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热应激下长时间轮班工作的产业工人的体液流失与水合状态

Fluid losses and hydration status of industrial workers under thermal stress working extended shifts.

作者信息

Brake D J, Bates G P

出版信息

Occup Environ Med. 2003 Feb;60(2):90-6. doi: 10.1136/oem.60.2.90.

Abstract

AIMS

To assess whether workers under significant thermal stress necessarily dehydrated during their exposure and whether "involuntary dehydration" was inevitable, as supported by ISO 9866 and other authorities. Other objectives were to quantify sweat rates against recommended occupational limits, to develop a dehydration protocol to assist with managing heat exposures, and to understand the role of meal breaks on extended shifts in terms of fluid replacement.

METHODS

A field investigation to examine the fluid consumption, sweat rates, and changes in the hydration state of industrial workers on extended (10, 12, and 12.5 hour) shifts under significant levels of thermal stress (wet bulb globe temperature (WBGT) >28 degrees C) was conducted on 39 male underground miners. Urinary specific gravity was measured before, during, and at the completion of the working shift. Environmental conditions were measured hourly during the shift. Fluid replacement was measured during the working periods and during the meal breaks.

RESULTS

Average environmental conditions were severe (WBGT 30.9 degrees C (SD 2.0 degrees C), range 25.7-35.2 degrees C). Fluid intake averaged 0.8 l/h during exposure (SD 0.3 l/h, range 0.3-1.5 l/h). Average urinary specific gravity at start, mid, and end of shift was 1.0251, 1.0248, and 1.0254 respectively; the differences between start and mid shift, mid and end shift, and start and end shift were not significant. However, a majority of workers were coming to work in a moderately hypohydrated state (average urinary specific gravity 1.024 (SD 0.0059)). A combined dehydration and heat illness protocol was developed. Urinary specific gravity limits of 1.022 for start of shift and 1.030 for end of shift were selected; workers exceeding these values were not allowed into the workplace (if the start of shift limit was exceeded) or were retested prior to their next working shift (if the end of shift limit was exceeded). A target of 1.015 as a euhydrated state for start of shift was adopted for workforce education.

CONCLUSIONS

This study found that "involuntary dehydration" did not occur in well informed workers, which has implications for heat stress standards that do not make provision for full fluid replacement during heat exposure. Fluid replacement during meal breaks was not significantly increased above fluid replacement rates during work time, with implications for the duration and spacing of meal breaks on long shifts. Testing of urinary specific gravity was found to be a good indication of hydration status and a practical method of improving workforce awareness and understanding of this important risk factor. Approximately 10 000 dehydration tests have been conducted under the dehydration protocol in a workforce of 2000 persons exposed to thermal stress and has proved practical and reliable.

摘要

目的

评估处于显著热应激状态下的工人在暴露期间是否必然会脱水,以及“非自愿性脱水”是否如国际标准化组织(ISO)9866及其他权威机构所支持的那样不可避免。其他目标包括根据推荐的职业限值对出汗率进行量化,制定一项脱水方案以协助管理热暴露情况,并了解在延长班次期间餐歇对液体补充的作用。

方法

对39名男性地下矿工进行了一项现场调查,以研究在显著热应激水平(湿球黑球温度(WBGT)>28摄氏度)下,从事延长(10小时、12小时和12.5小时)班次工作的产业工人的液体摄入量、出汗率及水合状态变化。在工作班次开始前、期间及结束时测量尿比重。在班次期间每小时测量环境条件。在工作期间及餐歇期间测量液体补充情况。

结果

平均环境条件较为恶劣(WBGT为30.9摄氏度(标准差2.0摄氏度),范围为25.7 - 35.2摄氏度)。暴露期间液体摄入量平均为0.8升/小时(标准差0.3升/小时,范围为0.3 - 1.5升/小时)。班次开始、中间和结束时的平均尿比重分别为1.0251、1.0248和1.0254;班次开始与中间、中间与结束以及开始与结束之间的差异不显著。然而,大多数工人上班时处于轻度脱水状态(平均尿比重1.024(标准差0.0059))。制定了一项综合脱水和热疾病方案。选择了班次开始时尿比重限值为1.022,结束时为1.030;超过这些值的工人不允许进入工作场所(如果超过班次开始限值),或者在下次工作班次前重新进行检测(如果超过班次结束限值)。采用1.015作为班次开始时正常水合状态的目标值对员工进行培训。

结论

本研究发现,在充分了解情况的工人中不会发生“非自愿性脱水”,这对热应激标准有影响,因为这些标准未规定在热暴露期间进行充分的液体补充。餐歇期间的液体补充量相比工作时间的液体补充率没有显著增加,这对长班次用餐时间的长短和间隔有影响。发现检测尿比重是水合状态的良好指标,也是提高员工对这一重要风险因素认识和理解的实用方法。在一项针对2000名暴露于热应激环境的员工的脱水方案下,已经进行了约10000次脱水检测,证明该方案切实可行且可靠。

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