住宅与办公场所卫生

1、第四节 室内空气污染对健康的影响及其卫生要求,第八章 住宅与办公场所卫生,The 20th century outdoor air pollution focus of public health concern The 20th century ends indoor air pollution significant public health problem,会议指出： 近20多年来，许多国家的室内空气品质不容乐观，室内空气污染引发了以下三种病症：病态建筑综合症、与建筑有关的疾病，以及多种化学污染物过敏症。 美国环境保护署(EPA)历时5年的调查结果显示，许多民用和商用建筑内的空气污染程

2、度是室外空气污染数倍至数十倍，有的甚至超过100倍。 与发达国家相比，我国室内空气污染问题更为严重。据统计，我国每年由室内空气污染引起的超额死亡数达11.1万人。严重的室内环境污染也造成了巨大经济损失，仅1995年我国因室内环境污染危害健康所导致的经济损失就高达107亿美元。,2005年4月1921日在北京召开了以“室内空气质量和污染物控制”为主题的香山科学会议。,在世界卫生组织公布的2002年世界卫生报告中，室内烟尘与高血压、胆固醇过高症及肥胖症等被共同列为人类健康的10大威胁。报告指出，尽管空气污染物主要存在于室外，但是人们长期生活在室内，因此人们受到的空气污染主要来源于室内空气污染。,S

3、ource and character Health effects Indoor air quality assessment,Indoor Air Pollution,一、室内空气污染的来源和特点Source and character of indoor air pollution,1、室外来源 室外空气 建筑材料 人为带入室内 生活用水污染 2、室内来源 燃料燃烧 人在室内的活动（吸烟） 室内建筑和装饰材料 室内生物性污染 家用电器,来 源,1. Sources of Indoor Air Pollutants,Combustion or Cooking Construction an

4、d decorative material Indoor human activities Indoor biological contamination Home electronic equipment Outdoor pollution,Tobacco smoking Fuel combustion Cooking smoking,Combustion or Cooking （燃烧或加热）,Tobacco smoking（香烟烟雾） Vapor phase (90%)： carbon monoxide (CO) carbon dioxide (CO2) nitrosamines form

5、aldehyde（甲醛） Particulate matter (8%): nicotine tar（焦油） (Carcinogenic PAHs) Metals: cadmium, lead,More than 4,500 compounds have been identified from burning tobacco.,Most solid fuels contain impurities that may result in emission of,- fluoride- metals (arsenic) - particles - sulfur oxides,Combustion

6、 sources burn at high temperature to produce:,- CO - nitrogen- and sulfur dioxide - particles - polyaromatic hydrocarbons (PAHs),Fuel combustion（燃料燃烧）,Cooking at high oil temperature can produce a series of complex pollutants. More than 200 compounds have been identified from cooking smoking. 主要有醛、酮

7、、烃、脂肪酸、 醇、芳香族化合物、酯、内酯、 杂环化合物等。在烹调油烟中 还发现挥发性亚硝胺等已知 突变致癌物。,Cooking smoking（烹调油烟）,VOCs Formaldehyde Radon,Construction and decorative material （建筑装饰材料）,VOCs: volatile organic compounds 挥发性有机污染物,主要来源于各种溶剂、粘合剂等化工产品,还来源于清洁剂、杀虫剂、办公设备 （传真机、电脑、打印机等）等。,挥发性有机化合物是一类重要的室内空气污染物，目前已鉴定出500多种（醇、醛、酮、苯、芳香烃等），它们各自的浓度并不

8、高，但若干种VOCS共同存在于室内时，其联合作用是不可忽视的，由于它们单独的浓度低，但种类多，故总称为VOCs，不予逐个分别表示，以TVOC表示其总量。,Formaldehyde 甲醛,One of the most ubiquitous indoor organic pollutant. Used in hundreds of products 油漆、塑胶、压缩木、夾板及醛泡沫树脂保 暖材料等 As a preservative (added to medicines, cosmetics, textiles, and to some food containers).,甲醛是一种挥发性有机

9、化合物； 大量存在于多种装饰材料中，也可来自建筑材料； 甲醛还可来自化妆品、清洁剂、杀虫剂、消毒剂、防腐剂、印刷油墨、纸张、纺织纤维等； 一般住宅在新装饰后的峰值约为0.2 mg/m3，个别可达0.87mg/m3，使用一段时间后下降至0.04mg/m3或更低。,Radon 氡,- soil toft（土壤地基） - building materials,Source,居室氡中的来源是多途径的，但主要是从房屋底下的岩石（土壤）等地质背景和墙地砖等建筑材料来的，其次是水源、煤气（天然气），五花八门的生活用具和室外更高氡浓度的地方传入。 室外空气中氡的年平均浓度约在0.1-10Bq/m3之间。室内空

10、气中约在5-100Bq/m3，甚至更高。 我国2002年发布的室内空气质量标准采取ICRP建议的中值（400Bq /m3）作为我国室内氡浓度的控制上限。,我国部分地区室内和地下建筑中氡浓度（Bq/m3),Saliva of patient and carrier Bacteria: - tubercle bacillus, - streptococcus Viruses:- influenza virus - hepatitis virus Cigarette smoking Exhalation (CO2, ammoniate),Indoor human activities,Indoor

11、biological contamination,Animals (dogs, cats, rabbits, mice) dander, saliva, excreta 有宠物房屋内变应原的浓度可以是无宠物房屋内的3-10倍。据调查，普通人群中对猫、狗的变态反应原有过敏反应的大约有15%。 Dust mite (尘螨) dust mite excreta，具有强烈的变态反应原性。 室内空气中尘螨的数量与室内的温度、湿度和清洁程度相关。,军团菌（legionella）,主要存在于现代建筑物贮水器的水中，如冷却塔水、冷凝水、温水箱水、制冰机用水、温水游泳池水、浴池水、以及水龙头、淋浴喷头、医用喷雾

12、器和空气调湿器的水中 其中空调系统（主要通过冷却塔水）带菌是引起军团菌病流行的常见原因。该病菌主要通过室内空气传播。,Home electronic equipment,Electromagnetic radiation（电磁辐射）,television computer mobile phone microwave oven,Sources:,Outdoor pollution,Outdoor air pollution,Domestic water,Soil toft,- industry - traffic - plant pollen,- pathogenic bacterial -

13、chemical pollutant,Legionella,- volatile compounds - off-gassing,2. Character of indoor air pollution,Indoor air can become contaminated from numerous sources. Indoor air can have significantly higher concentrations of air toxics than outdoor air.,Sources of PAH in indoor air,Environmental Tobacco S

14、moke (ETS),Building materials (parquet glues),Cooking with coal, fuel, wood (fossile energies),Other processes of combustions,Impact of outdoor pollution (industry, traffic),Impact of outdoor pollution (2) Tobacco smoking (3) Modern building materials (4) Air condition,industry, traffic, plant polle

15、n,formaldehyde, radon,various poisons,new health problem,Air condition,legionnaires disease, (军团菌病) Sick building syndrome, SBS (病态建筑物综合症) Building related illness, BRI (与建筑物有关的疾病),New health problem,Lack of optimal ventilation and air purification,二、室内空气主要污染物的危害Adverse health effectof indoor air po

16、llutant,Air pollutants responsible for health effects,Indoor,Bioaerosols (and allergens) Environmental tobacco smoke (ETS) Microbiological volatile organic compounds (MVOC) Semivolatile organic compounds (SVOV) (i.e. PCB, phthalates, pesticides) (Very) Volatile organic compounds (V)VOC Radon particl

17、es CO and CO2 fragrances Flame retardants,Outdoor,Chemical pollutant Biologic pollutant Physical pollution,Combustion products,- Cold mountainous area in China (fluorosis area) - Combustion of higher fluoride-content coal - Behindhand burning way - Higher concentration of fluorine in indoor air and

18、in stored food (corn, chilies and potatoes),含高氟的劣质煤,Endemic fluorosis,Harmful effect: dental fluorosis (氟斑牙） osteosclerosis（骨硬化）,Combustion products,含高砷的劣质煤,Endemic arsenic poisoning,arsenic melanosis (砷性黑皮症) hyperkeratosis (皮肤过度角化) skin cancer (皮肤癌）,Combustion products,燃烧劣质烟煤（云南宣威）,Higher concentra

19、tion of BaP in indoor air,Higher mortality of lung cancer,Combustion products,Tobacco tar （烟焦油） more than 500 PAHs 10 of which: stronger carcinogen,Tobacco smoke,Indicator-PAH: Benzoapyrene(BaP),Well-known toxicokinetics in animals and humans Usually existing in complex PAH mixtures of all sources H

20、igh toxic (carcinogenic) potency,Carcinogens in tobacco and cigarette smoke IARC evaluation of carcinogenicity,Cigarette smoking is the leading cause of lung cancer worldwide. The risk of getting cancer is generally greater for smokers than non-smokers by a factor of 2.24. Cardiovascular disease. Ch

21、ronic obstructive pulmonary disease (COPD),肺癌10-40倍 唇癌4.1倍 喉癌5.4倍 食道癌3.4倍 膀胱癌1.9倍 肾癌1.5倍,国外调查发现，吸烟者为不吸烟者死于各种癌症的倍数是：,Passive smoking,测流烟雾中不完全燃烧所产生的有害物浓度比主流烟雾多，如： CO3倍 BaP4倍 氨含量46倍,美国在一次调查中发现： 1个家庭中有1个吸烟者，该家庭全体成员患癌症的危险性就增加1.4倍； 1个家庭中有2个吸烟者，则患癌症的危险性增加2.3倍； 1个家庭中有3个或以上的吸烟者，患癌症的危险性增加2.8倍。,Volatile organi

22、c compounds, VOCs,在室溫中可挥发 对健康的影响： Irritants (formaldehyde) Neurotoxins (aromatic compounds) Carcinogens and mutagens (benzene) 刺激眼鼻喉及呼吸道，引起头痛、精神不集中、暈眩及疲倦、 病态建筑物综合症 (Sick building syndrome) ； 损害中央神经系統、肝脏及肾脏。,Sick Building Syndrome, SBS Building related illness, BRI,Sick building syndrome, SBS(病态建筑物综合

23、症),No specific illness or cause Building-associated complains: - mucous member irritation of eyes, nose and throat - headache - tiredness or fatigue - difficulty in concentration,眼、鼻和咽喉、上呼吸道刺激症、头痛、疲劳、精力不足、健忘、嗜睡、全身不适和工作效率低下等。,Building related illness (BRI) (与建筑物有关的疾病),comes from a known cause bacteri

24、a dust mite radon usually accompanied by sick building syndrome complaints.,Legionnaires disease,asthma,lung cancer,SBS的特点 1. 发病快；2. 患病人数多；3. 病因很难鉴别确认；4. 患者一旦离开污染的建筑物后，症状即可缓解或消失。,BRI的特点 1. 患者的症状在临床上可以明确诊断； 2. 病因可以鉴别确认，可以直接找到致病的污染物，乃至污染源；3. 患者即使离开发病现场，症状也不会很快消失，必须进行治疗才能恢复健康。,IMPACTS Allergic Eyes and

25、 nose irritation Headaches Dizziness Development of cancer,Formaldehyde 甲醛,甲醛 挥发性有机物 当其浓度很高時，会有化学气味 影响: 对眼、鼻及呼吸道有刺激性 可引起变态反应，主要是过敏性哮喘 被世界卫生组织确定为可疑致癌物质,长期接触l.34mg/m3甲醛，能出现神经衰弱症状；有的还可引起肝功能异常，出现中毒性肝炎；肺功能方面也可出现呼气性功能障碍； 遗传毒性研究发现甲醛能引起基因突变和染色体损伤。,IMPACTS Inhaled and deposited in the lungs where it can dama

26、ge lung tissue, possibly lung cancer. No immediate symptoms.,Radon 氡,lung cancer,氡是放射性气体，当人们吸入体内后，氡衰变产生的阿尔法粒子可在人的呼吸系统造成辐射损伤，诱发肺癌。,Rn55% 其他45%,氡对人体的辐射伤害占人体所受到的全部环境辐射中的55以上。 美国每年因为氡而死亡的人数高达30000人 我国每年因氡致肺癌为50000例以上。 世界卫生组织把氡列为19种主要的环境致癌物质之一，氡已成为除吸烟以外引起肺癌的第二大因素。,吸烟氡暴露患肺癌的高风险,135,8,71,4,57,3,29,2,15,1,9

27、,0.7,3,0.3,0,20,40,60,80,100,120,140,1,2,3,4,5,6,7,吸烟者,非吸烟者,每1000人一生可能患肺癌的人数,20 10 8 4 2 1.3 0.4 氡（pCi/L),高放射性的建筑材料,起源于火成岩的材料：花岗岩、火山 石、浮石； 工业废渣制造的材料：主要是钢渣、炉 渣、磷石膏、赤泥等。,What is Legionnaires disease ? (Legionellosis, 军团病, 军团菌病),Legionnaires disease acquired its name in 1976 when an outbreak of pneumon

28、ia occurred among persons attending a convention of the American Legion in Philadelphia. Later, the bacterium causing the illness was named Legionella (军团杆菌).,What are the symptoms of Legionnaires disease?,Early symptoms include: - fever (up to 40C). - headache (often severe). - shortness of breath.

29、 - sometimes a dry cough. - chills, muscle aches and pains. like a severe flu infection Legionnaires disease is a serious and sometimes fatal form of pneumonia.,How is legionellosis spread?,Outbreaks of legionellosis have occurred after persons have breathed mists (水雾) that come from a water source

30、(e.g. air conditioning, cooling towers, showers) contaminated with Legionella bacteria. Persons may be exposed to these mists in homes, workplaces, hospitals, or public places.,Where is the Legionella bacterium found?,in many types of water systems in warm, stagnant water - hot water tanks - cooling

31、 towers - evaporative condensers of large air- conditioning systems,Plant pollen pollen disease (花粉病） asthma, rhinitis Dust mite (尘螨） asthma， hypersensitive rhinitis hypersensitive dermatitis,尘螨具有强烈的变态反应原性。变应原不仅存在于尘螨本身，也存在于尘螨的分泌物、排泄物中。 尘螨可通过空气传播进入人体，因反复接触而致敏，引起过敏性哮喘、过敏性鼻炎，也可引起皮肤过敏等。在很多过敏性疾病患者家中，都能检出

32、大量尘螨。,Asthma, 20 million Americans have asthma Affects 1 in 20 Americans leading to more than 5000 deaths and close to million hospitalizations Our children Leading chronic-disease among children Nearly 5 million children have asthma Leading cause of school absences,Ranking of health risks caused by

33、 IAQ factors,SVOC (PCP, PCB),VOC (incl. Fragrances),Bioaerosols: Moisture and Moulds,MVOC,Radon,Smoking and ETS,Cooking under inadequate conditions,HVAC systems (room climate),Allergens (e.g. mites),Phthalates, Flame retardants,Noise,Major sources of noise indoors - industrial noise - living noise -

34、 traffic noise Noise: a public health problem,Adverse effects of noise exposure,hearing impairment and hearing loss annoyance sleep disturbance stress related health effects effects on performance speech interference other effects,噪声的危害： 影响休息和睡眠； 影响生活质量和工作效率。 40dB（A）的噪声环境一般对生活和工作影响并不大， 70dB（A）的噪声干扰谈

35、话、造成精神不集中、心烦意 乱、影响学习和工作效率等； 对健康的影响。 特异性危害：对听觉系统的损伤作用。 非特异性危害：噪声作用于机体各个方面，引起听 觉以外的反应。,室内允许噪声标准 dB（A） Standard of noise indoors dB (A),high rule normal rule Bedroom day 4045 night 3035 Living room day 4550 night3540,Adverse effects of electromagnetism radiation,reproductive and teratogenic effects hem

36、atopoietic (造血的), immune system, and endocrine effects neurologic and behavioral effects carcinogenic effects,Adverse effect of ionizing radiation,Major sources ionizing radiation indoors: - building materialsradon (Rn) - glass wallcobalt (Co) Adverse effect (low level and long time) - immune system

37、 effects - DNA damage and repair - embryo development,Short Term Health Impacts,Short Term Exposure Carbon monoxide VOCs Formaldehyde ETS Pesticides Bio-contaminants,Short Term Symptoms Irritation of ears, eyes, nose, and throat Headaches Dizziness Fatigue Watery eyes Sick Building Syndrome,Long Ter

38、m Exposure Asbestos Silica Lead and Mercury Radon ETS,Long Term Symptoms Respiratory disease Asthma Heart disease Cancer Sensitization Poor child development Legionnaires disease Sick building syndrome,Long Term Health Impacts,三、室内空气质量评价Assessment of indoor air quality,我国第一部室内空气质量标准,室内空气质量标准（GB/T188

39、83-2002）,标准中引入了室内空气质量（IAQ, Indoor Air Quality）的概念，在借鉴国外相关标准的基础上建立的。,标准中规定的的控制项目不仅有化学性污染，还有物理性、生物性和放射性污染。,室内空气质量标准,评价居室空气清洁度（空气质量）常用指标 (1) carbon dioxide (CO2) (2) carbon monoxide (CO) (3) microorganism and suspended particulates (4) sulfur dioxide (SO2) (5) other parameters: temperature, humidity, f

40、ormaldehyde, radon, total volatile organic compounds (TVOC),Carbon dioxide (CO2),主要来源于人的呼出气和燃料燃烧 人群积聚、燃料燃烧、冬节分散式采暖、通 风不良等可使室内CO2浓度升高 反映室内有害气体的综合水平 反映室内通风换气的实际效果 室内空气清洁度评价的重要指标,CO2浓度对健康的影响 0.07%人体感觉良好 0.07%敏感者感到不良气味，产生不适感觉 0.1%空气出现不良气味，较多人感到不舒适,室内空气质量标准规定：CO2 0.1%,Microorganism and Suspended Particul

41、ates,Microorganism Total aerobic bacterial count（细菌总数） Suspended Particulates PM10,室内空气质量标准规定： 细菌总数 2500 cfu/m3 （cfu：colony-forming unit）,细菌总数： 主要来源于人们在室内的活动； 空气中的细菌总数越高，存在致病微生物的可 能性越高； 常用的居室空气细菌学评价指标； 评价室内空气质量的重要指标。,室内空气中的致病微生物传播的三种主要方式 附着在尘埃上 附着于人的口或鼻腔喷出的飞沫小滴上 附着在飞沫表面蒸发所形成的飞沫核内,可吸入颗粒物（inhalable pa

42、rticle, IP） PM10: particles with diameters of 10 m,来源于燃料燃烧、吸烟、室外进入； 其含量与居室通风、卫生条件、居住人口多少 以及人们在室内的活动有关。,Sulfur dioxide (SO2),主要来源于含硫燃料燃烧（煤炉和煤气灶） 其浓度与家庭炊事模式、燃料种类、通风换气、室 外SO2浓度等有关。,Carbon monoxide (CO),主要来源于燃料燃烧（煤炉和煤气灶）、吸烟 是有毒的气体，能与血红蛋白结合形成碳氧血红蛋 白（CO-Hb），使血红蛋白的载氧量减少。,Formaldehyde (HCHO),主要来源于装饰材料和建筑材料 还可来自化妆品、清洁剂、杀虫剂、消毒剂、防腐 剂、印刷油墨、纸张、纺织纤维等 对人体健康的影响