、警示标识的设置等基本情况。第二步,选择5家企业,根据国家规定的方法检测作业场所空气中铅烟、铅尘浓度。第三步,选择防护设施较差、作业环境恶劣、作业场所铅烟浓度较高的回收企业的92名职业接触铅人群进行尿铅、血铅检测,分析和评估铅对职业接触人群健康的影响。流行病学调查结果显示,在上海市蓄电池行业中,生产型企业的规模相对较大,部分工序采用了自动化、密闭化生产,但也存在防护设施设计不合理、敞开作业等情况,同时不同企业之间在现场职业卫生管理等方面也存在较大的差异。组装型企业均为小型企业,生产的产品、产量差异较大,生产环境不理想,厂房设备简陋,主要采用手2122工具进行生产。回收型企业采用敞开式作业,生产环境恶劣,生产设备简陋,防护设施缺失或不足,职业卫生管理不规范。作业环境铅烟、铅尘检测显示：按照我国现行职业卫生标准,上海市蓄电池行业作业环境空气中铅烟浓度超标率为26.5%,最高浓度为0.900mg/m3,为国家职业卫生标准的10倍,平均浓度(P50)为0.037mg/m3(0.002-0.900mg/m3)；铅尘浓度超标率为21.2%,铅尘最高浓度为0.899mg/m3,约为国家职业卫生标准的6倍,平均浓度(P50)为0.031mg/m3(0.001-0.899mg/m3)。不同岗位其浓度差异较大,特别是磨边岗位,铅尘平均浓度(P50)达0.620mg/m3,超过职业卫生标准的4倍。生物接触指标检测结果显示：尿铅值和血铅值具有一定的相关性,相关系数为0.882(p<0.01)；男性工人尿铅与血铅相关系数为0.886(p<0.01),女性工人尿铅与血铅相关系数为0.795(p<0.01)。性别对血铅、尿铅无影响。在各年龄组中,女性铅接触工人血铅、尿铅值分布均衡,不随年龄增加而变化；男性铅接触工人血铅值随着年龄的增加而增加,经卡方检验(p=0.014)和趋势卡方检验(p=0.035)有显著性差异,尿铅分布均衡。将空气中铅接触外剂量与血铅和尿铅值之间进行相关性分析,男性工人外剂量与血铅相关系数为0.335(p=0.003),女性工人外剂量与血铅无相关性；男性工人外剂量与尿铅相关系数为0.353(p=0.002)；女性工人外剂量与尿铅无相关性。随着工龄的延长,接触的铅量越多,男性血铅、尿铅值逐渐增大(p<0.01),而女性铅接触工人血铅、尿铅值无明显变化。不同岗位铅接触工人血铅分布均衡,尿铅有显著性差异(p=0.02)。以上结果表明：1、改进生产工艺,合理设置防护设施,改善作业环境和加强职业卫生监管是防治铅中毒重要手段,加强职业卫生培训,提高作业人员的防护意识,加强个体防护也不容忽视。2、职业病危害因素检测是评价作业环境优劣程度的重要指标,是判断职业卫生管理的重要依据。3、通过对铅接触工人外剂量、血铅、尿铅的分析比较,可以发现外剂量指标和血铅、尿铅以及血铅和尿铅之间存在着一定的相关性,有助于职业健康检查及职业病诊断中标志物指标的选择。更多还原

【Abstract】 Lead is a kind of heavy metal, which is used to produce storage battery. There are a large number of occupational exposure people. Exposure to lead can cause nerve injury, kidney damage, and toxicity of hemoglobin metabolism, which is considered of one kind of suspicious carcinogens. According to deepen recognizing lead, every government are controlling the concentration of environmental lead. But the danger still exists, the harm hasn’t resolved until now.This research is investigating the occupational health of storage battery producing and retrieving factory in Shanghai, analyzing the effect of biochemical index of external dosage, blood lead and urine lead, and studying the health effect on lead exposure people. On the basis of monitoring the environmental lead dust, we evaluate the harm level and the protect effect, which can provide the scientific basis for occupational administration.This research includes three steps. First,13storage battery producing and retrieving factory are investigated in Shanghai, meanwhile the production engineering, equipment closed degree, protection facility and caution identification set up are also comprehended. Second, the lead dust concentration in the workshop environment is detected by the national standard in selected5factories. Third, blood lead and urine lead in92lead exposure workers in bad protection facility factory are detected, in order to analysis the effect on health of lead exposure workers.Occupational epidemiology investigation results show, the production factory adopt the automatic and closed manufacture, but there still exist the unreasonable protection facility design and open wide working, and there are some difference on occupational administration in different factory. Assembling factory is small business, and the production and outlet is different, working environment and equipment is bad. Retrieving factory adopts the open working, and the work environment and equipment are bad, meanwhile the occupational administration is not standard. The lead mist and lead dust test result in the workshop shows:According to national occupational standard, the lead mist concentration of environment in workshop of shanghai storage battery factory over proof rate is26.5%, and the highest concentration is mg/m3,reaching the10times of national standard, average concentration being0.037mg/m3(0.002-0.900mg/m3).The lead dust concentration over proof rate is21.2%,and the highest concentration is0.899mg/m3, reaching the6times of national standard, average concentration being0.031mg/m3(0.001-0.899mg/m3).The concentration in different station has different result, meanwhile the lead dust concentration of edging station is0.620mg/m3, over4times of national standard.The contact index testing result shows:There is certain correlation between urine lead and blood lead, and the correlation coefficient is0.882(p<0.01). The male correlation between urine lead and blood lead is0.886(p<0.01). And the female correlation between urine lead and blood lead is0.795(p<0.01). Sex has no influence on blood lead and urine lead. The concentration of blood lead and urine lead in female worker distribute equilibrium, without changing according to age. The concentration of blood lead and urine lead in male worker increases according to age, with significant difference though Chi-square test (p=0.014) and tendency Chi-square test (p=0.035).And the urine lead distributes equilibrium. We analyses the correlation between blood lead and urine lead in workshop environment. The correlation of external dosage and blood lead in male worker is0.335(p=0.003).The female workers’external dosage has no correlation with blood lead. The correlation between external dosage and urine in male workers is0.353(p=0.002).There is no correlation external dosage and urine in female workers. According to age increasing and exposure lead increasing, the male blood lead and urine lead increase (p<0.01). The female blood lead and urine lead has no significant change. Blood lead distributes equilibrium in different station and the urine lead has significant difference.The results shows:1Improving production engineering, installing protection facilities reasonably, and ameliorating the working environment is the important method in occupational administrator. Strengthening occupational health train, improving workers’ protection consciousness, enhancing individual protection is very important.2Occupational disease harmful factor testing is the important index to evaluate the work environment. And it is also important basis to evaluate the occupational administrater.3Though comparing the blood lead, urine lead and external dosage, we can find the external dosage, blood lead and urine lead have some correlation, contributing to select the occupational disease marker.更多还原