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目的用不同转换系数调整脉冲噪声所致工人高频听力损失剂量-反应关系曲线。方法以32名接触脉冲噪声的机械制造工人和163名接触稳态噪声的纺织工人为观察对象,用个体计量仪采集工人8 h工作期间的噪声暴露数据,计算8 h等效声级(LAeq.8h),并按不同转换系数(ER)将LAeq.8h和噪声作业工龄合并为累积噪声暴露量(CNE)。用常规方法测量工人左右耳气导听阈,按GBZ49-2002对听阈作年龄性别校正,并诊断是否为高频听力损失。结果用ER=3计算,脉冲噪声组的CNE[(103.2±4.2)dB(A).年]明显低于稳态噪声组[110.6±6.0 dB(A).年],P<0.01。增大ER值,脉冲噪声组的CNE升高,当ER=5.5时脉冲噪声组的CNE与稳态噪声组的CNE(ER=3)相似[110.3 dB(A).年vs 110.6 dB(A).年]。脉冲噪声噪声组高频听力损失患病率(68.8%)与稳态噪声组(65.0%)相似,P>0.05。两组CNE与高频听力损失患病率间均存在典型的剂量-反应关系,均P<0.01。用ER=3计算,脉冲噪声100~109 dB(A).年组的高频听力损失患病率(76.9%,90.9%)明显高于稳态噪声组(30.4%,50.0%,P<0.05);脉冲噪声组用ER=5.5计算CNE时,各组间高频听力损失患病率与稳态噪声组(ER=3)相比(0%vs 11.1%,33.3%vs 30.4%,70.0%vs50.0%,62.5%vs 79.5%,100.0%vs 90.4%)差异均无统计学意义(P>0.05)。Logistic回归模型显示,ER=3时脉冲噪声组CNE与高频听力损失患病率的剂量-反应关系曲线与稳态噪声组相比出现曲线左移,斜率增大;增大ER值,脉冲噪声组曲线右移,斜率减小,当ER=6时脉冲噪声组的剂量-反应关系曲线与稳态噪声组(ER=3)的曲线基本重合。结论脉冲噪声所致高频听力损失的危害在能量相同的情况下大于稳态噪声。增大ER值可以使脉冲噪声组的剂量-反应关系曲线与稳态噪声组基本重合。
Objective To adjust the dose-response curve of high-frequency hearing loss caused by impulse noise with different conversion factors. Methods Twenty - two mechanical workers exposed to impulsive noise and 163 textile workers exposed to steady - state noise were selected as the object of study. Noise exposure data collected during 8 h of operation were collected by individual meters to calculate the 8 h equivalent sound level (LAeq). 8h), and LAeq.8h and noise working age were combined into cumulative noise exposure (CNE) according to different conversion factors (ER). Measured by conventional methods around the hearing-induced hearing threshold of workers, according to GBZ49-2002 on the threshold for age-sex correction, and diagnosis of high-frequency hearing loss. Results Using ER = 3, CNE [(103.2 ± 4.2) dB (A) .year] in the impulse noise group was significantly lower than that in the steady-state noise group [110.6 ± 6.0 dB (A) .year], P <0.01. The CNE of the impulsive noise group increased when the ER value increased, and the CNE of the impulsive noise group was similar to CNE (ER = 3) when the ER = 5.5 [110.3 dB (A) .year]. The prevalence of high frequency hearing loss (68.8%) in impulsive noise group was similar to that in steady state noise group (65.0%), P> 0.05. There was a typical dose-response relationship between CNE and high-frequency hearing loss in both groups, both P <0.01. With ER = 3, the impulsive noise was 100 ~ 109 dB (A). The annual prevalence of high frequency hearing loss in the elderly group was significantly higher than that in the steady-state noise group (76.9%, 90.9%, P <0.05 ). When CNE was calculated with ER = 5.5 in the impulsive noise group, the prevalence of high-frequency hearing loss among the groups was significantly lower than that of the steady-state noise group (0% vs 11.1%, 33.3% vs 30.4%, 70.0% vs50.0%, 62.5% vs 79.5%, 100.0% vs 90.4%, respectively). There was no significant difference between the two groups (P> 0.05). Logistic regression model showed that the dose-response curve of CNE and high-frequency hearing loss in impulsive noise group at ER = 3 showed a curve shift to the left and the slope increased compared with that in steady-state noise group. Increasing ER value, impulsive noise The curve shifts to the right and the slope decreases. When ER = 6, the dose-response curve of impulse noise group basically coincides with the curve of steady noise group (ER = 3). Conclusion The harm of high frequency hearing loss caused by impulse noise is greater than steady state noise under the same energy condition. Increasing the ER value can make the dose-response curve of the impulsive noise group basically coincide with the steady-state noise group.