| 摘要: | 目的：
本研究主要目的為了解護理人員中醫體質、失眠易感性與睡眠品質的現況及其影響因素，並探討中醫體質與失眠易感性、睡眠品質之相關性。
方法：
本研究為橫斷式研究設計，研究對象為北、中、南、東共七家區域教學等級以上之軍方醫院護理人員，年齡20-45歲，工作年資半年以上者，排除懷孕、一個月內急性及慢性疾病發病者，共計252位完成收案。以結構式問卷收集資料，包含護理人員的個人屬性、工作型態、生活因子、中醫體質量表、福特失眠壓力反應量表及匹茲堡睡眠品質量表。資?分析採SPSS 20.0 版本進?描述性及推論性統計。
結果：
護理人員中醫體質分佈：平和體質者68人(27%)，陰血虛者154人(61.1%)；陽氣虛體質者152人(60.4%)；痰濕瘀滯體質者149人(59.1%)。護理人員中喝咖啡、喝酒是發生陰血虛體質的危險因子；自覺壓力感受高是陽氣虛體質的危險因子；熬夜為痰濕瘀滯體質的危險因子；有手術史、有喜好口味是陰血虛及陽氣虛體質的共同危險因子。運動為陰血虛體質的保護因子，自評健康分數較高則為三種偏頗體質的共同保護因子。失眠易感性方面，142人（56.3%）為高失眠易感性組，有過去病史、熬夜、自覺壓力感受高為失眠易感性的危險因子。172位（68.3%）護理人員匹茲堡睡眠品質量表總得分超過5分，顯示睡眠品質不佳。自覺壓力感受高、自評健康分數低、分段式睡眠型態為影響匹茲堡睡眠品質量表總得分的正向關聯因子。
護理人員中高失眠易感性者相較低失眠易感性者，陰血虛體質的風險增加1.747倍（95% CI, 1.047-2.917），陽氣虛體質的風險增加2.850倍（95% CI, 1.691-4.802），痰濕瘀滯體質的風險增加2.244倍（95% CI, 1.343-3.750）。除習慣性睡眠效率(habitual sleep efficiency)得分與是否具陰血虛體質無顯著差異外；陰血虛、陽氣虛、痰濕瘀滯體質者，在匹茲堡睡眠品質量表總得分(The Pittsburgh Sleep Quality Index)與量表之七個面向(seven component)的得分，顯著高於非陰血虛、非陽氣虛、非痰濕瘀滯體質者。此外，睡眠干擾是陰血虛體質的正向關聯因子；匹茲堡睡眠品質量表總得分是陽氣虛與痰濕瘀滯體質的正向關聯因子；日間功能失調程度是陰血虛、陽氣虛及痰濕瘀滯體質的正向關聯因子。
結論與應用：
本研究結果提供護理人員中醫體質、失眠易感性與睡眠品質相關性的實證資料，可做為護理人員身心健康促進策略及研究的參考依據。
Purpose:
This study aimed to explore the current situation, influencing factors, and correlation between body constitution (BC) types of Traditional Chinese Medicine, vulnerability to stress-related insomnia, and sleep quality in nurses.
Methods:
A cross-sectional survey on 252 nurses was conducted at seven military hospitals in Taiwan. The participants were aged 20–45 years, and they have worked for more than half a year, were not pregnant, and did not get sick within 1 month. The demographic characteristics, working styles, and living behaviors of nurses were assessed using a structured questionnaire. The constitutions of Yin-Xu, Yang-Xu, and Stasis were measured using the Body Constitution Questionnaire. Vulnerability to stress-related insomnia was assessed using the Ford Insomnia Response to Stress Test. Data on quality of sleep were obtained using the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI). The Statistical Package for the Social Sciences software version 20.0 was used to perform descriptive and inferential statistics.
Results:
The number of the nurses’ BC classified as balance, Yin-Xu, Yang-Xu, and Stasis were 68 (27%), 154 (61.1%), 152 (60.4%), and 149 (59.1%), respectively. Intake of caffeine and alcohol was the risk factor of Yin-Xu. Meanwhile, a high perception of stress was the risk factor of Yang-Xu, and staying-up late was the risk factor of Stasis. Moreover, surgical history and preference for flavor were the risk factors of Yin-Xu and Yang-Xu. Engaging in regular exercise was the protective factor of Yin-Xu, and a high perception of health status was the protective factor of Yin-Xu, Yang-Xu, and Stasis. A total of 142 (56.3%) nurses were at a higher vulnerability to stress-related insomnia, and past medical history, staying-up late, and higher perception of stress were the risk factors associated with developing insomnia vulnerability. Moreover, the CPSQI scores of 172 (68.3%) nurses were more than 5, and this result indicated a poor sleep quality. Higher perception of stress, lower perception of health status, and segmented sleep patterns were associated with the CPSOI score.
Moreover, in nurses, higher vulnerability to stress-related insomnia were significantly associated with Yin-Xu (odds ration [OR] = 1.747, 95% confidence interval [CI]: 1.047–2.917), Yang-Xu (OR = 2.85, 95% CI: 1.691–4.802), and Stasis (OR = 2.244, 95% CI: 1.343–3.750). Except for the components of habitual sleep efficiency was not significantly associated with Yin-Xu, participants with Yin-Xu, Yang-Xu, or Stasis exhibited a significantly higher CPSQI score than the balance BC types. In addition, sleep disturbance was a factor of Yin-Xu, and the total CPSQI score was correlated to Yang-Xu and Stasis. Moreover, daytime dysfunction was associated with Yin-Xu, Yang-Xu, and Stasis.
Conclusion：
The result of this study established empirical evidence about the BC of the nurses and its correlation with insomnia vulnerability and sleep quality. In the future, such findings can be used when providing health promotion interventions and utilized as basis of other studies about nursing staff. |
