台灣高雄捷運異壓性職業傷害之調查

The Investigation of Dysbaric Occupational Injuries for Kaohsiung Mass Rapid Transit in Taiwan

張陸澎(Lu-Peng Chang) ； 張致維(Chi-Wei Chang)

《中華職業醫學雜誌》 15卷4期 (2008/10) Pp. 261-272

https://doi.org/10.30027/CJOM.200810.0001

摘要

前言：過去台北捷運施工時，曾造成許多減壓病(Decompression Sickness)及異壓性骨壞死(Dysbaric Osteonecrosis)病例。本研究調查高雄捷運建造時之異壓性職業傷害情形。
方法：首先調查高雄捷運整體施工進度，瞭解異常氣壓施工路段、時間、及內容，然後舉辦異常氣壓作業安全講習，執行異常氣壓特殊體檢，篩選志願參與之勞工，最後收集所有參與壓氣工法勞工之健康檢查結果及其發生異壓性職業傷害情形。
結果：民國91-96年間所有高雄捷運工地，僅橘線第一區段(CO1)的4個連絡通道(CP1-CP4)需輔以壓氣工法施工，原因為臨海、地質鬆軟及原始潛盾工地坍塌。勞工體檢前，國軍在營總醫院與捷運工程局和施工雇主聯合辦理異常氣壓作業安全講習兩次。32名泰籍勞工志願者參加異常氣壓特殊體檢，5名無法通過試壓耐氧測試，3名因個人因素放棄，實際參與壓氣工法勞工計24名。異常氣壓工程分4階段完成，每階段（每連絡通道）施工一個月、休息一個月以上，全程歷時一年。24名勞工每人參與高壓環境施工約為4個月，每日工作的時間為8小時，工作環境壓力為1.23-1.43絕對大氣壓，加壓及減壓速率為每分鐘0.8kg/cm2，減壓程序採日本黑澤減壓表(Blackpool Table)。施工期間，無中耳擠壓傷害。(Middle ear Squeezes)發生，有6位工人罹患第一型減壓病（輕微型），經送國軍左營總醫院接受一次高壓氧治療後痊癒。工程結束時，每人長骨x-ray檢查並未有任何異壓性骨壞死現象。
結論：高雄捷運工程減壓病發生的比例不高(25%)，可能與施工前衛教、特殊體檢篩選、及高壓環境曝露時間較短有關。工程結束時長骨檢查正常，並不能完全排除將來發生異壓性骨壞死的可能性。

關鍵字

減壓病 ； 異壓性骨壞死 ； 高壓氧治療 ； 職業傷害 ； 壓氣工法 ； 高雄捷運

並列摘要

Introduction: Previously the construction of Taipei Rapid Transit System resulted in many cases of decompression sickness and dysbaric osteonecrosis. This study was aimed to investigate the dysbaric occupational injuries among the compressed air workers during the construction of Kaohsiung Mass Rapid Transit (KMRT).
Methods: Firstly, we investigated the progress, location, and the details of the compressed air works through the construction of KMRT. Secondly, we held dysbaric safety symposiums for the relevant personnel, and executed dysbaric physical examinations to the volunteers of compressed air work. Finally, we collected the results of health examinations and the data of dysbaric occupational injuries on all compressed air workers.
Results: The 4 connecting tunnels on CO1 region was the only area under compressed air work during the construction of KMRT between 2002 and 2007. This was because that the region was near the seashore had very loose geology, and had been collapsed twice during the constructions. Prior to the conduction of dysbaric physical examination, two consecutive symposiums related to dysbaric safety were held by the combination of Zuoying Armed Forces General Hospital, KMRT Cooperation, and the regional contractor Thirty-two Thailand volunteer workers participated in dysbaric physical examinations. Five of them failed to pass pressure and oxygen tolerance test three was quit for some personal reasons, and only the rest 24 workers engaged in compressed air works. The compressed air project divided into four stages. Each stage (each connecting tunnel) took one month for construction, and more than one month for rest and preparation. The whole project lasted for about one year. Each of the 24 workers exposed to high pressure around 1.23-1.43 ATA 8 hours daily for about four months. The Japanese Blackpool Table was used as the decompression procedure with a compression or decompression rate of 0.8 kg/cm2/mm. There was no middle ear squeeze during the construction. Although six workers suffered with type I decompression sickness, they all recovered after receiving hyperbaric oxygen therapy with US Navy treatment table 5A once. At the end of the project, the long bone x-ray examinations of the 24 workers did not show any evidence of dysbaric osteonecrosis.
Conclusion: The incidence of decompression sickness during construction of KMRT was not high (6124 or 25%). This might be attributed to the applications of dysbaric safety symposiums and physical examinations, and the shorter exposure durations under the hyperbaric environment. The negative findings on long bone x-ray studies at the end of compressed air project could not exclude the possible occurrence of dysbaric osteonecrosis in the future on these workers.

並列關鍵字

Decompression sickness ； Dysbaric Osteonecrosis ； Hyperbaric Oxygen Therapy ； Occupational Injuries ； Compressed Air Work ； Kaohsiung Mass Rapid Transit