中餐廚務人員肌肉骨骼不適之調查研究

Musculoskeletal Disorders among Chinese Restaurant Cooks

薛惠升(Huei-Sheng Shiue)

指導教授 ： 吳聰能

高雄醫學大學/健康科學院/職業安全衛生研究所/碩士(2006年)

摘要

中餐廚師的工作特性為長時間前彎站立及上肢多操作性及反覆性動作，而這都是目前認為和肌肉骨骼疾患相關的重要因子。但目前無論國內、外以廚師為對象的研究報告非常少，更遑論以中餐廚師人員為研究對象。因此，本研究之目的是希藉由問卷調查及就醫資料瞭解中餐廚務人員肌肉骨骼不適之盛行率以及在身體部位的分佈特性；並希望經由工作分析能更進一步瞭解其可能之工作危害來源。
在問卷調查部分，研究對象為135名持有中餐烹調證照的廚師及120名其他人員；問卷回收率分別為96%與98%。問卷內容包含基本資料、抽菸史、喝酒史、嚼食檳榔史、工作史、身體各部位一年內自覺症狀及就醫行為等。資料分析主要是以描述性統計表示自覺症狀的盛行率。另外，也以邏輯式迴歸分析兩組發生肌肉骨骼不適的相對危險性。在就醫資料方面，是以民國九十二年底前持有中餐烹調證照的有效資料52261筆為依據，再適當選取對照組後，以其健保就醫資料進行分析。在資料分析時，是以疾病盛行率、各年齡層盛行率、性別盛行率為主，同時以卡方檢驗計算兩組的相對危險性。現場工作分析則是以某飯店中餐廚師為對象，攝影記錄其工作情形，然後再以快速上肢評估法(RULA)分析各動作之可能危害程度。
問卷調查結果顯示廚師組及非廚師組一年期肌肉骨骼不適之盛行率分別為65.5%及26.1%，標準化相對危險性(adjusted Odd’s ratio, AOR)為5.48(95% CI 3.02 - 9.94)。在所有身體部位別廚師組盛行率均比非廚師組高；其中又以肘部差異最明顯，其AOR高達38.06(5.10 - 283.64)。廚師組與工作相關自覺症狀部分發生率最高的部位為下背(33.6%)，其次依序是右肩(31.3%)、右腕(28.9%)。健保就醫資料部分則顯示民國九十年廚師肌肉骨骼疾患之盛行率為25.98%，對照組為21.17%；民國九十一年則分別為26.25% 及21.65%，兩年的AOR分別是1.31 (1.28 – 1.34)及1.29 (1.26 – 1.32)。外側肱骨髁上炎在兩組盛行率分別為0.4%及0.2%，其AOR達2。廚師組的腕隧道症候群盛行率約在0.4%，對照組則約為0.25%；兩組的相對危險性為1.76(1.5 – 2.1)。以RULA分析工作可能危害的評估結果顯示右手在加水時和左手洗鍋時的翻鍋倒水的動作action level為4，需立即評估與改變；在食材前處理和烹飪時也有多項action level為3，需儘快評估與改變。
無論是問卷調查或就醫資料都顯中餐廚師肌肉骨骼疾患的盛行率都比一般族群高，最常見的發生部位是下背部。但在相對危險性則以上肢較高，尤其肘部。在工作分析上也顯示中餐廚師工作中有許多動作是需要再評估與改變。由上述種種，此可證明中餐廚師真的是肌肉骨骼疾患的高危險群。日後研究應著重如何以不同方式介入來減少中餐廚師發生肌肉骨骼疾患。

關鍵字

廚師 ； 肌肉骨骼疾患 ； 職業病 ； 盛行率 ； 人因工程

並列摘要

The characteristics of Chinese restaurant cooks work are long-term standing and repetitive manual motion in upper limbs which had been proved as the risk factors contributed to musculoskeletal disorders (MSDs). Though numerous reports on MSDs had been published but few of them concerned about the cooks. This study was conducted to survey the prevalence of MSDs among Chinese restaurant cooks and to survey the distribution of MSDs in body parts.
There were three steps of this study. First, a self-administrated questionnaire was issued to 135 registered Chinese restaurant cooks and 120 non-cooks. The response rates were 96% for cooks and 98% for non-cooks. We gathered the information of demographic data, experiences of musculoskeletal disorders of different body part in the previous year, exercise habit, and so on from the questionnaires. Second, the National Health Insurance Database (NHID) for 2001-2002 was used to obtain the prevalence of MSDs among 52261 registered Chinese restaurant cooks and among the referent group which was derived by the same database with 1: 4 age- and gender-match. Third, the working posture of Chinese restaurant cooks was recorded on video tapes and RULA was applied to analyze the possible high-risk working postures.
In the survey with questionnaires, the prevalence for MSDs were 65.6% among the cooks and 26.1% among the non-cooks and the adjusted OR was 5.48 (95%CI 3.02 – 9.94). The prevalence rates of musculoskeletal disorders for the cooks group in all body parts are higher than those in the non-cooks group. The leading body parts of work-related MSDs were low back (33.6%), right shoulder (31.3%) and right wrist (28.9%). Based on the NHID, the prevalence of MSDs was 25.98% for the cooks group and 21.17% for the referent group and the adjusted OR was 1.31 (1.28-1.34) in 2001. In 2002, the prevalence for these two groups were 26.25% and 21.65% respectively and the AOR was 1.29 (1.26 - 1.32). The body part with the highest AOR was elbow with the prevalence of 0.4% for the cooks group and 0.2% for the referent group. The prevalence of Carpal tunnel syndrome were 0.4% and 0.2% respectively for these two groups and the AOR was 1.76 (1.5 – 2.1). Working analysis with RULA showed adding water into a pot was rated as action level 4 and it indicated that this posture should be investigated and changed immediately. There were a lot of postures during cooking and food preparation classified as action level 3 and meant that they needed to be investigated further and changed soon.
These results demonstrated that Chinese restaurant cooks were under higher risk to get MSDs then other populations. The most frequently affected body part was low back. But when comparing with other populations, upper limbs were at higher risk then other body parts, especially elbows. Further ergonomic studies should be launched to innovate upon the working style to reduce MSDs among Chinese restaurant cooks.

並列關鍵字

Chinese restaurant cooks ； musculoskeletal disorders ； occupational disease ； prevalence ； ergonomics

參考文獻

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