臺灣博碩士論文加值系統

本研究之目的為對輪班型態造成女性月經影響之研究。
隨著經濟的發展輪班工作者有著明顯增加的趨勢，現今美國約有730萬輪班工作者，而目前國內也有35.4%的公司實施輪班制度。過去研究指出輪班型態，短期會直接影響睡眠時間、睡眠品質、心理壓力；長期而言易併發心臟血管性疾病（心律不整、呼吸短促）、腸胃道疾病（消化性潰瘍）、三酸甘油酯偏高、sleep-wake現象、生理週期不規則、心理壓力增加、飲食習慣改變及內分泌失調；對於女性輪班工作者更會造成生殖系統的危害，特別是月經異常對婦女的身心健康造成最直接影響。本研究分成二部份進行研究，第一部份針對學生、老師、半導體員工、護士、空服員進行橫斷性問卷調查研究，再依不同輪班型態進行多變項logistic迴歸分析，同時控制年齡、身體質量指數、抽煙、喝酒及壓力等干擾因素。第二部份、以基礎體溫測量及每日日記記錄方式，對自願者學生和空服員進行為期三個月之追蹤性研究。記錄之基礎體溫表由二位生殖內分泌專科醫師進行排卵日之辨讀。依辨讀結果之濾泡期、黃體期、月經、月經週期與壓力、睡眠品質進行線性迴歸分析。
橫斷性研究結果顯示，月經來的天數大於7天者，輪三班者之調整勝算比為不輪班者之2.22倍（95%信賴區間：1.06 ~ 4.46）；月經週期天數小於24天者，不固定班者之調整勝算比為不輪班者之2.53倍（95%信賴區間：1.09 ~ 5.88）；輪班型態中睡眠品質的好壞對月經的影響是一項重要的危險因子。在追蹤性研究中，睡眠品質分數的標準差和濾泡期長短呈負相關；整體壓力分數的平均和月經、濾泡期長短呈正相關；以睡眠品質與整體壓力進行多變相線性迴歸分析結果，濾泡期長度部份，睡眠品質分數標準差的係數為-0.61、標準差2.65、Ｐ值0.02；整體壓力分數的平均數，係數為2.49、標準差1.27、Ｐ值0.05，調整後R2為0.075。輪班型態確實會造成月經的影響，這和睡眠品質的好壞有著重要性的關係；而對於不同輪班型態對月經的影響，輪班型態中換班週期的快慢可能是一項危險因子。

The objective of this study is to investigate the effect of different patterns of shift work on menstrual function. Due to rapid industrialization, there were approximately 7.3 million shift workers in United States and 35.4% workers have carried out shifting work system in Taiwan. Short-term difficulties are associated with sleep disorder, poor sleeping quality, and psychological distress. Long-term effects include the complication of cardiovascular diseases (arrhythmia, and shortness of breath), gastrointestinal diseases (gastrointestinal ulceration), the increase of triglyceride, sleep-wake disorder, irregular menstrual cycles, the increase of psychological disorder, change of eating behavior, and endocrine disorder. There is a potentially reproductive hazard to female shift workers, especially menstrual dysfunction. It will lead to the decrease of fecundability, infertility, osteoporosis, breast cancer, emotional unsteadiness, and the increase of cardiovascular diseases. This study focused on four different patterns of shift work involving flight attendants (oscillating shifts), hospital nurses (three rotating shifts), wafer workers (two fixed shifts), and primary school teachers (permanent day work) and college nursing students. We randomly selected 200 subjects with 20-30 years of age form each group and excluded those with their working years less than 1 year, the history of chronic diseases or gynecological diseases, or the current use of oral contraceptives or intrauterine devices, and dietary restraints and sportswomen. Firstly, we used a questionnaire interview to conduct a cross-sectional study. Secondly, we will conducted a follow-up study for 3 consecutive menstrual cycles using the basal body temperature and diary recording.Multiple logistic regression and linear regression analyses were performed on menstrual function. Women whose work were three rotating shifts had twice of the risk for long menses (more 7 days) compared with women who were permanent day workers (adjusted odds ratio =2.22, 95% confidence intervals 1.06-4.64). Those who were oscillating shift workers had 2.53 of the risk for short cycle length (<24 days)(adjusted odds ratio =2.53, 95% confidence intervals 1.09-5.88). The association was evident that sleep quality was a important factor. In following study, we found that there was negative linear relation between the standard deviations of sleep quality and follicular phase, positive linear relation between the means of total stress ,menses and follicular phase. Shift work was related to an increased risk for menstrual dysfunction. And sleep quality was a important risk factor.

中文摘要1
Abstract2
目錄3
表列6
誌謝8
第一部份：不同輪班型態對月經影響之橫斷性研究9
壹、緒論10
一、前言10
二、研究目的11
三、研究假說11
貳、文獻探討12
一、輪班型態定義12
二、生理規律性12
三、輪班對健康的影響13
1、睡眠障礙13
2、腸胃道不適14
3、心臟血管性疾病14
4、生殖危害15
參、材料與方法21
一、研究設計21
二、研究對象21
三、研究步驟21
四、問卷設計22
五、輪班型態分組22
六、研究對象限制22
七、統計分析23
肆、名詞定義及操作型定義24
伍、結果25
一、各研究組群基本資料比較25
二、各研究組群月經比較26
三、不同輪班方式基本資料描述26
四、各輪班型態人員月經比較27
五、輪班型態相關性比較28
六、月經迴歸性分析比較28
陸、討論34
一、研究限制34
二、健康工人效應34
三、樣本的可比性34
四、職業因素之影響探討35
五、測量問題36
六、輪班型態36
柒、結論與建議38
第二部份：以基礎體溫追蹤測量進行月經異常之危險因子探討60
壹、前言61
貳、材料與方法62
一、研究對象62
二、研究步驟62
三、研究方法62
1、基礎體溫追蹤測量62
2、日記記錄63
四、統計分析63
參、結果64
肆、討論66
伍、結論與建議67
參考文獻74
附錄80

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