三级医院手术室护士工作相关肌肉骨骼疾患潜在类别分析及影响因素研究

Latent class analysis and influencing factor study of work-related musculoskeletal disorders among operating room nurses in tertiary hospitals

  • 摘要:
    背景 工作相关骨骼疾患(WMSDs)作为世界范围内重大职业健康问题之一,阳性率逐年增高。手术室护士因工作的特殊性,其WMSDs阳性率高于其他职业人群,因此需积极关注。
    目的 调查三级医院手术室护士WMSDs患病情况,探讨三级医院手术室护士WMSDs患病特征、潜在类别,分析WMSDs发生的影响因素。
    方法 采用随机整群抽样法,于2023年12月—2024年1月从抽取乌鲁木齐市9家三级医院手术室护士作为研究对象,采用一般资料调查表、手术室护士人体工效学评价问卷、中国肌肉骨骼疾患问卷进行调查,使用潜在类别分析方法对手术室护士WMSDs进行分析,用χ2检验及无序多元logistic回归分析手术室护士WMSDs的影响因素。
    结果 本次调查共回收411份有效问卷,过去一年内三级医院手术室护士WMSDs阳性率为91.9%,阳性率由高到低的部位分别为颈部79.1%、肩部70.3%、下背部68.1%。经潜在类别分析方法将手术室护士WMSDs各部位发生情况共分为3类:全身多部位发生组、颈肩-全背共患组、颈部-下背共患组。无序多元logistic回归分析显示性别、工作紧张程度、手术室人体工效学负荷水平和工作涉及寒冷或凉风是手术室护士WMSDs潜在分析的影响因素,其中工作年限<5年、手术室护士人体工效学低水平负荷、工作不紧张、工作不太紧张是手术室护士WMSDs的保护性因素;工作环境涉及凉风或寒冷、女性是手术室护士WMSDs的危险因素。无序多元logistic回归分析显示,颈部-下背共患组与颈肩-全背共患组相比,工作不紧张(OR=0.168,95%CI=0.029~0.968)、女性(OR=4.847,95%OR=2.506~9.378)归为颈肩-全背共患组概率更大;颈部-下背共患组与相比全身多部位发生组,低水平工效学负荷(OR=0.079,95%CI=0.015~0.412)、工作不紧张(OR=0.019,95%CI0.002~0.145)、工作不太紧张(OR=0.080,95%CI=0.016~0.401)、工作紧张(OR=0.132,95%=0.027~0.647)、工作年限<5年(OR=0.173,95%CI=0.044~0.683)、女性(OR=2.424,95%CI=1.130~5.200)、工作环境涉及寒冷或凉风(OR=3.277,95%=1.657~6.481)归为全身多部位发生组概率大。
    结论 三级医院手术室护士WMSDs阳性率高,人群有明显的分类共患特征,可根据不同WMSDs患病模式特点开展多种方式WMSDs健康教育和预防WMSDs的培训,改善工作环境,合理调配人力资源等,降低手术室护士WMSDs的发生风险,切实保障手术室护士的职业健康。

     

    Abstract:
    Background Work-related musculoskeletal disorders (WMSDs), as one of the major occupational health issues worldwide, have shown an increasing positive rate year by year. Due to the unique demands of work, operating room nurses exhibit a higher positive rate of WMSDs compared to other occupational groups, necessitating active attention and intervention.
    Objective To estimate the prevalence of WMSDs among operating room nurses in tertiary hospitals, explore the characteristics and latent categories of WMSDs, and analyze the influencing factors associated with the occurrence of WMSDs.
    Method Using a randomized cluster sampling method, operating room nurses from nine tertiary hospitals in Urumqi were selected as study participants between December 2023 and January 2024. Data were collected through a general information questionnaire, an ergonomic questionnaire for operating room nurses, and the Chinese Musculoskeletal Disorders Questionnaire. Latent class analysis was employed to examine the patterns of WMSDs among the nurses, while chi-square test and multinomial logistic regression were utilized to analyze the influencing factors of WMSDs.
    Result A total of 411 valid questionnaires were collected in this survey. The positive rate of WMSDs among operating room nurses in the tertiary hospitals of Urumqi over the past year was 91.9%. The positive rates, ordered from highest to lowest by body region, were neck (79.1%), shoulders (70.3%), and lower back (68.1%). The operating room nurses were categorized into three distinct groups by latent class analysis: multi-site pain group, neck-shoulder-back pain group, and neck and lower back pain group. The results of the multinomial logistic regression models revealed that gender, job strain level, ergonomic load level in the operating room, and exposure to cold or drafty working conditions or not were significant influencing factors for reporting WMSDs among operating room nurses. Specifically, having less than 5 years of work experience, low ergonomic load level, low job strain, and moderate job strain were identified as protective factors against WMSDs. Conversely, exposure to cold or drafty working environments and being female were identified as risk factors for WMSDs. The logistic regression models also indicated that compared to the neck-lower back pain group, the neck-shoulder-back pain group had a higher probability of reporting low job strain (OR=0.168, 95%CI: 0.029, 0.968) and being female (OR=4.847, 95%CI: 2.506, 9.378). In contrast, when comparing to the neck-lower back pain group, the multi-site pain group had a higher probability of reporting, low-level ergonomic workload (OR=0.079, 95%CI: 0.015, 0.412), low job strain (OR=0.019, 95%CI: 0.002, 0.145), moderate job strain (OR=0.080, 95%CI: 0.016, 0.401), high job strain (OR=0.132, 95%CI: 0.027, 0.647), less than 5 years of work experience (OR=0.173, 95%CI: 0.044, 0.683), being female (OR=2.424, 95%CI: 1.130, 5.200), and exposure to cold or drafty working environments (OR=3.277, 95%CI: 1.657, 6.481).
    Conclusion The positive rate WMSDs among operating room nurses in tertiary hospitals is notably high in Urumqi, with distinct co-occurrence characteristics observed within the population. To mitigate the risk of WMSDs, it is essential to implement targeted health education and prevention training programs tailored to different patterns of WMSDs. Additionally, improving working conditions, optimizing human resource allocation , and other proactive measures should be undertaken. These efforts will effectively reduce the incidence of WMSDs among operating room nurses and safeguard their occupational health.

     

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