臺灣博碩士論文加值系統

摘要
消防人員因救火任務，時常將身體暴露於急性的危害中，從事此類職業的人員，除了物理性及化學性暴露之危害外，生物性氣膠之危害更須加以注意。由於消防人員長期使用灑水設備救火，且在救火現場必須穿著防護衣、帽、鞋、手套及呼吸器以保護消防人員免於吸入毒性物質，但當消防人員完成任務回到消防大樓，消防人員總會將個人防護具隨手吊掛在旁，以便下一次出勤時使用，再加上通常清洗狀況不佳，因此本研究以消防大樓進行生物氣膠空氣採樣及防護器具上的生物氣膠之擦拭採樣，藉此確認發生於消防人員過敏、呼吸道疾病、肺工能衰退等健康危害與生物氣膠暴露量之間的相關性。
本研究以台灣南部地區消防大樓為對象；使用Andersen N6、Burkard衝擊式生物採樣器，採集空氣中的生物氣膠，另以擦拭採樣採集個人防護具包括消防衣、呼吸面罩之細菌與真菌的分佈狀況。消防人員健康問卷，內容包括有個人基本資料、工作特性、胸腔健康及自覺症狀四大項。
研究結果顯示，空氣中真菌及細菌之幾何平均濃度分別為1648 ± 2.34CFU/m3及981 ± 2.48 CFU/m3，而真菌濃度中較高濃度之真菌菌屬為Fusarium(59.95％) 、Penicillium(18.34％) 、Aspergillus(5.12％) 及Yeast(8.15％)。消防衣上的真菌及細菌濃度分別為5.03 ± 2.95 CFU/cm2及4.86 ± 2.50CFU/cm2，真菌濃度中較高濃度之真菌菌屬為Cladosporium(30.16％) 、
Penicillium(11.68％)及Yeast(24.18％)。呼吸面罩之真菌及細菌濃度分別為3.46 ± 3.45 CFU/cm2及4.66 ± 3.90 CFU/cm2，真菌濃度中較高濃度之真菌菌屬為Cladosporium(33.75％) 、Aspergillus(20.75％) 、及Yeast(22.75％)。

暴露組與非暴露組之罹病比較，慢性咳痰（P＜0.01）及支氣管炎（P＜0.05）兩者皆有顯著性差異。而暴露組自覺症狀中則以肩膀酸痛的比率為最高（45.7％），其次為打噴嚏比率為34.3％。暴露組資歷與疾病之相關性探討發現:腸胃疾病與資歷有顯著相關（OR = 6.13；95％C.I =1.93-280.73），而自覺症狀則與資歷及真菌濃度均有顯著相關，其OR 值分別為（OR = 2.02；95％C.I = 0.61-21.78）、（OR = 4.27；95％C.I =1.07-11.67）。

Abstract
The working environment is especially dangerous for fire fighters as they are constantly exposed to chemical and physical hazards. Chemical hazardous substances include PVC, polypropylene, polyurethane, ABS, SAN, etc, which are released into the air as things burn. The physical hazards include heat stress, noise damage, etc. According to our observation, bio-aerosol is the
more damaging of the hazards and is often found on the firefighters’equipment such as jackets, hats, boots and gloves. Among all bio-aerosols of
current research interest, endotoxin is present among many occupational environments. The bio-aerosols hazards that could be potentially harmful to health include bacteria, fungi, virus, parasite, allergen, etc. This study is to
first determine what to measure by looking at their occupational diseases records. Then the study will take samples of bio-aerosols off their
equipment and from the air of their resting area to perform the measurements. Finally, the study will evaluate the relationship between bio-aerosols and various diseases among fire fighters. This study was conducted in the fire department buildings in southern Taiwan. Two sampling equipments, Andersen N6 and Burkard, were used for air sampling of all stations. In addition, Swab sampling was used for collecting the bio-aerosols on the surfaces of personal protective equipments including both protective suits and masks. A questionnaire was used for
collecting background information about the firefighters including their demographics (age, sex, ethnicity, occupation, smoking history, and pets), work characteristics (attendance records and job duration), medical history, and their self-conscious symptoms among fire-fighters.
The results of this study indicate that the geometric mean (GM) concentration of fungi in their resting area was 1648 ± 2.34 CFU/m3 , and the geometric mean concentration of bacteria was 981 ± 2.48 CFU/m3. The higher concentration of fungal species were Fusarium(59.95％) 、Penicillium(18.34％ ) 、Aspergillus(5.12 ％ ) and Yeast(8.15 ％ ). The geometric mean concentrations of fungi and bacteria were 5.03 ± 2.95 CFU/cm2 and 4.86 ±
2.50 CFU/cm2 on protective suits. The higher concentration of fungal species were Cladosporium(30.16％)、Penicillium(11.68％)、Fusarium (9.78％) and Yeast(24.18％). In addition, the geometric mean concentration of fungi and
bacteria were 3.46 ± 3.45 CFU/cm2 and 4.66 ± 3.90 CFU/cm2 on masks. The higher concentration of fungal species were Cladosporium(33.75 ％ ) 、
Aspergillus(20.75％) 、Fusarium(4.75％) and Yeast(22.75％).
Comparing the group exposed to the bio-aerosols with the control group not exposed, the probabilities of chronic expectoration (P<0.01) and bronchitis (P<0.05) were visibly different among the two groups. It is noticeable that the shoulder ache was the highest self-consymptom felt at 45.7%, followed by sneezing at the rate of 34.3%. And after studying the job characteristics and symptoms of the exposed group, we found that the stomach disease is related to the years of service (OR =6.13; 95% C.I =1.93-280.73). Finally, it is found that the self-conscious symptoms are related with the job duration and the concentration of fungi (OR=2.02; 95% C.I =0.61-21.78), (OR =4.27; 95% C.I =1.07-11.67).

壹、前言……………………………………………………………………1
一、研究緣起…………………………………………………………1
貳、文獻回顧………………………………………………………………3
一、消防人員的健康危害……………………………………………3
二、生物性氣膠對人體的健康效應…………………………………4
(一) 大樓環境微生物………………………………………………4
(二) 真菌對人體的健康影響………………………………………5
(三) 細菌對人體的健康影響………………………………………6
(四) 環境因子對生物氣膠的影響…………………………………7
(五) 生物採樣器…………………………………………………..…8
(六) 擦拭採樣……..………………………………………………....8
参、材料與方法………..…………………………………………………...10
一、研究架構……………………………………………………….…10
二、健康問卷……………………………………………………….…11
三、研究族群………………………………………………………..…12
(一) 空氣採樣………………………………………………………12
(二) 擦拭採樣項目…………………………………………………12
四、材料與設備………………………………………………………..12
(一) 空氣採樣設備…………………………………………………12
(二) 環境因子採樣器………………………………………………13
(三) 擦拭採樣材料…………………………………………………14
(四) 培養基成份……………………………………………………14
五、採樣及分析方法…………………………………………………..15
(一) 空氣樣本………………………………………………………15
(二) 擦拭樣本………………………………………………………17
六、統計分析方法……………………………………………………...18
肆、研究結果………………………………………………………………..20
一、消防人員基本資料………………………………………………...20
二、消防大樓生物氣膠濃度…………………………………………...21
(一) 採樣環境條件…………………………………………………21
(二) 環境微生物濃度………………………………………………27
三、擦拭採樣…………………………………………………………..39
四、消防人員的疾病與自覺症狀的相關因子探討…………………..41
伍、討論…………………………………………………………………….54
一、真菌分析……………………………………………………….....54
二、細菌分析……………………………………………………….....55
三、擦拭採樣……………………………………………………….....56
四、消防人員的疾病與自覺症狀的相關因子探討…………………57
陸、結論……………………………………………………………………58
參考文獻……………………………………………………………………59
附錄一Andersen 校正表…………………………………………………..69
附錄二Burkard 校正表……………………………………………………70
附錄三消防人員健康問卷表……………………………………………..71

圖表目錄
表1、風速設定對照表………………………………………………….…13
表2、消防人員問卷之基本資料……………………………………….….20
表3、暴露組與非暴露組之資料對照表…………………………….....….21
表4、消防大樓採樣現場條件平均值……………………………………..22
表5、生物氣膠與環境因子間之相關係數………………………………..23
表6、各地點粉塵粒徑分佈(Particle/L)………………………………..…24
表7、真菌及細菌濃度與粉塵粒徑之相關係數………………………..…26
表8、分隊、時間及地點之真菌濃度分佈………….…………………..…27
表9、各地點之真菌濃度相關比較………….………………………….…29
表10、Andersen N6 和Burkard採樣器之真菌濃度(CFU/m3) ……….….30
表11、消防大樓各採樣地點之優勢真菌菌屬濃度分佈(CFU/m3) ……...32
表12、分隊、時間及地點之細菌濃度分佈………………………….…...34
表13、各地點之細菌濃度相關比較……….………………………………36
表14、Andersen N6 和Burkard採樣器之細菌濃度(CFU/m3) ……………37
表15、消防大樓革蘭氏陰性與陽性細菌濃度分佈（CFU/m3）…………38
表16、防護具之真菌和細菌平均值濃度（CFU/cm2）………………….39
表17、消防衣與呼吸面罩之優勢菌屬濃度分佈（CFU/cm2）………….40
表18、暴露組過敏疾病之因子分佈……….………………………………41
表19、暴露組與非暴露組之疾病比較…….………………………………42
表20、自覺症狀與相關因子之百分比分佈（％）………………………45
表21、腸胃疾病與生物氣膠濃度之相關性.………………..…….………46
表22、自覺症狀與自覺症狀環境因子之相關性……….………..……..…47
表23、疾病與相關因子之比較.……………………………….……………49
表24、胸腔疾病與相關因子之比較………………………..….……………50
表25、自覺疾病與相關因子之比較……………………..….……………..51
表26、腸胃疾病與相關因子之比較……………………..….……………..52
表27、眼部疾病與相關因子之比較……………………..….……………..53
圖1、實驗流程圖…………………………………………………………...23
圖2、各分隊之真菌濃度分佈圖……………………………………………28
圖3、各地點之真菌濃度分佈圖…………………………………………...28
圖4、消防大樓優勢菌種濃度與地點之分佈……………………………...32
圖5、各分隊之細菌濃度分佈圖……………………………………….......35
圖6、各地點之細菌濃度分佈圖……………………………………….......35

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