| 摘要: | 近年來台灣勞工工作壓力問題導致過勞的情況有日益嚴重的趨勢，而過勞會導致急性循環系統疾病。根據行政院勞工委員會之「職業促發腦血管及心臟疾病之認定基準」包括腦血管疾病及心臟疾病之急性發作兩大類。腦血管疾病包括腦溢血、腦血栓、腦栓塞、腦梗塞、蜘蛛膜下出血，通稱為中風及高血壓腦病變；心臟疾病包括心臟性猝死、心肌梗塞、心臟衰竭及主動脈剝離。腦血管及心臟疾病並非只由單一疾病引起，而是由好幾種病因引起，其致病的危險因子大致為原有疾病、宿因等，如高血壓、動脈硬化、糖尿病、高脂血、高尿酸血症、腦動脈瘤、梅毒、心臟肥大及心臟瓣膜疾病等，具有家族病史、不良的飲食習慣，如攝取高鹽分或高脂肪飲食、氣溫急遽變化、吸菸、飲酒，藥物作用等。但由於引起急性循環系統疾病的原因有很多，上述之危險因子並不足以能完全解釋其致病原因，但勞工若有上述病因或家族史等危險因子，若在加上「超出尋常工作的特殊壓力」即可能促發過勞，而此認定基準是指該工作者發病前，有與工作有關聯之突發事件或在特定的工作時間內有從事特別激烈的工作所致的精神上或身體上的負擔。而勞委會於民國93年12月31日修正認定基準內容中，將「正常工作時間以外之時數認定為加班時數，只要有工作事實者，且能提出合理證明為工作所耗用時間，均納入認定時工作過重考量」、「勞工工作可能造成特殊工作壓力之工作型態增列工作時間以外考量的工作型態，考量不規律的工作、工作時間長、經常性出差、輪班、夜班、溫度、噪音或時差等之工作型態與負荷程度評估等可能引起過勞事項」以及「勞工因長期疲勞蓄積可能為發病因素，將疲勞的累積考量為特殊壓力之ㄧ」。
本研究對象為中部科學園區之某高科技產業員工，在取得公司同意的前提下，進行本研究。本研究以該公司最近一次之健檢資料為基礎，並於2012年5月至10月間依據健檢資料分析中有代謝症候群之勞工發放問卷，排除問卷和健康檢查資料不齊全的員工，建立80位員工問卷資料檔。並使用該公司之健康檢查資料及環境職業醫學會，過負荷作業健康服務工作指引(第三版)之附件二「疲勞和壓力累積量表」，以SPSS17版建檔並進行資料分析。
本研究第一階段以健檢資料進行分析，刪除資料不全後，分析人數為737人，其中男性共641(87%)人、女性共96(13.0%)人。年齡層分析，≦39歲佔大多數共433(58.8%)人、40-49歲共236(32.0%)人、≧50歲共68(9.1%)人。分析各項造成代謝症候群之危險因子之盛行率中，腰圍異常盛行率為25.2%、血糖異常盛行率為27.0%、三酸甘油脂異常盛行率為27.3%、高密度膽固醇異常盛行率為27.7%、高血壓盛行率60.9%、罹患代謝症候群者，三項異常者盛行率為15.2%、四項異常者盛行率為6.6%、五項皆異常之盛行率為3.8%。
以Framingham Risk Score(FRS)估算十年心臟病風險，男性由33.3%其FRS≧5%，而女性則沒有個案，FRS≧5%。工作年資大於十年者，FRS≧5%者有37.5%，而工作年資小於十年者有28.2%，勝算比為1.53(0.56-4.16)。一個月的時間外勞動狀況(加班)為多或非常多者，比起正常加班者，其FRS≧5%的勝算比為1.23(0.45-3.37)。不規則勤務多者比起少有不規則勤務者，其FRS≧5%的勝算比為1.42(0.45-4.46)。工作上的精神負擔大或非常大者，比起精神負擔極小者，其FRS≧5%的勝算1.16(0.44-3.03)。工作壓力狀況在3分以上者，比起壓力狀況小於3分者，其FRS≧5%的勝算比為1.23(0.46-3.26)。這些勝算比雖均未達統計上顯著差異，但亦可看出工作壓力大者，有增加未來罹患心血管疾病風險之趨勢。
綜合本研究結果，造成心血管疾病並非單一因素而是由許多方面共同造成，醫學上之心血管疾病危險因子(如高血壓、吸菸等)仍為相當重要的貢獻因子，而工作壓力可能造成血壓上升、睡眠問題等產生進而提高罹患心血管疾病之高危險性。此外，本研究使用Framingham heart scorer推估10年內得心血管疾病之風險，由於該計算模式，年齡為相當重要的一個變項，隨著年齡越高，所加乘的比重越重，而本研究對象平均年齡為38.5歲，還尚未達到高危險加乘的年齡，但推論往後幾年，其10年內得心血管疾病之風險將大幅增加。因此建議，首要應著重於罹患有代謝症候群及心血管疾病防治之工作上，同時也應照顧到勞工心理壓力層面，工作時數、睡眠等可能促發的危險因子，也應列入防治項目。
In recent years, the tendency of job stress leading to overwork has become increasingly severe in Taiwan. According to the Establishment Standards for Cerebrovascular Diseases and Heart Diseases Caused by Occupation issued by the Council of Labor Affairs, overwork can lead to acute circulatory system diseases, including cerebrovascular disease and acute attacks of heart diseases. Cerebrovascular diseases include: cerebral hemorrhage, cerebral thrombosis, cerebral embolism, cerebral infarction and subarachnoid hemorrhage, which are generally known as apoplexy and hypertensive encephalopathy; heart diseases include: sudden cardiac death, myocardial infarction, cardiac failure and aortic dissection. Cerebrovascular and heart diseases are not caused by a single disease, but by several pathogeneses, and the risk factors causing the diseases include preexisting diseases such as: hypertension, arteriosclerosis, diabetes, hyperlipidemia, hyperuricemia, cerebral aneurysm, syphilis, cardiac hypertrophy, heart valve disease, etc; as well as family medical history; and poor eating habits, such as a diet high in salt and fat; rapid temperature change; smoking, drinking, drug effects, and so on . However, as acute circulatory system diseases can be caused by various factors, the abovementioned risk factors are insufficient to completely explain the pathogenesis; if workers are exposed to the above disease factors or have family medical history, coupled with excessive job stress, this may lead to overwork. The Establishment Standards refer to the mental or physical burdens on the workers before the attack of diseases caused by emergent incidents related to job or particularly intense work within the specific work period. Nevertheless, the Council of Labor Affairs revised the Establishment Standards on December 31, 2004 and decided that in the establishment, “hours beyond normal working time shall be identified as overtime hours and actions related to work can be reasonably included as work hours, and be regarded as overwork”; “work which could cause special stress on the workers shall be included as work beyond normal work hours and regarded as irregular work, long work hours, frequent business trips, shift work, night shifts, ‘temperature, noise or time difference’, load degree assessment and other matters causing overwork”; and “long-time fatigue accumulation could probably be a pathogenic factor and shall be deemed as irregular stress”.
The subjects of the study were employees from a company in the high-tech industry in the Central Taiwan Science Park, and the study was conducted on the premises after obtaining the consent of the company. Based on data from the company’s last physical examination, questionnaires were distributed among employees with metabolic syndromes in the physical examination data analysis between May and October, 2012. Excluding employees with incomplete questionnaires and physical examination data, questionnaire data files of 80 employees were established.
This study used the physical examination data of the company and the Fatigue and Stress Cumulative Scale in Annex II of the Health Service Guideline for Overload Operation (Edition 3) issued by the Environmental and Occupational Medicine Association; the files were set up using the SPSS17 version, and data analysis was carried out.
After calculating the risk with Framingham score, 33.3% of male has the 10-year risk of ≧5%, while none of female has the 10-year risk of ≧5%. If we compare workers who worked for over 10 years with those who worked for less than 10 years, the percentage with the 10-year risk of≧5% is 37.5% vs. 28.2%, with the odds ratio being 1.53(0.56-4.16). When comparing work beyond normal hours in a given month, those who answered “much” or “very much” has the odds ratio of 1.23(0.45-3.37) vs those who answered “normal”. In comparing “irregular duty” with “normal duty”, the odds ratio is 1.42(0.45-4.46). In comparing “huge burden” with “minimal burden”, the odds ratio is 1.16(0.44-3.03). When it comes to stress score of over 3 vs. less than 3, the odds ratio is 1.23(0.46-3.26). Those numbers are not significant statistically, but do show the trend that job stress can increase the chance of future cardiovascular disease. In drawing conclusions from the results of the study, it is evident that cardiovascular diseases are not caused by a single factor, but by many aspects. Medical risk factors of cardiovascular diseases (such as hypertension and smoking) are still important contributors, while job stress can probably cause rising blood pressure and sleep problems, which then increase the high risk of cardiovascular diseases. Moreover, this study uses the Framingham heart scorer to estimate the risk of suffering from cardiovascular diseases within 10 years. As age is a quite important variable in the calculation method, the higher the age, the greater the risk; the average age of the study subjects is 38.5 years old and has not reached the age of high risk. However, it can be inferred that the risk of suffering from cardiovascular diseases within 10 years will significantly increase in the next few years. Therefore, it is suggested that attention should be paid to the prevention of metabolic syndromes and cardiovascular diseases. Risk factors which can trigger the disease, such as mental stress, working hours and sleep should also be listed as key items in disease prevention. |
