摘要目的:探讨不同行业噪声作业工人佩戴护听器的防护效果现状及其可能影响因素。方法:于2020年10月至2023年12月，采用方便抽样的方法，抽取石化行业、汽车制造业、塑胶制造业、金属制造业等7个行业的3 634名噪声作业工人作为调查对象；采用课题组自行设计的调查问卷调查工人护听器（泡棉型耳塞、预成型耳塞、耳罩）的使用情况；利用3M TM E-A-R fit TM双耳验证系统测量工人佩戴护听器的个体声衰减值（personal attenuation rating，PAR），主要开展包括基线PAR、干预PAR（正确佩戴护听器培训演示、更换合适的护听器等干预措施）、随访PAR三个过程测试。采用非参数检验分析各组PAR差异，广义线性回归模型探索可能影响基线PAR的因素。 结果:3 634名工人佩戴护听器所获得基线PAR的 M（ Q1， Q3）为12（2，19）dB；三类护听器的基线PAR差异有统计学意义（ H=336.39， P<0.001），且佩戴泡棉型耳塞、耳罩的工人基线PAR均高于预成型耳塞（ P<0.05）；不同行业的工人基线PAR差异有统计学意义（ Z=359.73， P<0.001）。大专及以上文化水平、护听器佩戴年限10~<30年、泡棉型耳塞和耳罩、噪声强度≥85 dB（A）、知道正确佩戴方法与评价护听器舒适的工人基线PAR较高（ P<0.05）。1 559人（42.9%）未通过基线PAR测试；干预后，工人的PAR从基线时的1（0，6）dB提高至干预后的18（14，22）dB（ P<0.001）；随访测试发现，328名工人的随访PAR高于基线PAR，低于干预后PAR（ P<0.001）。 结论:部分噪声作业工人佩戴的护听器实际防护效果不佳，主要与工人护听器佩戴知识不足、高强度噪声接触、文化水平较低等因素有关。企业应借助护听器适合性检验方法，加强工人护听器正确佩戴培训，科学选择适合的护听器，必要时开展定期随访。

abstractsObjective:To explore the current status of the protective effects of hearing protection devices worn by noise-exposed workers in different industries and its possible influencing factors.Methods:From October 2020 to December 2023, by using the method of convenient sampling, 3634 noise-exposed workers from 7 industries including the petrochemical industry, automotive manufacturing industry, plastic manufacturing industry, and metal manufacturing industry, were selected as the survey subjects. A questionnaire designed by the research group was adopted to investigate the usage of hearing protection devices (foam earplugs, preformed earplugs, and earmuffs) among workers. The personal attenuation rating (PAR) of workers wearing hearing protection devices was measured by using the 3M TM E-A-R fit TM binaural verification system. Three process tests were carried out, including baseline PAR, intervention PAR (training demonstration of correct wearing of hearing protection devices, replacement of appropriate hearing protection devices and other interventions), and follow-up PAR. The differences of PAR in each group were analyzed by non-parametric tests, and the generalized linear regression model was used to explore the factors that might affect the baseline PAR. Results:The M ( Q1, Q3) of the baseline PAR obtained by 3634 workers wearing hearing protection devices was 12 (2, 19) dB. There was a statistically significant difference in baseline PAR among the three types of hearing protection devices ( H=336.39, P<0.001), and the baseline PAR of workers wearing foam earplugs and earmuffs were higher than that of preformed earplugs ( P<0.05). There was a statistically significant difference in baseline PAR among workers in different industries ( Z=359.73, P<0.001). Workers with college degree or above education level, wearing hearing protection devices for 10 to <30 years, foam earplugs and earmuffs, noise intensity≥85 dB (A), knowing the correct wearing method and evaluating the comfort of hearing protection devices had a higher baseline PAR ( P<0.05). There were 1559 workers (42.9%) failed the baseline PAR test. After the intervention, the PAR of the workers increased from 1 (0, 6) dB at baseline to 18 (14, 22) dB after the intervention ( P<0.001). The follow-up test found that the follow-up PAR of 328 workers was higher than the baseline PAR but lower than the intervention PAR ( P<0.001) . Conclusion:The actual protective effect of the hearing protection devices worn by some workers exposed to noise is not good, mainly related to factors such as insufficient knowledge of wearing hearing protection devices among workers, exposure to high-intensity noise, and low educational level. Enterprises should enhance the training of workers on the correct wearing of hearing protection devices by means of hearing protection device fit test methods, select suitable hearing protection devices scientifically, and conduct regular follow-ups when necessary.