口罩在在嚴重急性呼吸道症候群（SARS）的疫情中，是維護醫護人員生命安全重要的防護措施之一，但因缺乏針對不同類型口罩之實證性研究，故本研究目的旨在了解與比較呼吸胸腔科加護單位之護理人員於執行護理活動時，佩戴手術口罩、N95口罩及P100口罩，其生理反應與自覺呼吸困難程度之差異及是否會隨佩戴時間的增加，而影響其生理反應與自覺呼吸困難程度。
本研究採時間序列研究法，以立意取樣方式於北部某一醫學中心之呼吸胸腔科加護單位之護理人員為對象，並分別使其在佩戴三種不同類型之口罩下執行護理活動。研究工具有二，一為「護理人員生理反應登錄表」，包括人員基本資料及體溫、血壓、脈搏、呼吸次數、血氧飽和度，二為「改良式Borg Scale量表」，以了解護理人員其自覺之呼吸困難程度。生理變化與自覺呼吸困難程度於護理人員未佩戴口罩前5分鐘及佩戴後，每隔45分鐘測量，測至護理人員自覺呼吸困難或任何情況下停止時為止。
統計方法以SPSS/Windows 11.0版中文套裝軟體以及SAS 8.1統計軟體進行資料分析。統計方法包括描述性統計方法（包括人數、平均值、標準差），以了解與比較護理人員的基本屬性及其生理變化與自覺呼吸困難的分數。另以重複測量變異數分析作為佩戴三種口罩與生理指標、自覺呼吸困難程度之差異檢定。
研究結果顯示，胸腔科加護單位護理人員在佩戴三種口罩執行護理活動時，主觀症狀陳述方面，佩戴手術口罩時，皆無人有任何不適之主訴，但佩戴N95口罩與P100口罩者則會有不適之主訴。佩戴N95口罩者多以鼻子癢症狀最多，而P100口罩則以鼻子痛、呼吸緊迫（p < .05）及注意力不集中（p < .05）為最多。在生理指標中，血壓、脈搏不會隨著時間增加而有所變化，但呼吸與血氧飽和度則會，當護理人員佩戴N95口罩時，其呼吸變化較P100口罩及手術口罩明顯增加（p < .001），而血氧飽和度則顯示P100口罩的變化要比N95口罩與手術口罩明顯降低 （p < .001），但在佩戴135分後，P100口罩的血氧飽和度恢復至未戴前程度要比N95口罩佳。另在自覺呼吸困難程度方面，護理人員佩戴P100口罩較N95口罩及手術口罩在統計上有顯著差異（p < .001）。
本研究結果發現佩戴三種不同類型的口罩於執行護理活動時，確實會造成呼吸、血氧飽和度的變化及自覺呼吸困難或不舒適等主訴，其中又以N95口罩及P100口罩較手術口罩為劇，因此在護理人員排班上應考量佩戴時間的長短，以免造成護理人員因生理不適或自覺呼吸困難而影響病患照護品質，且須考量護理人員之個別性需求以達最有效之防護及生理與心理的舒適度。

One of the most important protective facilities by which could save health providers’ life was the respirator, especially during the widespread of Severe Acute Respiratory Syndrome (SARS); however, few evidence-based studies were conducted related to respirators. Therefore, the aims of this study were to understand and compare physiological responses and self-perception of breathing stamina by nurses, and whether physiological responses and self-perception of breathing stamina would change while wore different respirators, such as surgical mask, N95, and P100 respirator, under nursing activities.
The design was time series model. Samples were recruited from nurses at a chest intensive care unit in a medical center of northern Taiwan. Nurses were all independently wearing three different respirators in performing nursing activities. Two instruments were used in this study. First was the
“Physiological Responses Collection Tool”, which recorded subjects
demographics, body temperature, blood pressure, pulse rate, respiration rate, and saturated oxygen-blood density. Second was the “Modified Borg Scale” that was used to measure nurses’ self-perception of breathing stamina. Physical responses were measured five minutes before the beginning of the study and every 45 minutes after wearing respirators. This procedure was stopped while nurses reported difficult breathing and any unconditional happened or interrupted.
Data were analyzed by the statistical packages, SPSS/Windows Version 11.0 in Chinese and SAS Version 8.1. Descriptive statistics such as number, mean, and standard deviation were used to understand and compare nurses’ demographics and changes in physiological responses and self-perception of breathing stamina’s scores. Besides, Repeated Measured ANOVA was applied to test the differences among physiological responses and self-perception of breathing stamina while nurses wore respirators under nursing activities.
The results showed that the chief complaints by nurses only reported on who wore N95 and P100 respirators. Nurses who wore N95 respirators reported more symptoms on nose tickling. In contrast, nurses who wore P100 respirators reported more symptoms on dazzling, flaming, and flatly to speak out. In the physiological responses, the blood pressure and pulse rates were not changed significantly when time increased, but both the respiration rates and saturated oxygen-blood densities were changed when time increased. When nurses wore N95 respirators, the respiration rate was changed more significantly than those of P100 respirators and surgical masks (p < .001). However, the saturated oxygen-blood density was changed more significantly when nurses wore P100 respirators than those of N95 respirators and surgical masks (p < .001). Furthermore, after wearing P100 respirator in 135 minutes, the saturated oxygen-blood density that recovered to its original status was better than those of N95 respirators and surgical masks. For the study of the self-perception of breathing stamina, wearing P100 was found more statistical significant than those of N95 respirators and surgical masks (p < .001).
In conclusive, nurses were really affected by wearing these three different respirators in performing nursing activities, especially in the changes of respiration rate, saturated oxygen-blood density, self-perception of breathing stamina, and uncomfortable symptoms. Among these three respirators, nurses who wore N95 and P100 respirators were found more severe than those of surgical masks. As a result, the assignment of duty for nurses should consider the working hours in order to avoid uncomfortable states in physiological responses and difficult to breath during patient care. And also, the individual needs should also be considered to achieve effective protection and physical and psychological comforts.

致 謝 …………………………………………….……………... Ⅰ
中文摘要 …………………………………………….……………... Ⅲ
英文摘要 …………………………………………….…………….. Ⅴ
目 錄 …………………………………………….…………….. Ⅷ
圖表目次 …………………………………………………………… Ⅹ

第一章 緒論
第一節 研究動機與重要性……………………….………………. 1
第二節 研究目的………………………………….………………. 3
第三節 研究假設………………………………………………….. 4
第四節 名詞定義………………………………………………….. 5
第二章 文獻查証
第一節 口罩的相關防護概念…………….…………………......... 7
第二節 活動與生理反應之相關概念………………..…………… 12
第三節 呼吸困難測量之工具…………………………………….. 13
第四節 概念架構………………………………………………….. 17
第三章 研究方法
第一節 研究設計與對象…………….………………………......... 19
第二節 研究工具………………………………..………………… 20
第三節 研究工具信效度………………………………….…......... 21
第四節 資料收集過程…………………………………………….. 22
第五節 資料分析………………………………………………….. 24
第四章 分析與結果
第一節 研究對象之基本屬性…………..………………………… 26
第二節 護理人員佩戴三種類型口罩於執行護理活動時之自覺感受……………………….……………..………………. 28
第三節 護理人員佩戴三種類型口罩於執行護理活動時其生理變化情形………………………………………………… 30
第四節 護理人員佩戴三種類型口罩於執行護理活動時其自覺呼吸困難程度…………………………………………… 65
第五章 討論
第一節 護理人員佩戴三種類型口罩執行護理活動時之自覺感受…………………………………………….…………... 73
第二節 護理人員佩戴三種類型口罩執行護理活動時之生理反應…………………………………………….…………... 74
第三節 護理人員佩戴三種類型口罩執行護理活動時之自覺呼吸困難程度……………………………………………… 75
第六章 結論與建議
第一節 結論……………………………………………….…......... 76
第二節 研究貢獻……………………………………….……......... 78
第三節 研究限制…………………………………………..……… 79
第四節 建議……………………………………………………….. 80

參考資料
中文部分…………………………………………………………… 81
英文部分…………………………………………………………… 82
附錄
附錄一 護理人員生理反應登錄表……………………………….. 89
附錄二 改良式Borg Scale自覺呼吸困難程度及困難程度量表………………………………………………………… 90
附錄三 同意書…………………………………………………….. 91

圖表目次

圖一 護理人員佩戴三種不同類型口罩執行護理活動時間長短與其生理變化及自覺感受之概念架構………………………………. 18
圖二 資料收集流程圖…………………………………………………. 23
圖三 護理人員在佩戴手術口罩執行護理活動時，其收縮血壓變化情形…………………………………………………...................….. 32
圖四 護理人員在佩戴N95口罩執行護理活動時，其收縮血壓變化情形………………………………………………………………. 33
圖五 護理人員在佩戴P100口罩執行護理活動時，其收縮血壓變化情形………………………………………………………………. 34
圖六 護理人員在佩戴手術口罩執行護理活動時，其舒張血壓變化情形…………………………………………………………………. 35
圖七 護理人員在佩戴N95口罩執行護理活動時，其舒張血壓變化情形………………………………………………………………. 36
圖八 護理人員在佩戴P100口罩執行護理活動時，其舒張血壓變化情形………………………………………………………………. 37
圖九 護理人員佩戴三種類型口罩執行護理活動時，其血壓之變化情形…………………………………………………………………. 39
圖十 護理人員在佩戴手術口罩執行護理活動時，其脈搏變化情形…………………………………………………………………. 43
圖十一 護理人員在佩戴N95口罩執行護理活動時，其脈搏變化情形…………………………………………………………………. 44
圖十二 護理人員在佩戴P100口罩執行護理活動時，其脈搏變化情形………………………………………………………………… 45
圖十三 護理人員佩戴三種類型口罩執行護理活動時，其脈搏之變化情形.………………………………………………………………… 47
圖十四 護理人員在佩戴手術口罩執行護理活動時，其呼吸變化情形…………………………………………………………………. 50
圖十五 護理人員在佩戴N95口罩執行護理活動時，其呼吸變化情形………………………………………………………………….. 51

圖十六 護理人員在佩戴P100口罩執行護理活動時，其呼吸變化情形………………………………………………………………. 52
圖十七 護理人員佩戴三種類型口罩執行護理活動時，其呼吸之變化情形…………………………………………………………….. 54
圖十八 護理人員在佩戴手術口罩執行護理活動時，其血氧飽和度變化情形……………………………………………….…………. 58
圖十九 護理人員在佩戴N95口罩執行護理活動時，其血氧飽和度變化情形………………………………………………………. 59
圖二十 護理人員在佩戴P100口罩執行護理活動時，其血氧飽和度變化情形………………………………………………………. 60
圖二十一 護理人員佩戴三種類型口罩執行護理活動時，其血氧飽和度之變化情形…………………………………………………….. 62
圖二十二 護理人員在佩戴手術口罩執行護理活動時，其自覺呼吸困難程度………………………………………………….…………. 67
圖二十三 護理人員在佩戴N95口罩執行護理活動時，其自覺呼吸困難程度…………………………………………………………. 68
圖二十四 護理人員在佩戴P100口罩執行護理活動時，其自覺呼吸困難程度…………………………………………………………. 69
圖二十五 護理人員佩戴三種類型口罩執行護理活動時，其自覺呼吸困難程度…………………………………………………………. 71


表一 美國NIOSH防護性口罩分級標準……………………………… 11
表二 資料之統計分析…………………………………………………. 25
表三 護理人員之基本資料分布情形…………………………………. 27
表四 護理人員佩戴三種類型口罩之不適主訴症狀人數……………. 29
表五 護理人員佩戴三種類型口罩執行護理活動時之血壓分布情形……………………………………………….………………… 38
表六 護理人員的收縮壓在三種類型口罩及不同時間之變異數分析…………………………………………………………………. 40
表七 護理人員的舒張壓在三種類型口罩及不同時間之變異數分析……………………………………………….………………… 41
表八 護理人員佩戴三種類型口罩執行護理活動時之脈搏分布情形…………………………………………………………………. 46
表九 護理人員的脈搏在三種類型口罩及不同時間之變異數分析…………………………………………………………………. 48
表十 護理人員佩戴三種類型口罩執行護理活動時之呼吸分布情形……………………………………………….…………………. 53
表十一 護理人員的呼吸在三種類型口罩及不同時間之變異數分析………………………………………………………………….. 55
表十二 護理人員的呼吸在三種類型口罩及不同時間之重複測量變異數分析……………………………………………………………. 56
表十三 護理人員佩戴三種類型口罩之血氧飽和度分布情形.................. 61
表十四 護理人員的血氧飽和度在三種類型口罩及不同時間之變異數分析……………………………………………………………….. 63
表十五 護理人員的血氧飽和度在三種類型口罩及不同時間之重複測量變異數分析…………………………………………………….. 64
表十六 護理人員佩戴三種類型口罩之自覺呼吸困難程度分布情形（Borg Scale）…………………………………………………… 66
表十七 護理人員的自覺呼吸困難程度在三種類型口罩及不同時間之變異數分析………………………………………………………. 70
表十八 護理人員的自覺呼吸困難程度在三種類型口罩及不同時間之重複測量變異數分析…………………………………………….. 72

3M香港子公司網站‧（無日期）‧有關3M呼吸防護產品的問與答‧摘自
12月24日，2004年，http://www.3m.com/intl/hk/chinese/hk_
frontpage/Q&A1.html
社區大學SARS資訊網‧（5月14日，2003年）‧SARS防護口罩與預防
措施‧摘自12月10日，2004，http://www.bamboo.hc.edu.tw/
information/sars/masks.html
社區大學SARS資訊網‧（5月14日，2003年）‧SARS口罩防護原理‧
摘自12月10日，2004，http://www.bamboo.hc.edu.tw/
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清華大學動力機械系彭明輝教授整理-台灣與香港衛生署、台灣3M、香
港中文大學等網站‧（無日期）‧口罩的戴法、清理與保養‧摘自12月12日，2004，http://sars.heart.net.tw/sarsmedicalfacemask1.doc
行政院勞工委員會南區勞動檢查所‧（無日期）‧如何正確使用呼吸防護具‧摘自2月24日，2005，http://www.slio.gov.tw/menu-8/menu-8-4.htm
袁宗凡編譯（2000）。新編蓋統醫用生理學。臺北市：合記。
勞工安全衛生研究所‧（無日期）‧拋棄式口罩之使用注意事項‧摘自
2月24日，2005年，http://www.iosh.gov.tw/netbook/mask1.htm
勞工安全衛生研究所‧（無日期）‧醫護人員預防SARS防塵口罩選用技
術問答集‧摘自9月2日，2003，http://www.iosh.gov.tw/
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潘震澤編譯（1999）。人體生理學（7版）。臺北市：合記。
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