臺灣女性護理人員生殖健康之探討

Explore Reproductive Health in Female Nurses in Taiwan

秦唯珊(Wei-Shan Chin)

指導教授 ： 蕭淑銖

國立臺灣大學/醫學院/護理學研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.03101

摘要

醫療工作環境中潛藏著許多健康危害物質，台灣勞工安全衛生研究所對有進行化學治療的醫院進行調查，發現只有38.7%的醫療院所對懷孕或哺乳期的工作人員做特殊保護措施。芬蘭的研究亦發現相較於一般辦公室人員，女性護理人員懷孕時期從事護理工作有較高的風險生產體重小於懷孕週數的新生兒(Small for gestational age;SGA)。在台灣醫療院所中執業的醫事人員以女性護理人員為最多，而這些護理人員又大多處於育齡年齡，目前國內外探討女性護理人員生殖危害之研究大多僅就單一危害因子進行探討，缺乏全面性的職業暴露與生殖結果之研究，故本研究將廣泛地探討護理特殊職業暴露對護理人員致孕力、生殖結果與胎兒出生狀況之影響。
研究對象為『醫療人員健康安全衛生中心』長期合作的60家醫院中年齡介於20~49歲之女性護理人員，以自填式問卷調查個人基本資料、歷年工作史與歷次懷孕史。以第一次懷孕經驗分析特殊工作暴露對生產結果與胎兒出生狀況之影響，以最後一次懷孕經驗分析特殊工作暴露對於致孕力之影響。
結果發現特殊工作暴露對受孕力之影響並未有統計上相關。不過，有使用輻射劑量章者，生產結果為未足月或不良生產結果(早產、死產、非自願性流產)的風險都比沒有使用輻射劑量章者高(AOR=2.3，95% CI=1.1~4.9，P<0.05；AOR=2.4，95% CI=1.1~5.1，P<0.05) 。每班工作站立7小時以上會增加非自願性流產的風險(AOR=2.2，95% CI=1.1~4.1，P<0.05)。使用酒精的人胎兒發生死產的風險高於未使用者，且達統計上之意義(AOR=13.1，95% CI=1.9~59.0，P<0.01)。至於胎兒出生狀況，曾經輪班的人其胎兒出生時異常的風險比不曾輪過班者高（AOR=2.2，95% CI=1.2~4.5，P<0.05）。使用消毒溶液的人胎兒死亡(死產與非自願性流產)的風險高於未使用者，且達統計上之意義(AOR=1.8，95% CI=1.0~3.3，P<0.05)。
本研究雖未發現特殊工作暴露對於女性護理人員致孕力之影響，但懷孕前或懷孕當時曾經輪班、使用輻射劑量章、每班工作站立時間超過7小時，以及使用消毒溶液對生產結果與胎兒出生狀況之不良影響，均達統計上之相關。建議有生育計劃的女性護理人員應盡量避免上述之工作暴露。

關鍵字

女性生殖危害 ； 工作暴露 ； 生殖結果 ； 受孕力 ； 護理人員

並列摘要

There are potential hazards in healthcare settings. According to a study conducted by the Institute of Occupational Safety and Health (IOSH ) of Taiwan, there were only 38.7% hospitals provided adequate personal protective equipments to expectant nursing staff in those hospitals provided chemotherapy. One Finnish study identified a higher risk of having a baby being small for gestational age (SGA) in nursing staff, compared to babies of other female working groups. Relatively few studies had focused on the occupational reproductive health in Taiwan nurses, despite the majority of such group are in their childbearing years. This study was therefore intended to explore the potential impact of occupational exposures to nurses’ fecundability and birth outcomes.
The study population was all female nurses aged from 20~49 years old, from the sixty hospitals of Center of Medical Employee Safety and Health (C-MESH). Data collected using a self-administered questionnaire. Questions include demographic information, employment history, and pregnant history. We analyzed the relationship between occupational exposure and birth outcomes using information given from the first pregnancy of the respondent, and the relationship between occupational exposure and fecundability using information given from the latest pregnancy.
Occupational exposure did not significantly affect nurses’ fecundability. However, adverse birth outcomes (prematurity, stillbirth, and spontaneous abortion) were found to be significantly higher in those whose work required to wearing a radiation badge than not (AOR=2.3，95% CI=1.1~4.9，P<0.05；AOR=2.4，95% CI=1.1~5.1，P<0.05). Standing for longer than 7 hours at each shift increased the risk of spontaneous abortion (AOR=2.2，95% CI=1.1~4.1，P<0.05). Exposed to alcohol was also associated with stillbirth (AOR=13.1，95% CI=1.9~59.0，P<0.01). As for other birth outcomes, shift work was found to be highly associated with fetal congenital abnormalities (AOR=2.2，95% CI=1.2~4.5，P<0.05). In addition, exposed to disinfectant fluids at work was also found to be associated with fetal death (stillbirth and spontaneous abortion) (AOR=1.8，95% CI=1.0~3.3，P<0.05).
Occupational exposures were not significantly associated with poor fecundability in nurses. However, shift work, required to wearing a radiation badge at work, standing for longer hours (>7), and exposed to disinfectant fluids at work, before and during pregnancy, had negative impacts on birth outcomes. We suggest female nurses who plan to conceive should avoid occupational exposures to the above mentioned working environment.

並列關鍵字

female reproductive hazards ； occupational exposure ； birth outcome ； fecundability ； nurse.

參考文獻

章馨仁 (2006)。女性護理人員輪值大夜班對生理狀況及出生性別比之影響。高雄醫學大學研究所，未出版，高雄市。

王秀紅 (2008)。台灣的健康現況。行政院衛生署。

宋永魁等編 (1997)。生殖內分泌及不孕症概要。台北：健康文化事業股份有限公司。

蕭伃伶、劉淑娟、黃金蓮、謝佑珊、徐姍姍、黃嗣棻等 (2005)。台北市護理人員離職狀況及其相關因素之探討。領導護理，6(2)，11-19。

熊映美、陳秋蓉、余孟庭、嚴聿沛、陳文清 (2008)。醫院化學治療作業工作安全衛生調查。勞工安全衛生研究季刊，16(2)，164-178。