潛水人員減壓症盛行率及其危險因子分析

Prevalence and Determinants of Decompression Sickness of Divers

減壓症是國內異常氣壓作業勞工最容易罹患之職業病。不同異常氣壓作業種類，其罹病之危險因子及盛行率並不相同。由於國內過去並未有大規模之流行病學調查，故有必要就此問題加以探討並提出預防對策。本研究利用專家會議，修訂國際潛水警示網（D.A.N.）針對減壓症調查之問卷，於84年10月至86年6月進行潛水人員減壓症盛行率及其危險因子分析研究。研究方法除實際現場訪視外，並舉辦九場次體檢及潛水安全講習會，針對485名參加者實施結構問卷調查；受訪族群計有247名為職業潛水勞工、92名潛水漁撈人員、146名休閒潛水，另以郵寄方式取得43名科技潛水人員調查問卷（回收率86%）。經由問卷結果並查核醫院病歷資料發現，受訪者在受訪前過去一年曾罹患減壓症之盛行率，漁民組群為23.9%、職業潛水勞工為22.7%、休閒潛水組群為4%以及科技潛水人員為2.3%。另以受訪者一生中是否曾罹患過減壓症分為兩組，經由Student-t　test篩選問卷中可能的影響變項，再投入以對數邏輯迴歸方法（logistic　regression　analysis）分析各樣本之危險因子；結果發現影響職業潛水勞工罹病的因子為工作狀況、平均下潛次數、年齡、水底工作時間、是否健康檢查、減壓頻率與減壓程序等變項；漁民組群的影響因子為B.M.I.>25、平均下潛次數、抽菸及年齡等變項；而休閒潛水組群的危險因子為是否定期健康檢查、沒有同伴潛水、無潛水紀錄與一年下潛超過200次。科技潛水因樣本數與罹病率較低而未能發現顯著因子。為減少減壓症的發生，本研究建議主管機關、雇主及勞工應從1.作業流程2.健康3.教育訓練4.操作5.設備及6.環境等方面加以重視及改善，並落實安全衛生的勞動檢查。

The decompression sickness (DCS) is the disease most commonly occurred in underwater-workers and fishermen who violate the regulation of step decompression. The purpose of this series of studies is to initiate a demographic and epidemiological survey on workers who are commercial under-water workers, and explore the possible etiological factors leading to the occurrence of DCS in Taiwan. We interviewed 247 underwater construction workers, 92 fishermen, 146 sports divers and 43 research divers using a well designed questionnaire. The nature of work, training history, diving related health problems and records of health care characterized each diving group. The results showed that the prevalence of DCS during last year was 23.9% in fishermen, 22.7% in professional divers, 4.υ% in sports diver and 2.3% in research divers. The risk factors in the group of professional divers relating to the high prevalence of DCS, using logistic regression analysis are: (1)knowing concept of step decompression, (2)following the decompression table, (3)performing the annual physical examination, (4)number of dives for each shift, (5)bottom time, and (6)full time or part-time work, and (7)age. The risk factors in the group of fishermen relating to the high prevalence of DCS are: (1)BMI, (2)smoking, (3)number of dives for each shift, and (4)age. Moreover, the risk factors in the group of sports divers relating to the high prevalence of DCS are: (1)performing the annual physical examination, (2)diving with a partner, (3)over 2υυ dives per year, and (4)data recording during the dive. Therefore, to improve the safety during the dive in different groups, we suggest that responsible government agencies launch a series of amending programs regarding to (1)operation plan, (2)training and education, (3)equipment, (4)work practice, (5)selected location and (6)environment recognition.