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研究生:謝名峰
研究生(外文):Hsieh Ming-Feng
論文名稱:職場運動對站坐姿工作人員肩足微循環影響分析-應用雷射都卜勒量測儀技術
論文名稱(外文):Exercise effect on the shoulder/foot microcirculation of workers-Application of Laser Doppler Flowmetry technique
指導教授:賈台寶
學位類別:碩士
校院名稱:弘光科技大學
系所名稱:職業安全與防災研究所
學門:環境保護學門
學類:環境防災學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:98
中文關鍵詞:雷射都卜勒微循環血流量運動介入
外文關鍵詞:Laser Doppler Flowmetrymicrocirculationblood flowexercise intervention
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中文摘要
  國內工作者工作時數目前高居世界第三,伴隨之工作壓力對肩足及身心健康造成威脅,也呼應國內逐年上升的肌肉骨骼傷病賠償。本研究目的為針對長時間久坐久站的員工(1)依北歐肌肉骨骼問卷及身心健康狀態問卷評估肩足不適程度及自覺身心健康程度。(2)以微循環量測技術評估肩足部微循環特性。(3)結合問卷與量測評估站坐姿員工運動介入的成效。
  本研究對象為43名電器設備組裝廠久站久坐的工作者,依其工作性質分為站姿運動組(n=13),坐姿運動組(n=15)及坐姿對照組(n=15),連續介入4週且每週累積達80分鐘中強度以上的運動,於介入運動前後量測工作者肩足部微循環血液流量(DC值)、收縮壓、舒張壓及心跳數,再應用SPSS 12.0統計軟體進行各組頸肩部症狀與生活特性相關及運動介入前後之差異分析。
  本研究結果發現:(1)坐姿工作者年齡、BMI與頸部、左肩症狀有顯著相關(p<0.05)。(2)坐姿工作者有左肩、右肩或頸部疼痛症狀的比例為73%,認為「完全或一部分是與工作有關」的佔77%、90%及85%;站姿工作者膝蓋、腳踝或足部有疼痛約為27%。(3)坐姿者頸及左、右肩部症狀對受測者影響為「工作能力稍微或明顯降低」所佔比例為64%、67%及40%。(4)站坐姿員工運動介入後收縮壓、舒張壓、心跳數平均值下降比例較站姿運動組高。(5)站坐姿運動組平均DC值運動4週後差異雖未達顯著水準,但均有回復至本研究假設之健康基準值(DC=20, 60)的趨勢;不運動後運動組第8週收縮壓、舒張壓、心跳有回復至0週較不健康狀態的趨勢。
本研究以LDF成功區別站坐姿員工肩足的兩種不健康狀態,並介入職場短時間運動使久站久坐工作者生理值之改善有正面效益。建議未來在職場廣為推行短時間運動有助於員工健康促進,避免久坐久站,於工作期間內採十分鐘中強度運動或休息及適度伸展,以促進微循環健康。並建議職場健康檢查增設肩足部微循環量測,及早提醒員工做好肩足疼痛的預防措施,避免職業傷病及降低逐年增高的肌肉骨骼傷害之醫療損失。

關鍵詞:雷射都卜勒、微循環、血流量、運動介入

Abstract
 Average working hours of workers in Taiwan was ranked third among the countries in the world recently. Job stress not only poses threat to shoulder and foot health, but also echoes an increase in the domestic musculoskeletal injuries compensation. This study aimed to (1) to assess the degree of perceived shoulder/foot symptoms using the Nordic Musculoskeletal Questionnaire (NMQ) and physical and mental health using the short form Questionnaire of physical and mental health (SF-12); (2) to evaluate the microcirculatory characteristics of shoulder/foot using LDF technique; (3) to assess the effectiveness of exercise intervention based on the results of questionnaire survey and LDF measurements.
  Forty-three employees with long-term sitting or standing posture were recruited in an electrical equipment assembly plant. They were divided into three groups according to their nature of work, which was exercise group A (n = 13, standing posture), exercise group B (n = 15, sitting posture) and the control group C (n = 15, sitting posture). Vigorous exercise intervention was involved up to 80 minutes per week and continuously in four weeks. The shoulder/foot blood flow intensity (DC value), systolic blood pressure, diastolic blood pressure and heart rate were measured pre- and post-intervention. SPSS 12.0 statistical software was applied to analyze the relationship between perceived symptoms and life-related characteristics, and the difference of DC valued between groups pre- and post-intervention.
  The results of the study include: (1) the age, BMI of workers (sitting posture) were significantly correlated with neck and left shoulder symptoms (p <0.05). (2) the prevalence of shoulders or neck pain for workers with sitting posture was 73%, which 77%、90% and 85% were “in whole or partly work-related”; the prevalence of knee, ankle and foot pain for workers with standing posture was 27%. (3) the ratio of the resulting effect ”slightly or significantly reducing work ability” caused by neck and shoulder symptoms for workers with sitting posture was 79%、60% and 67%. (4) Average systolic blood pressure, diastolic blood pressure and heart rate of the Group B reduced more post-intervention compared to Group A. (5) The DC value of Group A and B had not yet reached a significant level after four weeks, but revived to the hypothesized healthy reference value (DC =20 or 60); on the other hand, the systolic blood pressure, diastolic blood pressure, heart rate and DC value of Group B returned to unhealthy state after 8 weeks.
  In this study, two unhealthy status of the shoulder/foot microcirculation of workers were successfully distinguished using LDF technique. It is also found that short time and vigorous exercise have positive benefits on the workers’ physiological parameters. It is suggested that implementing 10 minutes vigorous exercise or stretching might promote the microcirculatory health of employees. And the shoulder/foot microcirculation health is recommended to be included in the health examination for early precautions of shoulder/foot symptoms. Hopefully the increasing occupational-related musculoskeletal injuries, diseases and medical loss year by year can be lowered.

Keywords: Laser Doppler Flowmetry, microcirculation, blood flow,
exercise intervention


目 錄
中文摘要 I
Abstract III
目 錄 V
圖目錄 VII
表目錄 IX
名詞解釋 X
第一章 前言 1
1-1研究背景 1
1-2研究目的 3
第二章 文獻回顧 4
2-1肩/足部症狀的定義 4
2-2肩/足部職業傷病 7
2-2-1肌肉骨骼傷害盛行率 7
2-2-2肩足部傷害盛行率 8
2-3血液微循環與量測 14
2-4職場運動介入成效 17
第三章 研究方法 22
3-1研究設計架構 22
3-2研究對象 24
3-3問卷調查 24
3-4微循環量測 25
3-5職場運動介入 32
3-6統計分析 34
第四章 結果 35
4-1員工基本資料與自覺症狀 35
4-2員工肩足部不適症狀之差異與相關分析 49
4-3坐姿員工運動介入成效 54
4-4站姿員工運動介入成效 63
4-5介入運動之身心健康程度比較 67
第五章 討論 72
5-1員工肩足不適程度比較 72
5-2員工身心健康評估比較分析 74
5-3員工生理值比較分析 76
5-4職場運動介入成效分析 78
第六章 結論與建議 81
參考文獻 83
附件一 問卷 88
附件二 測者量測注意事項 98

圖目錄
圖2-1 過去輔導案的整體改善績效(潘等2011) 20
圖3-1研究流程圖 23
圖3-2雷射都卜勒血流量量測儀(LDF) 25
圖3-3量測實照 26
圖3-4 LDF量測程序 27
圖3-5肩部拉伸 28
圖3-6足部拉伸 29
圖3-7微循環血流圖(Jian-GuoBau 2013) 30
圖3-8職場應用健身划步機之介入運動 33
圖4-3-1坐姿運動組之DC值與收縮壓變化圖(DC值<60者) 57
圖4-3-2坐姿運動組之DC值與舒張壓變化圖(DC值<60者) 58
圖4-3-3坐姿運動組之DC值與心跳壓變化圖(DC值<60者) 58
圖4-3-4坐姿運動組之DC值與收縮壓變化圖(DC>60者) 59
圖4-3-5坐姿運動組之DC值與舒張壓變化圖(DC>60者) 59
圖4-3-6坐姿運動組之DC值與心跳壓變化圖(DC>60者) 60
圖4-3-7坐姿對照組與坐姿運動組之舒張壓與心跳壓變化(DC>60者) 61
圖4-3-8坐姿對照組與坐姿運動組之DC值與收縮壓變化圖(DC>60者) 62
圖4-4-1站姿運動組之DC值與收縮壓變化圖(DC<20者) 63
圖4-4-2站姿運動組之DC值與舒張壓變化圖(DC<20者) 64
圖4-4-3站姿運動組之DC值與心跳壓變化圖(DC<20者) 64
圖4-4-4站姿運動組之DC值與收縮壓變化圖(DC>20者) 65
圖4-4-5站姿運動組之DC值與舒張壓變化圖(DC>20者) 65
圖4-4-6站姿運動組之DC值與心跳壓變化圖(DC>20者) 66

表目錄
表 4-1-1受測者基本資料 36
表 4-1-2受測者生活與工作情形 37
表4-1-4膝蓋頸部肌肉骨骼傷害調查(NMQ) 43
表4-2-1頸肩部症狀相關性分析 50
表4-2-2頸肩部症狀與生活特性相關分析 51
表4-2-3介入運動對肩足血流量DC值差異分析 52
表4-2-4介入運動組與對照組肩部血流量DC值差異分析 53
表4-3-1介入運動對頸肩疼痛症狀比較 55
表4-3-2介入運動對足部疼痛症狀比較 56
表4-5-1身心健康評估調查(SF-12) 69
表4-5-2 PCS、MCS 0週與4週比較 71


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