目的了解铁路企业毒物危害因素分布情况,掌握有害接触危害因素职工的健康状况,探讨毒物对铁路职工的健康影响及变化趋势,为制定相应干预措施提供依据。方法采用普查的方法,收集济南铁路局毒物危害因素检测资料和接害职工健康监护资料以及调查铁路企业采取的有毒有害作业防治措施,分析防治措施存在的不足,提出改进措施。结果铁路企业主要毒物有铅及其化合物、锰及其化合物、二氧化硫、氮氧化合物等14余种,涉及20种以上工作岗位。145个毒物固定作业点中,经营集团构成比最高,占35.17%;车务部门构成比最低,占0.69%;其次工务部门、车辆部门、机务部门、电务部门构成比分别占22.76%、18.62%、17.24%、5.52%。检测总达标率为88.28%,其中1级毒物检测达标率最高,为92.45%;2～4级毒物检测达标率呈降低趋势,4级毒物检测达标率最低,为80.00%。调查接害的3 925名职工中,血液检测中高血脂检出率最高,为30.47%;高血糖检出率最低,为6.52%。B超检查中脂肪肝检出率最高,为32.05%;胆囊炎检出率最低,为1.58%。心血管检查,高血压检出率最高,为19.29%;早搏检出率最低,为1.63%。结论铁路企业毒物作业点检测达标率较高,但仍存在超标作业点的情况,须加强监管。铁路企业职工长期接触职业病危害因素,健康可能受到一定的影响,应进一步加强卫生防护。 OBJECTIVE To understand the distribution of hazardous factors in railway enterprises, to understand the health status of workers exposed to harmful factors, to explore the health effects and trends of toxicants on railway workers, and to provide the basis for the corresponding interventions. Methods The method of census was used to collect the testing data of hazardous elements of Jinan Railway Bureau and the health guardianship data of workers and the measures of prevention and control of toxic and harmful occupations taken by railway enterprises. The deficiencies of prevention and control measures were analyzed and the improvement measures were put forward. Results The main toxic substances in railway enterprises include more than 14 kinds of lead and its compounds, manganese and its compounds, sulfur dioxide and nitrogen oxides, involving more than 20 kinds of jobs. Among the 145 poisonous fixed operation sites, the operating group has the highest composition ratio of 35.17%, the lowest proportion of vehicle department, accounting for 0.69%, followed by 22.76% for engineering department, vehicle department, maintenance department and electricity service department, accounting for 18.62% %, 17.24%, 5.52%. The total compliance rate of detection was 88.28%, among which the detection rate of grade 1 poison reached the highest rate of 92.45%. The detection rate of grade 2 ~ 4 poisoning decreased and the rate of grade 4 poison detection reached the lowest, which was 80.00%. Of the 3 925 workers who were injured in the survey, the highest detection rate of high blood lipids in blood tests was 30.47%, while the lowest rate of high blood sugar tests was 6.52%. B-ultrasound in the highest detection rate of fatty liver, 32.05%; the lowest detection rate of cholecystitis, 1.58%. Cardiovascular examination, the highest detection rate of hypertension, was 19.29%; the lowest rate of premature beats, was 1.63%. Conclusion The detection rate of poisonous operation point in railway enterprises is relatively high, but there are still cases of excessive operation point, so supervision should be strengthened. Long-term exposure of workers in railway enterprises occupational hazards, health may be affected to some extent, should further strengthen health protection.