我国临床护士肌肉骨骼疾患患病率及影响因素的meta分析
Prevalence and influencing factors of work-related musculoskeletal disorders among clinical nurses in China: A meta-analysis
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摘要:
背景 职业性肌肉骨骼疾患（WMSDs）严重影响护士的工作效率和生活质量，目前对临床护士WMSDs的调查研究存在较大差异。
目的 系统评价我国临床护士WMSDs患病率，并分析其主要影响因素。
方法 检索中国知网（CNKI）、万方数据（Wanfang data）、维普（VIP）、中国生物医学文献服务系统（SinoMed）、PubMed、Cochrane Library、Web of Science、Embase，检索时间范围均为建库至2022年12月31日，查找有关我国临床护士WMSDs现状及影响因素的相关文献，按照纳入排除标准筛选文献。使用美国卫生保健质量和研究机构（AHRQ）推荐的质量评价标准评估横断面研究文献质量，将提取的资料应用Stata 15.0软件进行分析，根据异质性大小选取随机效应模型或者固定效应模型计算合并效应量。
结果 最终纳入19篇文献，包括14篇中文文献，5篇英文文献，共调查17852名护士。我国临床护士工作以来WMSDs患病率为85.5%（95%CI：79.8%~91.1%）、年患病率为81.0%（95%CI：75.2%~86.8%）、周患病率为65.0（95%CI：48.5%~81.5%）。亚组分析显示急诊、ICU、助产等特殊区域的护士WMSDs患病率为88.6%（95%CI：82.6%~94.6%），高于综合岗位护士79.0%（95%CI：72.5%~85.5%）；2018—2022年报告的WMSDs患病率为82.2%（95%CI：75.0%~89.4%），高于2004—2017年报告的76.8%（95%CI：67.2%~86.4%）。并且年龄＞40岁(OR=2.34，95%CI：1.69~3.24）、工龄＞10年(OR=2.12，95%CI：1.43~3.15）、肥胖（OR=2.73，95%CI：1.56~4.77）、夜班(OR=2.03，95%CI：1.81~2.28)、搬抬重物（OR=3.80，95%CI：1.79~8.07）、工间休息（OR=0.49，95%CI：0.30~0.83）以及弯腰（OR=3.47，95%CI：2.37~5.08）均是护士发生WMSDs的影响因素。
结论 我国护士WMSDs患病率较高，并呈逐年增长趋势，急诊、ICU、助产等特殊区域的护理人员相较于综合岗护士表现出更高的患病率。年龄＞40岁、工龄＞10年、肥胖、轮夜班、搬抬重物、弯腰是护士发生WMSDs的危险因素，工间休息是保护因素，可针对上述因素做好早期防范工作，如增加辅助助力设施、改善工作模式等降低WMSDs风险。
Abstract:Background Work-related musculoskeletal disorders (WMSDs) seriously affect work efficiency and quality of life of nurses. Currently, there are significant differences in the published studies on WMSDs in nurses.
Objective To systematically evaluate the prevalence of WMSDs among nurses in the mainland of China and analyze its main influencing factors.
Methods Eight databases (CNKI, Wanfang data, VIP, SinoMed, PubMed, Cochrane Library, Web of Science, and Embase) were selected for searching literature reporting prevalence and influencing factors of WMSDs among clinical nurses in China from inception to December 31, 2022. The literature was included according to a pre-set criteria of inclusion and exclusion. The quality of cross-sectional studies was assessed using the criteria recommended by the Agency for Healthcare Research and Quality (AHRQ), and the extracted data were analyzed by Stata 15.0 software. A random effect model or a fixed effect model was selected to calculate combined effects based on heterogeneity of included studies.
Results A total of 19 studies were included in this meta-analysis, including 14 studies published in Chinese and 5 in English, involving 17852 nurses in total. The estimated prevalence rate of WMSDs since work among clinical nurses in China was 85.5% (95%CI: 79.8%, 91.1%), the estimated annual prevalence rate was 81.0% (95%CI: 75.2%, 86.8%), and the estimated weekly prevalence rate was 65.0% (95%CI: 48.5%, 81.5%). The results of subgroup analysis showed that the prevalence rate of WMSDs among nurses in specific departments of emergency, ICU, and midwifery was 88.6% (95%CI: 82.6%, 94.6%), higher than that among nurses in general departments 79.0% (95%CI: 72.5%, 85.5%). The reported prevalence of WMSDs from 2018 to 2022 was 82.2% (95%CI: 75.0%, 89.4%), which was higher than that from 2004 to 2017 76.8% (95%CI: 67.2%, 86.4%). Age >40 years (OR=2.34, 95%CI: 1.69, 3.24), length of service >10 years (OR=2.12, 95%CI: 1.43, 3.15), obesity (OR=2.73, 95%CI: 1.56, 4.77), night shift (OR=2.03, 95%CI: 1.81, 2.28), lifting heavy objects (OR=3.80, 95%CI: 1.79, 8.07), rest during work (OR=0.49, 95%CI: 0.30, 0.83), and bending (OR=3.47, 95%CI: 2.37, 5.08) were influencing factors of WMSDs in nurses.
Conclusion The prevalence rate of WMSDs among Chinese nurses is high, and it is increasing year by year. Nurses in specific departments such as emergency, ICU, and midwifery show higher prevalence rates than those in general departments. Age > 40 years, length of service >10 years, obesity, night shifts, lifting heavy objects, and bending are risk factors for WMSDs among nurses, while rest during work is a protective factor. Therefore, early prevention actions should be taken targeting the above factors, such as increasing auxiliary assistance facilities and improving work patterns, so as to reduce the risk of WMSDs.
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