王榮德Wang, Jung-Der臺灣大學:職業醫學與工業衛生研究所羅士翔Lo, Shih-HsiangShih-HsiangLo2010-05-112018-06-292010-05-112018-06-292008U0001-2807200821244200http://ntur.lib.ntu.edu.tw//handle/246246/182328背景 為發現不同輪班工作中之心臟壓力，我們研究年輕護士輪班工作中血壓及心搏變異之變化法 研究對象為16名年輕輪班之護士，對照組為6位正常班護士；在工作日與工作後休息日連續兩日接受動態心電圖與血壓之監測。果 線性混合效應統計顯示在睡眠與夜班、小夜班時，副交感神經控制會增加；在工作及輪班大小夜班後的睡眠中，副交感神經控制則會減少，血壓及交感神經控制則會增加，比白班睡眠偏高。輪班後隔日休假小夜班及白班狀況的血壓及心搏變異會回復至正常白班狀況，但輪大夜班則無法完全恢復（p<0.05）。收縮壓與舒張壓在睡眠中會明顯下降，在工作時會顯著上升與心臟交感神經調節增加及副交感神經控制降低時之狀態具相同情形。不同輪班護士在工作天與隔天之睡眠血壓下降/非下降狀態（dipper/nondipper）改變率分別為門診33%、大夜班44%、小夜班50%和白班38%；69 %輪班護士至少改變一次。論 年輕女護士輪班工作與心搏、血壓變異狀態有顯著相關。輪班時生理與心理壓力負擔，不僅於工作期間，輪大、小夜班後的睡眠中，輪大夜班之工作天，尤其顯著。年輕女護士輪班與睡眠血壓下降/非下降狀態有顯著相關，除大夜班外，輪班隔天之血壓皆會回復至正常白班狀況，大夜輪班之效應會持續到隔天休息日。我們建議測量血壓時應將輪班之狀況納入考量。Dynamic Blood Pressure, Heart rate Variability Changes and Recovery under Different Work Shifts ackground To explore the effect of shift work on cardiac stress, we studied the heart rate variability (HRV) profiles and blood pressure (BP) change in young female nurses.Methods We recruited 16 young female nurses working rotating shifts and 6 working the regular day shift and gave each of them simultaneous and repeated 48-hour ambulatory electrocardiography and BP monitoring during their workdays and the following off-duty day.esults Using a linear mixed effect model, we found increased vagal autonomic control during sleep and on a night or an evening shift, and a decreased vagal autonomic control and increased BP at work, during sleep after a night or evening shift, and on the work day of a night shift. Cardiac sympathetic modulation showed reciprocal changes in the corresponding conditions (all P<.005). Blood pressure (BP) appeared to synchronize with the increased cardiac sympathetic modulation and decreased vagal modulation. The recovery of HRV and BP on the following off-duty day appeared incomplete after adjustment for other risk factors. The rates of change in dipper/nondipper status between work day and off-duty day were 33%, 44%, 50%, and 38% for nurses worked in outpatient clinic, night shift, evening shift, and day shift, respectively. We also found 69% of those working rotating shifts had at least changed once in dipper/nondipper status.onclusion The effects of rotating shifts on HRV and BP in young female nurses are significant not only at work but also on the day of a night shift, during sleep on days of a night shift or an evening shift, and the entire work day of a night shift. Shift work is significantly associated with BP and HRV and possibly dipper/nondipper status in young female nurses. We recommend that potential influence of shift work be considered when evaluating a person’s blood pressure. The residual effect of night shifts may carry over to the next off-duty day.目 次 1 目 錄 2 目 錄 3文摘要 4bstract 6一章 背景 8二章 研究目的 9三章 研究設計 10.1 研究對象 10.2 研究設計 10.3 24小時動脈血壓監測 11.4 24小時心電圖監測 11.5 統計分析 12四章 結果 14五章 討論 24六章 結論 27考文獻 28錄 33 目 錄 4 - 1 研究對象基本特性 16 4 - 2 血壓線性混合效應統計模式之結果：相關係數及標準誤 17 4 - 3 心搏變異線性混合效應統計模式之結果：相關係數及標準誤 18 4 - 4 心搏變異恢復情形。線性混合效應統計模式之結果(各輪班及各時段)：相關係數及標準誤 19 目 錄 4 - 1 輪班動態血壓變化及睡眠段。平行線表示門診護士之平均收縮壓及舒張壓(111 and 61 mmHg)，陰影高度表睡眠人數及時間(平均值±標準差) 20 4 - 2 比較各班別血壓於休息日恢復之情形。，以白班之次日休息日為參考值，則各班、各段之每小時平均血壓減此參考值，則獲得各班、各時段之差異值，此差異值依各班、各時段，取中間直及25至75百分位及10至90百分位作比較 21 4 - 3 輪班護士在之睡眠血壓下降/非下降狀態(dipper/nondipper）之變化；輪班比較(上圖)及工作日與休息日比較(下圖) 22 4 - 4 各輪班動態血壓變化、心搏變異及睡眠段。陰影表示收縮壓及舒張壓 23application/pdf4320175 bytesapplication/pdfen-US輪班血壓動態血壓監測動態心電圖監測心搏變異Shift workblood pressureambulatory blood pressure monitoringambulatory electrocardiographic monitoringheart rate variabilitythesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/182328/1/ntu-97-D91841002-1.pdf