卫生研究

目的 基于中国有色金属矿山开采企业探讨矽尘暴露致矽肺的职业健康风险水平。方法 于2019年6月至2020年7月，采用典型抽样方法选取七省(自治区)44家有色金属矿山开采企业，最终纳入37家，其中36家(97.30%)属井下开采。通过开展现场职业卫生调查，以及主要矽尘作业岗位现场检测，收集企业基本信息及其关键岗位的矽尘暴露资料。采用改良的国际采矿和金属委员会(International Council on Mining and Mentals, ICMM)风险评级表法，以及职业危害风险指数法(INDEX法)职业健康风险评估模型，从总粉尘和呼吸性粉尘两方面分别分析有色金属矿山矽尘暴露致矽肺的职业健康风险水平。采用二次加权Kappa检验分析两种风险评估方法的一致性。结果 中型企业[64.69%(40.38%,73.41%)]、银矿[84.69%(63.38%,86.06%)]和锑矿(72.22%)开采企业工人矽尘暴露率较高(以四分位数表示)。职业卫生学检测结果(以四分位数表示)显示：(1)降尘样本游离二氧化硅含量为21.18%(17.03%,30.47%);(2)总粉尘浓度为1.60(0.86,2.46)mg/m³,超出我国8小时时间加权平均容许浓度(简称超标)样本数占比为64.47%;(3)呼吸性粉尘浓度为0.68(0.30,1.18)mg/m³,超标样本数占比50.00%;(4)中型企业以及凿岩工和破碎工的矽尘暴露水平较高。矽尘暴露致矽肺的职业健康风险评估结果显示：(1)整体职业健康风险水平为中等：总粉尘方面ICMM风险评级表法和INDEX法的综合评估结果分别为高和中等风险(S_weighted分别为3.52和2.79),呼吸性粉尘方面则均为中等风险(S_weighted分别为2.78和2.35);(2)中型企业风险水平高于其他企业。整体上ICMM风险评级表法和INDEX法在总粉尘或呼吸性粉尘方面均具有较强的一致性(Kappa≥0.600)。结论 七省有色金属矿山矽尘暴露致矽肺的职业健康风险等级为中等，其中尤以中型开采企业，以及凿岩工和破碎工的风险水平较高。

OBJECTIVE To explore the occupational health risk level of silicosis caused by silica dust exposure in non-ferrous metal mining enterprises.METHODS Using typical sampling method, 44 non-ferrous metal mining enterprises were selected in seven provinces. 37 non-ferrous metal mining enterprises were included, and most of them were underground enterprises(97.30%). Enterprises basic information and silica dust exposure data of key positions were collected by using on-site hygiene investigation and detecting method. Finally, the International Council on Mining and Metals'(ICMM) risk rating table method and occupational hazard risk index method(INDEX) were used to analyze the occupational health risk level of silicosis caused by silica dust exposure in non-ferrous metal mines from total and respirable dust views, respectively. Meanwhile, the square weighted Kappa test was performed to analyze the consistency between two risk assessment method.RESULTS Medium enterprises(64.69%(40.38%,73.41%)), silver mining enterprises(84.69%(63.38%,86.06%)) and antimony mining enterprises(72.22%) had relatively higher silica dust exposure rates. On-site hygiene detecting result showed that:(1) M(P25,P75) of free silica content was 21.18%(17.03%, 30.47%).(2) 1.60(0.86, 2.46)mg/m³ for total dust concentration, 64.47% total dust concentration samples exceeding Chinese permissible concentration-time weighted average(PC-TWA), 0.68(0.30,1.18) mg/m³ for respiratory dust concentration, 50.00% respirable dust concentration samples exceeding Chinese PC-TWA.(3) Medium-sized enterprises, as well as rock drillers and crushers, had higher levels of silica dust exposure. Occupational health risk assessment result showed that:(1) The overall occupational health risk level of silicosis caused by silica dust exposure in non-ferrous metal mining enterprises was medium:(1) In term of total dust, ICMM risk rating table method and INDEX method indicated high and medium risks, respectively(S_weighted were 3.52 and 2.79).(2) In term of respirable dust, both ICMM risk rating table and INDEX method indicated medium risks(S_weighted were 2.78 and 2.35).(2) Medium-sized enterprises risk level was higher than other two production scales enterprises. ICMM risk rating table method and the INDEX method consistency analyses showed that these two risk assessment method had strong consistencies in terms of total dust or respirable dust(both Kappa values ≥ 0.600).CONCLUSION The overall occupational health risk level of silicosis caused by silica dust exposure in non-ferrous metal mining enterprises was medium, and the risk levels of medium production-scale mining enterprises, rock driller and crusher were higher.