卫生研究

目的 使用国际采矿与金属委员会定量评估(International Mining and Metals Association, ICMM)法和职业危害风险指数(occupational hazards risk index, INDEX)法评估中国八省(自治区)小微型非煤矿山企业的矽尘暴露职业健康风险，同时确定矽尘暴露高风险岗位，比较两种评估方法的风险评估结果。方法 于2018—2020年以方便抽样法抽取广东、江苏、山东、湖南、湖北、辽宁、甘肃、内蒙古8个省(自治区)的84家小微型非煤矿山企业为研究对象，开展职业卫生调查和职业危害因素检测，采用ICMM法和INDEX法对其进行职业健康风险评估，对两法标化评估结果使用kappa检验比较评估结果的一致性。结果 调查企业中矽尘暴露率为57.65%(n=3440),呼吸性粉尘时间加权平均接触浓度[M(P25,P75)]为0.60(0.37,1.23)mg/m³,呼吸性粉尘超标率为48.83%(n=897)。风险评估结果显示，ICMM法井下和露天开采风险等级差异无统计学意义(CMH χ²=0.198,P>0.05),两者标化评估等级为中等风险。ICMM法各工种间风险等级差异有统计学意义(CMH χ²=54.713,P<0.05),中控工和筛分工标化评估等级为极高风险，凿岩工、破碎工、磨工和包装工标化评估等级为高风险。INDEX法井下和露天开采风险等级差异有统计学意义(CMH χ²=71.228,P<0.05),井下和露天开采标化评估等级为中等风险。INDEX法各工种间风险差异有统计学意义(CMH χ²=26.122,P<0.05),爆破工、破碎工、中控工、筛分工、包装工的标化评估等级为高风险，其他为中等风险。ICMM法和INDEX法总体评估结果存在正相关关系(r=0.777,P<0.01)。一致性检验结果显示，两法评估结果一致性较好(κ_总体=0.681,95%CI 0.652～0.709,P<0.05),各工种评估结果κ值为0.432～0.826,整体一致性在中等以上。结论2018—2020年中国八省(自治区)小微型非煤矿山企业矽尘暴露率高，接尘岗位呼吸性粉尘超标率高，两种评估方法均显示小微型非煤矿山各岗位处于较高的健康风险等级。两种评估方法均偏定性，一致性较好，ICMM法易高估职业健康风险，而INDEX法会低估危害等级。

OBJECTIVE Using quantitative International Committee Mining and Metals evaluation(ICMM) and the occupational hazards risk index(INDEX) method to evaluate occupational health risks of silica dust exposure in small and micro non-coal mining enterprises in some Chinese provinces and cities. At the same time, the high risk positions of silica dust were determined and the risk assessment result of the two assessment method were compared. METHODS Sampling 84 small and micro non-coal mining enterprises conveniently selected from Guangdong, Jiangsu, Shandong, Hunan, Hubei, Liaoning, Gansu Provinces and Inner Mongolia Autonomous Region during 2018-2020 as the research object, we carried out occupational health investigation and occupational hazard factor and assessed occupational health risk assessment by ICMM method and INDEX method. Kappa test was used to compare the consistency of the two standardized evaluation result. RESULTS The exposure rate of silica dust in small and micro non-coal mine enterprises was 57.65%(n=3440)in Chinese provinces and the concentration-time-weighted average(M(P25,P75)) of respirable dust was 0.60(0.37,1.23) mg/m³, the over-standard rate of dust samples was 48.83%(n=897). The risk assessment result showed that the ICMM method had no statistical significance in the difference between the risk levels of underground and opencast mining(CMH χ²=0.198, P>0.05), and the standard assessment level of underground and opencast mining was medium risk. The risk difference among different jobs was statistically significant(CMH χ²=54.713, P<0.05). The standardized assessment level of central control workers and screening workers was extremely high risk, and the standardized rating level of rock drilling workers, crushing workers, grinders and packers was high risk. The difference of risk grade between underground and opencast mining by INDEX method was statistically significant(CMH χ²=71.228, P<0.05), and the standard assessment grade of underground and opencast mining was medium risk. The risk difference among different types of work was statistically significant(CMH χ²=26.122, P<0.05). The standard assessment level of blasting workers, crushing workers, central control workers, screening workers and packing workers was high risk, while others were medium risk. There was a positive correlation between the overall evaluation result of ICMM method and index method, and the correlation coefficient was r=0.777(P<0.01).The consistency test result showed that the ICMM and INDEX method had good consistency, κ_overall=0.681(95%CI 0.652-0.709, P<0.05),The κ values of all types of work were within the range of 0.432-0.826, and the overall consistency was above medium. CONCLUSION The silica dust exposure rate of small and micro non-coal mining enterprises in some Chinese provinces investigated is high, and the respiratory dust over standard rate of dust exposure positions is high. Both evaluation method show that all posts in small and micro non-coal mines in China are in a higher level of health risk. Two evaluation method have good consistency. The result of ICMM are easy to be judged subjectively and overestimate occupational health risks, INDEX method may underestimate the hazard level.