臺灣博碩士論文加值系統

二手菸含有四千餘種的成分，其中包括三十種金屬元素例如砷、鋁、銅、鐵、鋅、鎘、鉻、鉛、鎳、硒等，過去相關文獻得知孕婦在懷孕期間暴露到二手菸，這些金屬會透過胎盤對其胎兒之發育有不同程度健康之影響。
衛生署自民國86年3月19日正式公佈菸害防治法，國內男性勞工吸菸率一直維持50％，其中職場亦是暴露二手菸之主要場所，因此暴露二手菸對懷孕婦女及其新生兒之健康效應尤其重要，然而目前台灣地區暴露二手菸中重金屬對其健康影響之研究較少。故本研究之目的是測量孕婦暴露二手菸其血液、胎兒臍帶血及胎盤中鉛與鎘之含量，並探討各檢體鉛與鎘之濃度與新生兒健康指標之相關性。總共收集中部某婦產科醫院共計137名孕婦，自產檢期間收集問卷並在其生產時收集其血液、新生兒臍帶血和胎盤。各檢體中鉛與鎘以石墨式原子吸收光譜儀（GF-AAS）分析，所有檢體的測量均在嚴格的品質控制下執行，結果顯示孕婦血液與胎兒臍帶血鉛具統計之相關性（r=0.644）且胎盤鉛與臍血鉛亦有統計相關性（r=0.407），表示孕婦血鉛會透過胎盤傳輸到胎兒；且孕婦血中鎘與胎盤鎘亦有高度相關，而臍血鎘與胎盤鎘則無，可知鎘金屬易蓄積在胎盤不易傳輸到胎兒，胎盤對鎘具有阻隔作用。母血鉛值愈高其新生兒體重及懷孕週數有減少的趨勢，但不具統計上顯著差異。
本研究除可建立國內孕婦在家庭、工作場所及公共場所二手菸之暴露外，並與國外文獻資料相比較，除瞭解國內自民國86年以後實施菸害防治法之成效，對台灣地區建立二手菸資料有所助益外，亦可作為衛生及環保機關推展菸害防治之參考，降低對懷孕婦女及新生兒的危害，以確保國人健康水準及提昇環境之品質。

Environmental tobacco smoke (ETS) contains over 4000 compounds, including numerous heavy metals, such as lead, cadmium, arsenic and chromium. These heavy metals pass through placental blood for the fetus and cause developmental problems for newborn. In 1997, the Tobacco Act prohibited smoking in public indoor places throughout Taiwan. Half of Taiwanese male workers had consumption of cigarette smoking, it is important to understand the health effects of ETS on pregnant women and the newborn. However, there have been few studies on the health effects of heavy metals from ETS.
The objective of this study is to measure lead and cadmium levels in the blood of pregnant women, cord blood and placenta, and to correlate them with ETS levels. Participants were collected from an obstertrics and gynecology hospital in central Taiwan. All specimens of lead and cadmium will be analyzed by atomic absorption spectrophotometer/ graphite furnace（GF-AAS）. Strict quality control was performed for all measurements. Our results show significant correlations of lead level between the maternal blood and cord blood（r=0.644）in the placenta and cord blood（r=0.407）. It indicated blood lead passed through placenta to the fetus. A significant correlation of cadmium level was found between the maternal blood and placenta but cord blood but not found in placenta. Our finding was consistent with previous studies which cadmium accumulated easily in placenta. The maternal blood lead was not significant correlation with birth weight and gestation period
Levels of lead and cadmium in cord blood samples are compared to those reported in previous studies. Blood lead levels will be compared pre- and post-treatment of using lead-free gasoline in Taiwan to understand the impact on the healths of pregnant women and the newborn. Our finding can take as reference for governmental regulations to reduce the levels of ETS in public building and alleviate the harmful effects done to pregnant women and newborns.

中文摘要...............................................Ι
英文摘要...............................................Ⅲ
目錄
表目錄
第一章、前言
第一節、 研究動機....................................1
第二節、 研究目的....................................3
第二章、文獻探討
第一節、 二手菸之特性................................4
第二節、 鉛(金屬)之特性..............................6
第三節、 鎘(金屬)之特性..............................8
第四節、 鉛及鎘對新生兒之健康效應...................10
第三章、研究方法與材料
第一節、 研究架構...................................12
第二節、 研究對象...................................13
第三節、 實驗儀器與藥品.............................14
第四節、 研究方法與步驟.............................16
第五節、 實驗室之品質管制...........................18
第六節、 資料整理與統計分析..........................20
第四章、結果
第一節、 研究對象之基本資料..........................21
第二節、 影響各檢體其鉛與鎘含量之多變項迴歸分析......22
第三節、 暴露二手菸及各檢體鉛、鎘濃度與新生兒健康指標
之相關性....................................24
第四節、 不同暴露情形對各檢體間鉛、鎘濃度的變化......29
第五章、討論
第一節、 研究對象之基本特性..........................30
第二節、 母血、臍血及胎盤中鉛與鎘之相關性............30
第三節、 各檢體中鉛及鎘濃度與新生兒健康指標之相關性..32
第四節、 研究限制與未來研究方向......................33
第六章、結論與建議
第一節、 結論........................................35
第二節、 建議........................................35
第七章、參考文獻........................................37
附表
附表一、胎盤鎘濃度......................................45
附表二、胎盤鉛濃度......................................45
附表三、以石墨式原子吸收光譜儀測定紅血球及胎盤中鉛所使用 的條件分析......................................46
附表四、以石墨式原子吸收光譜儀測定紅血球及胎盤中鎘所使用 的條件分析......................................47
附錄
附錄一、懷孕期間調查表..................................64
附錄二、嬰兒出生調查表..................................69
表目錄
表一、各檢體鉛、鎘之檢量線及偵測極限.....................48
表二、以參考標準品分析鉛之準確度.........................48
表三、血中鎘重覆分析的精密度.............................49
表四、利用參考標準樣本(SRM1577a)確認方法的準確度.........49
表五、有無暴露二手菸與研究對象人口基本資料之相關性.......50
表六、影響各檢體鉛含量之多變項迴歸分析...................52
表七、影響各檢體鎘含量之多變項迴歸分析...................53
表八、研究對象在各種檢體鉛及鎘濃度之分布.................54
表九、暴露二手菸與各種檢體鉛、鎘濃度之比較...............54
表十、依暴露二手菸分層在各種檢體鉛與鎘濃度之相關性.......55
表十一、依暴露二手菸分層在各檢體鉛與鎘之相關性...........55
表十二、二手菸暴露組及非暴露組在新生兒結果之比較.........56
表十三、各種檢體鉛、鎘濃度與新生兒健康指標之相關性.......56
表十四、母血鉛濃度與臍血及胎盤之相關性...................57
表十五、母血鎘濃度與臍血及胎盤之相關性...................57
表十六、鉛與鎘之生物性指標影響新生兒結果之多變量線性迴歸
模式.............................................58
表十七、母血鉛與各檢體中鎘濃度在懷孕週數之雙方變異數分析(two-way ANOVA).................................59
表十八、母血鉛與各檢體中鎘濃度在頭圍之雙方變異數分析(two-way ANOVA)..........................................60
表十九、血鉛與各檢體中鎘濃度在體重之雙方變異數分析(two-way ANOVA)..........................................61
表二十、母血鉛與各檢體中鎘濃度在身長之雙方變異數分析(two-way ANOVA)..........................................62
表二十一、職場及家庭中二手菸暴露對各檢體間鉛及鎘濃度之比較
.................................................62
表二十二、職場及家庭中二手菸暴露對新生兒健康指標的影響..63

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