護理人員之輪班工作、健康行為與代謝症候群之探討

Shift Work, Health Behavior and Metabolic Syndrome in Nurses

蔡淑美(Shu-Mei Tsai)

指導教授 ： 廖玟君

中山醫學大學/護理學院/護理研究所/碩士(2011年)

https://doi.org/10.6834/CSMU.2011.00075

摘要

前言:護理人員經常在輪班型態下工作，日韻節律失序可能對其健康有重大的衝擊；忙碌的工作也將導致健康行為如飲食、運動習慣及睡眠型態改變，因此輪班工作的護理人員是具有罹患代謝症候群之增加危險。然而，在輪班的護理人員之中，是輪班工作本身還是因輪班所導致行為改變而影響其健康，這是不清楚的。因此，我們探討不同輪班工作下之護理人員，其健康行為與代謝症候群指標之相關。
方法:在此橫斷式研究中，92名現今為健康且未懷孕的護理人員（固定白班 n=40，固定夜班 n=23，以及輪值三班 n=29），從中台灣一家醫學中心被納入。問卷被運用來收集基本特徵、工作狀況、健康行為以及睡眠品質；代謝症候群的指標，包括身體質量指數（body mass index）、腰圍、血壓以及生化指標（總膽固醇、三酸甘油酯、高密度脂蛋白膽固醇、低密度脂蛋白膽固醇、空腹血糖、高敏感性C-反應蛋白、以及糖化血色素）也被測量。
結果:研究之護理人員其輪班年資平均為7.5年。而護理人員其代謝症候群指標異常比例分別為收縮壓4.4%、舒張壓8.7%、三酸甘油脂5.4%、空腹血糖6.5%、腰圍13.0%、以及高密度脂蛋白膽固醇18.5%。身體質量指數隨年齡增加而增加（r = 0.20, p = 0.05），舒張壓隨著輪班年資增加而增加（r = 0.27, p = 0.008）。在目前固定班別為白班的護理人員，其收縮壓( p = 0.03)及舒張壓( p = 0.05)皆較非白班者低；而過去一年為固定白班者，有較高的高密度脂蛋白膽固醇濃度( p =0.03)及較低的高敏感性C-反應蛋白濃度( p = 0.02)，相較於非白班工作者。目前為白班者PSQI總分較非白班者低( 5.4 vs 6.5, p = 0.03)，以及有較好的自覺睡眠品質(p = 0.02)。在健康行為方面，護理人員年齡越大，飲用飲料時所加的糖量越少(r = -0.24, p = 0.01)，並且攝食較多的蔬果(r = 0.33, p = 0.002)。喝較多含糖飲料量(＞1500cc/天)與從飲料中攝取較多糖者(＞45g/天)，相較於飲用較少者，其三酸甘油脂(p = 0.0001)及總膽固醇(p = 0.04)濃度也較高。
結論:本研究的結果顯示輪班工作以及較差的健康行為可能增加護理人員其代謝症候群之危險。在未來，需要較大型的縱貫性研究來檢驗護理人員之輪班工作以及健康行為對於代謝症候群的效應。

關鍵字

護理人員 ； 輪班工作 ； 健康行為 ； 代謝症候群

並列摘要

Introduction: Nurses often work under the shift pattern. Interrupted circadium rhythm by shifts may have great impacts on health. Nurses’ busy schedules also affect their health behaviors such as diets, exercise habits, and sleep patterns.Thus shift work nurses are at increased risk for metabolic syndrome. However, it is not clear whether shift work per se or behavior changes due to shift work affects health in shift work nurses. We investigated the relationship between health behaviors and indexes of metabolic syndrome in different shift work nurses.
Methods: In this cross-sectioal study, nurses (day shift n= 40, fixed night shift n= 23, and rotating shift n= 29) who were healthy and without current pregnancy were recruited from a medical center in central Taiwan. Questionnaires were appied to collect demographic characteristics, working status, health behaviors, and quality of sleeping. Indexes of metabolic syndrome including body mass index, waist circumference, blood pressure, and biochemical markers (total cholesterol, riglycerides, HDL-C, LDL-C, fasting sugar, HS-CRP and HbA1C) were also measured.
Results: The average time of shift work for nurses in this study was 7.5 years. Abnormal rates in metabolic syndrome indicators were 4.4% in systolic blood pressure, 8.7% in diastolic pressure, 5.4% in triglycerides, 6.5% in fasting blood sugar, 13.0% in waist circumference, and 18.5% in HDL-C, respectively. Body mass index was increased with age (r = 0.20, p = 0.05), and diastolic blood pressure increased with longer shift-years (r = 0.27, p = 0.008). Systolic blood pressure (p =0.03) and diastolic blood pressure (p =0.05) were lower in current day- shift nurses than those in other kind of shift nurses. HDL-C level (p = 0.03) was higher and HS-CRP level (p = 0.02 ) was lower in nurses with major day shifts during the past year than those in nurses with other kind of shifts. Current day shift nurses had lower PSQI scores ( 5.4 vs 6.5, p = 0.03) and better sleep quality (p = 0.02) than those in other kind of shift nurses. Regarding health behaviors, the older nurses drank beverage with less amount of sugar (r = -0.24, p = 0.01), and ate more fruits and vegetables (r = 0.33, p = 0.002). Those who drank more sugary beverages (＞1500cc/day) and consumed greater amount of sugar (＞45g/day) also had higher triglycerides (p = 0.0001) and total cholesterol(p= 0.04) than those who drank less sugary beverages and consumed less amount of sugar, respectively.
Conclusions: Our findings revealed that shift work and poor health behaviors could increase the risk of metabolic syndrome in nurses. In the future, larger longitudinal studies are necessary to examine effects of shift work and healthy behaviors on metabolic syndrome in nurses.

並列關鍵字

Nurse ； Shift Work ； Health Behavior ； Metabolic Syndrome

參考文獻

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