重症监护病房中的职业性听力损失：ICU与非ICU护理人员之间的比较研究

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中文摘要

背景： 在重症监护病房（ICU）中长期暴露于持续高噪声水平可能对医护人员的听觉健康构成重大风险。
目的： 本研究评估中国医疗机构中在重症监护病房（ICU）与非ICU环境工作的护理人员中听力障碍的患病率及特征。
研究设计： 在中国重庆一家医院开展了一项横断面研究。参与者接受了全面的听力学评估，包括纯音测听（PTA）和中文噪声下数字测试（DIN）（测试言语接受阈（SRT））。统计分析采用单因素和多因素logistic回归模型，以识别听力障碍的独立预测因素。
结果： 最终分析共纳入93名注册护士（45名ICU护士和48名非ICU护士）。与非ICU护士相比，ICU护士的听力阈值显著更差，尤其是在高频（4-8 kHz）。约20%的ICU护士在高频表现出听力损失（> 25 dB HL），而非ICU环境中为10%。在ICU环境工作（调整后OR = 2.82，95% CI：1.25-6.35）、每周工作50-60小时（调整后OR = 4.15，95% CI：1.18-14.60）以及每周工作超过60小时（调整后OR = 5.85，95% CI：1.55-22.10）成为听力障碍的显著独立预测因素。ICU护士的言语接受阈显著更差（p < 0.05），PTA阈值与SRT表现呈强相关（r = 0.824，p < 0.001）。多元回归分析确定2 kHz是两组在噪声中言语理解的最关键贡献频率。
结论： 本研究提供了有力证据，表明中国ICU护士相比非ICU护理人员具有更高的听力障碍风险。这些发现凸显了针对在高噪声环境中工作的护理人员开展有针对性的职业健康干预和听力保护计划的迫切需要。
对临床实践的相关性： 本研究强调了对ICU护士，尤其是工作时间较长者，采取有针对性的职业健康措施的必要性。临床方案应优先监测高频听力阈值，并纳入噪声下言语评估以检测功能性缺陷。此外，实施工作负荷管理策略对于减轻噪声暴露的剂量-反应风险并保护护士的长期听觉健康至关重要。

英文摘要

BACKGROUND: Occupational exposure to sustained high-noise levels in intensive care units (ICUs) could pose significant auditory health risks for healthcare professionals.
AIM: This investigation evaluates the prevalence and characteristics of hearing impairment among nursing staff working in an intensive care unit (ICU) versus non-ICU environments within Chinese healthcare facilities.
STUDY DESIGN: A cross-sectional study was conducted at a hospital in Chongqing, China. Participants underwent comprehensive audiological assessments including pure-tone audiometry (PTA) and Chinese digits-in-noise (DIN) (testing for speech reception thresholds (SRT)). Statistical analyses employed univariate and multivariate logistic regression models to identify independent predictors of hearing impairment.
RESULTS: A total of 93 registered nurses (45 ICU and 48 non-ICU) were included in the final analysis. ICU nurses demonstrated significantly worse hearing thresholds compared to non-ICU counterparts, particularly at high frequencies (4-8 kHz). Approximately 20% of ICU nurses exhibited hearing loss (> 25 dB HL) at high frequencies, compared to 10% in non-ICU settings. Working in ICU environments (adjusted OR = 2.82, 95% CI: 1.25-6.35), working 50-60 h per week (adjusted OR = 4.15, 95% CI: 1.18-14.60), and working more than 60 h per week (adjusted OR = 5.85, 95% CI: 1.55-22.10) emerged as significant independent predictors of hearing impairment. Speech reception thresholds were significantly poorer among ICU nurses (p < 0.05), with PTA thresholds showing a strong correlation with SRT performance (r = 0.824, p < 0.001). Multiple regression analysis identified 2 kHz as the most critical frequency contributing to speech understanding in noise for both groups.
CONCLUSIONS: This study provides compelling evidence of elevated hearing impairment risk among ICU nurses compared to non-ICU nursing staff in China. These findings highlight the urgent need for targeted occupational health interventions and hearing conservation programmes for nursing staff working in high-noise environments.
RELEVANCE TO CLINICAL PRACTICE: This study emphasises the necessity of targeted occupational health measures for ICU nurses, particularly those with prolonged working hours. Clinical protocols should prioritise monitoring high-frequency hearing thresholds and incorporating speech-in-noise assessments to detect functional deficits. Furthermore, implementing workload management strategies is essential to mitigate the dose-response risk of noise exposure and preserve nurses' long-term auditory health.