臺灣博碩士論文加值系統

本橫斷性研究主要的目的在於評估暴露於機動車輛廢氣的環境對高速公路女性收費員是否有過度呼吸道症狀、刺激性症狀的影響，以及探討上肢重複性動作、長久站立工作和肌肉骨骼健康的相關性。暴露族群由484位中山高速公路女性收費員組成，以國道高速公路局全體237位女性行政職員為對照族群。利用郵寄自填式問卷的方式收集研究族群的健康資料。收費員、行政人員問卷回收率分別為96.49%、77.64%。在呼吸道健康分析上排除兩個族群中工作未滿6個月之新進員工、有抽菸習慣以及16歲前罹患過呼吸道疾病者；肌肉骨骼健康部分則排除工作未滿6個月之新進員工。研究結果顯示，收費員與行政人員在所有呼吸道症狀的盛行率上並無顯著差異。收費員急性刺激性症狀包括喉嚨疼痛、鼻塞、胸痛、噁心、頭痛之盛行率顯著較行政人員高；喉嚨疼痛、鼻塞、頭痛症狀與機動車輛廢氣暴露程度有明顯之劑量反應關係。收費員肩頸、上肢、下肢、下背部位不適之盛行率明顯高於行政人員，而收費員頸部、手腕部位不適與收費站車流量間有顯著的劑量反應關係。本研究中機動車輛廢氣暴露與慢性呼吸道症狀間並未發現有相關性存在，可能是受到收費員工作年資過短的影響。機動車輛廢氣與急性刺激性症狀的產生有極高的相關性。上肢重複性動作、長久站立可能是造成收費員肌肉骨骼不適的因素。

The aims of this cross-sectional study was to examine the effects of automobile exhaust on respiratory symptoms and irritative symptoms, and to evaluate the relations between the musculoskeletal disorders and work related postures such as repetitive movements of upper limbs and long-hour standing. The study subjects were 484 female toll collectors at the Chung-Shan freeway tollbooths (exposure group) and 237 female office employees with the National Freeway Bureau (control group). The data were collected using self-reported questionnaires mail with response rates of 96.5% among exposure group and 77.6% among control group. Individuals with an employment history of less than six months, ever smoking, and having respiratory disease history prior to the age of sixteen year were excluded for data analysis. For the analysis of musculoskeletal effects, we excluded individuals with a work history of less than six months. The level of automobile exhaust that toll collectors exposed to was estimated using the average daily vehicle flow at each toll station in 1998.
For all respiratory symptoms, the exposure group were at higher risk than controls, but not significant. Acute irritative symptoms were more prevalent in the exposure group than in controls including throat pain, nasal congestion, chest pain, nausea, and headache. There was an apparent dose-response relationship between the level of automobile exhaust and the acute irritative symptoms. Compared to the office employees, the tool collectors had significant higher prevalence rates of complains for neck, shoulders, upper limbs, lower limbs, and low back. Musculoskeletal disorders of the neck, and wrists were strongly associated with the traffic flow.
In conclusion, toll collectors are at elevated risk of musculoskeletal disorders, including neck, shoulders, upper limbs, lower limbs, and low back, and some acute irritative symptoms, such as throat pain, nasal congestion, chest pain, nausea, and headache.

目 錄
中文摘要………………………………………………………… I
英文摘要………………………………………………………… II
第一章 緒論
第一節 前言……………………………………………… 2
第二節 研究目的………………………………………… 6
第二章 文獻探討
第一節 高速公路交通現況……………………………… 8
第二節 機動車輛廢氣與成人呼吸道健康間的關係…… 12
第三節 收費員工作型態與職業性肌肉骨骼症狀……… 24
第三章 材料與方法
第一節 研究對象………………………………………… 34
第二節 問卷調查………………………………………… 35
第三節 統計分析………………………………………… 38
第四章 結果
第一節 呼吸道症狀與刺激性症狀問卷調查…………… 41
第二節 肌肉骨骼症狀問卷調查………………………… 48
第五章 討論
第一節 機動車輛廢氣暴露對於收費員健康之影響…… 57
第二節 收費員工作性質與肌肉骨骼不適的關聯性…… 66
第三節 結論……………………………………………… 72
第六章 參考文獻……………………………………………… 73
附表……………………………………………………………… 83
表 目 錄
表一 高速公路歷年通過收費站之交通量統計………… 84
表二 中山高速公路各收費站平均每日交通流量統計… 85
表三 研究族群問卷回收率與其他特徵之比較………… 86
表四 研究族群人口學基本資料（排除工作未滿六個月、
曾經或目前抽菸、16歲前患呼吸道疾病者）…… 87
表五 研究族群呼吸道症狀與刺激性症狀盛行率……… 88
表六 職業暴露史與居家環境調查……………………… 89
表七 呼吸道症狀多變項對數迴歸分析………………… 90
表八 刺激性症狀多變項對數迴歸分析………………… 91
表九 收費員呼吸道症狀盛行率與中山高速公路各收費站
交通流量之關係…………………………………… 92
表十 收費員刺激性症狀盛行率與中山高速公路各收費站
交通流量之關係…………………………………… 93
表十一 不同車輛廢氣暴露程度之呼吸道症狀與刺激性症狀
盛行率……………………………………………… 94
表十二 收費員不同廢氣暴露程度之呼吸道症狀危險對比值 95
表十三 收費員不同廢氣暴露程度之刺激性症狀危險對比值 96
表十四 人口學基本資料（排除工作未滿六個月者）…… 97
表十五 研究族群工作狀況比較（排除工作未滿六個月者） 98
表十六 研究族群肌肉骨骼「酸」症狀盛行率…………… 99
表十七 研究族群肌肉骨骼「疼痛」症狀盛行率………… 100
表十八 研究族群肌肉骨骼「麻木」症狀盛行率………… 101
表十九 研究族群肌肉骨骼「腫脹」症狀盛行率………… 102
表二十 研究族群肌肉骨骼「活動困難」症狀盛行率…… 103
表二十一 研究族群自覺性肌肉骨骼症狀盛行率…………… 104
表二十二 肩頸、上肢部位不適多變項對數迴歸分析……… 105
表二十三 下肢、其他部位不適多變項對數迴歸分析……… 106
表二十四 不同車流量之收費站收費員肌肉骨骼不適盛率… 107
表二十五 不同車流量收費站收費員肩頸、上肢部位不適危險
對比值……………………………………………… 108
表二十六 不同車流量收費站收費員下肢、下背部不適危險對
比值………………………………………………… 109

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