| 摘要: | 背景與目的：麻醉人員長時間在開刀房內工作，面對需要手術的重症病患與瞬息萬變的病情變化，在醫界被公認為是高風險的工作，除了工作量大與無形的工作壓力，工作環境中也含有病人排出的麻醉廢氣，對身心健康是否有影響值得探討。本研究針對中國醫藥大學附設醫院麻醉部新訓麻醉醫療人員，訓練前後的身心變化，以各種診斷工具了解麻醉工作的壓力對醫療人員造成的影響。
材料與方法：選擇二十位新訓麻醉人員為受試者，在受訓前與受訓後三個月，分別接受寺澤捷年的氣虛與血瘀診斷基準量表、SF-36量表之分析，與舌診儀、脈診儀、心率變異度（HRV）之檢測。
結果：受試者共有二十位，其中女性有18位、男性有2位，平均年齡為 26.75 ± 3.31 歲，平均體重為 54.15 ± 10.81 公斤，平均身高為160.35 ± 5.09公分。若以寺澤捷年量表所得之氣虛與血瘀分數分析，有統計學上的意義（p<0.05）；但若依其定義之氣虛（總分30以上為氣虛）與血瘀（血瘀指數大於20點），則無統計學上的意義。SF-36健康評估量表中因生理健康問題造成的角色限制（RP, role limitation due to physical problems）、一般健康（GH, general health）、活力（VT,vitality）、因情緒問題造成的角色限制（RE, role limitation due to emotional problems）、心理健康（MH, mental health）及心理部份總和(MCS, mental component summary)等等都有統計學上的意義；若以年齡區分，分成25歲以下及25歲以上，只有GH有統計學上的意義。經過兩位資深中醫師判讀的舌診，氣滯與血瘀有統計學上的意義。脈波頻譜右手寸脈中取與右手尺脈沈取具有統計學上之意義。心率變異度分析中，低頻譜（LF_P）、高頻譜（HF_P）與高低頻譜比（LF/HF）有統計學上的意義。
結論：綜合以上研究結果可得知，麻醉人員在忙碌與高壓力的工作環境下，經過不同的儀器檢測、中醫診斷與健康量表的分析下，都發現會產生影響身心健康的變化，其影響的機轉與後續的變化，值得進一步探討。
關鍵詞:工作壓力、心率變異度、麻醉人員、舌診、脈診、SF-36、氣虛診斷基準、血瘀診斷基準
Backgrounds and Objectives: Anesthesia was well known to be high risk because of the critical and complicated patients. Anesthesia personnels should work at the operation room and face high working strain. There were few reports regarding the relation of working stress in anesthesia trainee and healthy status. This study was designed to investigate the change of working stress before and after anesthesia training.
Matherials and Methods: Twenty anesthesia trainees were enrolled in this study. The evaluation tools included SF-36 health survey, qi-deficiency and blood-stasis diagnosis criteria by Katsutoshi Terasawa, tongue-viewing system, pulse diagnosis system and heart rate variablility. They received the evalutation before and after training for 3 months respectively.
Results: There were twenty trainees enrolled in the study, 18 females and 2 males, the average age of 26.75 ± 3.31 y/o, average weight of 54.15 ± 10.81 kgs, and average height of 160.35 ± 5.09 cms. There was no significant difference about the qi-deficiency and blood stasis diagnosis criteria by Katsutoshi Terasawa. According to the SF-36 health survey, the role-physical, general health, vitality, role-emotioal, mental health, and mental component summary had significant differences. Two senior Chinese medical doctors made the diagnosis accoriding to the image from tongue-viewing system. There were significant differences in qi-stagnancy and blood-stasis. According to the power spectral analysis, middle reading of inch pulse and deep reading of foot pulse at right hand had significant differences. According to the heart rate variability, there were significant differences in low-frequency power, high frequency power and the ratio of low-frequency power and high frequency power.
Conclusions: We found that there were significant changes after anesthesia training. They might be due to the heavy working strain and stress. The mechanisms and effects needed further evaulation. |
