醫院病房熱環境之舒適要求實測調查研究; A Field Survey on Thermal Requirements in Hospital Wards

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(1)中國醫藥大學碩士論文編號：DOSH-0108 醫院病房熱環境之舒適要求實測調查研究 A Field Survey on Thermal Requirements in Hospital Wards. 所別：職業安全與衛生學系碩士班指導教授：黃瑞隆. 博士. 學生：簡瑞宏 Chien, Jui-Hung 學號：9372008. 中. 華. 民. 國. 95. 年. 7. 月.

(2) 誌謝論文終於接近尾聲了，研究所生涯也將告一段落。本研究論文得以完成，首先當感謝指導老師黃瑞隆教授的悉心指導，從研究主題的選定、架構的建立、實驗的進行…等，均蒙黃老師諄諄教誨，亦使知識領域得以全面性的拓展。在論文審查的過程中，感謝口試委員鄭明仁教授、郭昭吟教授以及蘇崇輝教授的不吝指教，使得論文架構以及內容缺失得以補完。感謝賴俊雄教授、王文忻教授、廖宏章教授、趙克平教授、蔡詩偉教授、張大元教授、許文信教授、林文海教授以及陳強琛教授在課堂上的授業解惑，提升其他專業領域的學習視野。感謝研究室學妹聖慈、乃榕、嫻真、茹涵、婉珩、家蓁、家伃、譽文、宜紋、偉婷在研究上的支持與協助，亦感謝一同奮鬥的友校同學昭明的互相扶持與鼓勵。感謝辛勤育我養我的父母，在我感到挫折失意時給我溫暖、支持與鼓勵，迷惑時給我指引，讓我有繼續向前的動力及方向。也感謝默默支持我的女友珮君，在遇到難題時給予我幫助及扶持，文書處理上的長才實在助我良多。謹以本論文獻給所有幫助過我的人，並致上最高的敬意與謝意。簡瑞宏. i. 于中國醫藥大學 2006.07.13.

(3) 摘要近十年內，住院成長率超過五成，故舒適性的病房環境對住院病患日益重要。若病患處於舒適的熱環境中，對病情的恢復有正面的影響。為了解 ASHRAE Standard 55 是否適用於年齡、健康狀況以及居住行為不同於一般人的住院病患，本研究以中部某醫學中心 83 間內、外科病房的住院病患為對象，以現場實測和問卷調查同步進行的方式調查住院病患的熱舒適性。從 2005 年一月到六月之間，收集有效問卷 933 份，其中冬天 442 份，夏天 491 份。問卷中除了對病患的熱舒適進行評估，亦詢問病患的背景資料以及對病房環境特性的滿意度。實測結果發現因為溼度控制不當，大多數實測數據並未落在舒適區內，但仍有超過八成的受訪者對熱環境表示滿意。藉由機率迴歸分析發現住院病患的冬、夏兩季的中性溫度分別為 23 °C ET*和 24°C ET*，喜好溫度為 23.3°C ET*和 24°C ET*，舒適溫度範圍為 21.4°C ET*~25.2°C ET*，較 ASHRAE Standard 55 建議的舒適溫度範圍窄。卡方檢定的結果發現住院病患的健康狀況與其熱感覺相關，但年齡、住院天數以及原居住地都未達顯著水準。虛弱群不論是在中性溫度、喜好溫度或者舒適溫度範圍上都略高於健康群約 1°C ET*，與其他場所的研究相比則擴大到 1.4~2.5°C ET*之間，顯示住院病患想要有較暖和的熱舒適環境。. 關鍵字：熱舒適、住院病患、中性溫度、喜好溫度 ii.

(4) ABSTRACT In recent ten years, the ratio of hospitalization grows more than fifty percent. A comfortable environment of ward is more and more important. If an inpatient stays in a comfortable environment, it will make an active influence on recovering. This project examines the comfort criteria of ASHRAE Standard 55 for the application of inpatients. Field experiments used survey questionnaires and physical measurements were conducted in 83 medical and surgical wards of a medical center in Taichung. A total of 933 data were collected from January to June in 2005, and there were 442 data in winter and 491 data in summer. Field measurements show that most measured thermal environments don’t fall in comfort zone, due to inappropriate humidity control, but there are still more than eighty percent of subjects accept the thermal environment they occupied. According to the probit regressive analysis, the thermal neutral temperatures for inpatients in winter and summer occurred at 23℃ ET* and 24℃ ET* respectively, and thermal preferred temperatures occurred at 23.3℃and 24℃ ET*. The range of acceptable thermal comfort zones of inpatients is 21.4℃~25.2℃ ET*, which is narrower than that recommended by the ASHRAE Standard 55. The chi-square tests were applied to find the significant aspects that affect the inpatients’ thermal sensations. The results show that health status of inpatients has significant influence but the age, gender, and the time to be in hospital have no statistical significance. The weak group is a little higher by 1°C ET* then the healthy group. Comparing with the results of the experiments in other places, the range enlarges to 2°C ET*. The result shows that the inpatients want warmer thermal comfort conditions.. Keyword: thermal comfort, inpatient, neutral temperature, preferred temperature iii.

(5) 目錄第一章緒論 ················································································ 1 第一節研究動機與目的 ········································································1 第二節文獻剖析····················································································3 第三節研究內容與流程 ········································································7. 第二章研究方法······································································· 12 第一節研究對象 ·················································································12 第二節儀器設備··················································································15 第三節問卷內容··················································································25 第四節實驗步驟··················································································29 第五節分析方法··················································································30. 第三章問卷與物理測定結果彙整··········································· 34 第一節受訪者基本特性統計······························································34 第二節受訪者反應特性統計 ······························································41 第三節物理測定數據彙整 ··································································49. 第四章研究結果······································································· 56 第一節受訪者熱接受、熱喜好以及熱感覺的交叉分析···················56 第二節熱接受度··················································································60 第三節中性溫度··················································································63. iv.

(6) 第四節喜好溫度··················································································67 第五節熱舒適範圍 ··············································································71. 第五章檢定結果······································································· 74 第一節受訪者背景資料檢定 ······························································74 第二節病房背景資料檢定 ··································································82. 第六章討論 ·············································································· 91 第一節影響熱感覺的其他因子 ··························································91 第二節與其他文獻比較 ······································································96. 第七章結論 ·············································································· 99 參考文獻 ···················································································· 102. v.

(7) 表目錄表 2-1 ISO 7726 測量室內環境熱舒適參數所需儀器標準···················16 表 2-2 病患基本資料問卷········································································26 表 2-3 病房內熱舒適方面資料問卷························································27 表 2-4 病房內環境特性滿意度方面資料問卷 ········································28 表 2-5 穿衣量及身體狀況方面資料問卷 ················································28 表 3-1 受訪者熱感覺投票分佈································································42 表 3-2 受訪者熱喜好投票分佈································································43 表 3-3 受訪者熱接受投票分佈································································44 表 3-4 物理測定資料彙整········································································52 表 4-1 受訪者熱接受對熱喜好的交叉分析 ··············································56 表 4-2 受訪者熱接受對熱感覺的交叉分析 ··············································58 表 4-3 受訪者熱接受對熱感覺的交叉分析 ··············································59 表 4-4 冬天受訪者熱感覺中間值詢問統計表 ········································63 表 4-5 夏天受訪者熱感覺中間值詢問統計表 ········································64 表 4-6 冬天受訪者熱喜好詢問統計表 ····················································67 表 4-7 夏天受訪者熱喜好詢問統計表 ····················································68 表 5-1 受訪者性別之卡方檢定結果························································76 表 5-2 受訪者年齡之卡方檢定結果························································77. vi.

(8) 表 5-3 受訪者床位之卡方檢定結果························································78 表 5-4 受訪者居住地之卡方檢定結果 ····················································79 表 5-5 受訪者住院天數之卡方檢定結果 ················································80 表 5-6 受訪者健康狀況之卡方檢定結果 ················································81 表 5-7 受訪者噪音滿意度之卡方檢定結果 ············································83 表 5-8 受訪者照明滿意度之卡方檢定結果 ············································84 表 5-9 受訪者空氣品質滿意度之卡方檢定結果 ····································85 表 5-10 受訪者空間大小之卡方檢定結果 ·················································86 表 5-11 受訪者病床舒適度之卡方檢定結果 ··········································87 表 5-12. 受訪者醫護人員服務滿意度之卡方檢定結果 ··························88. 表 5-13. 受訪者空調狀況之卡方檢定結果 ··············································89. 表 6-1 受訪者年齡、健康度、住院天數以及居住地卡方檢定表 ········91 表 6-2 其他文獻比較表············································································97. vii.

(9) 圖目錄圖 1-1 研究流程 ·······················································································11 圖 2-1 病房樓層平面圖············································································14 圖 2-2 病房內基本配置平面圖··································································15 圖 2-3 Busch 在泰國所使用之儀器·························································18 圖 2-4 Kwok 在夏威夷所使用之儀器 ·····················································18 圖 2-5 Krzysztof 在澳洲所使用之儀器 ···················································19 圖 2-6 Wang 在哈爾濱進行實驗所用儀器··············································20 圖 2-7 現場測量用之室內氣候採擷系統 ··················································21 圖 2-8 PMV、PPD 與熱感尺度之關係示意圖 ·······································23 圖 2-9 實測調查的進行方式及住院病患的穿著狀況 ······························30 圖 3-1 受訪者人數與月份分佈································································35 圖 3-2 受訪者人數與星期分佈································································35 圖 3-3 受訪者樓層分佈············································································36 圖 3-4 受訪者病床分佈············································································37 圖 3-5 受訪者性別分佈············································································38 圖 3-6 受訪者年齡分佈············································································38 圖 3-7 受訪者居住地分佈········································································39 圖 3-8 受訪者住院天數分佈····································································39. viii.

(10) 圖 3-9 受訪者健康程度分佈····································································40 圖 3-10. 受訪者熱感覺投票分佈······························································41. 圖 3-11 受訪者熱喜好投票分佈 ······························································42 圖 3-12. 受訪者熱接受投票分佈······························································43. 圖 3-13. 受訪者氣流感覺投票分佈··························································44. 圖 3-14. 受訪者空氣溼度感覺投票分佈 ··················································45. 圖 3-15. 受訪者空氣品質感覺投票分佈 ··················································45. 圖 3-16. 受訪者噪音滿意度投票分佈······················································46. 圖 3-17. 受訪者照明滿意度投票分佈······················································46. 圖 3-18. 受訪者空氣品質滿意度投票分佈 ··············································47. 圖 3-19. 受訪者空間滿意度投票分佈······················································47. 圖 3-20. 受訪者病床滿意度投票分佈······················································48. 圖 3-21. 受訪者醫護人員服務滿意度分佈 ··············································48. 圖 3-22. 一月物理測定資料數據分佈······················································49. 圖 3-23. 二月物理測定資料數據分佈······················································50. 圖 3-24. 三月物理測定資料數據分佈······················································50. 圖 3-25. 四月物理測定資料數據分佈······················································51. 圖 3-26. 五月物理測定資料數據分佈······················································51. 圖 3-27. 六月物理測定資料數據分佈······················································52. ix.

(11) 圖 3-28 冬天物理測定結果········································································54 圖 3-29 夏天物理測定結果········································································54 圖 4-1 三種接受度評估比較····································································61 圖 4-2 冬天熱中性溫度迴歸圖································································66 圖 4-3 夏天熱中性溫度迴歸圖································································66 圖 4-4 冬天熱喜好溫度迴歸曲線圖··························································70 圖 4-5 夏天熱喜好溫度迴歸曲線圖··························································70 圖 4-6 全年溫度下限與 ASHRAE 建議溫度下限比較 ····························73 圖 4-7 全年溫度上限與 ASHRAE 建議溫度上限比較 ····························73 圖 5-1 受訪者性別分佈··············································································75 圖 5-2 受訪者年齡分布············································································77 圖 5-3 受訪者床位分布············································································78 圖 5-4 受訪者居住地分布········································································79 圖 5-5 受訪者住院天數分佈····································································80 圖 5-6 受訪者健康狀況分布····································································81 圖 5-7 受訪者噪音滿意度分布································································83 圖 5-8 受訪者照明滿意度分布································································84 圖 5-9 受訪者空氣品質滿意度分布························································85 圖 5-10. 受訪者空間大小滿意度分布······················································86. x.

(12) 圖 5-11 受訪者病床舒適滿意度分布 ······················································87 圖 5-12. 受訪者醫護人員服務滿意度分布 ··············································88. 圖 5-13. 受訪者空調狀況分布··································································89. 圖 6-1 冬天受訪者虛弱族群與健康族群中性溫度比較 ························93 圖 6-2 夏天受訪者虛弱族群與健康族群中性溫度比較 ························93 圖 6-3 冬天健康族群與虛弱族群喜好溫度比較 ····································95 圖 6-4 夏天健康族群與虛弱族群喜好溫度比較 ····································95. xi.

(13) 第一章緒論第一節研究動機與目的一九九六年至今，平均每半年住院成長率為百分之二點八，總成長率超過五成。現今的消費意識抬頭，民眾對於品質的要求提升，住院病患所重視的焦點除了醫護人員的醫療技術以外，也開始重視病房的環境品質，因此舒適性的病房環境對住院病患日益重要。若病患處於舒適的熱環境中，不但有助於安定病患的心情，對其病情的恢復絕對有正面的幫助。舒適是人的一種感覺，是人透過自己的感覺器官而獲得身體或精神上的愉悅感。廣義上的舒適，涉及氣象、醫學、生物、人文地理、心理學等諸方面。如果狹義地理解，舒適也可認為是人體與環境達到熱量的平衡。人體會透過平衡身體內部經由新陳代謝所產生的熱量和散失到外部環境的熱量，而與外界的熱環境相互作用。為了達到身體溫度的平衡，必須藉由傳導、對流、輻射以及蒸散等方式來獲得或是失去熱量。這些熱交換的機制被以下六個因子所影響：（1）乾球溫度（2）平均輻射溫度（3）相對溼度（4）空氣流動（5）活動量（6）衣著量。當人覺得熱不舒適時，就必須去改變其中一個或數個因子，以重新達到熱舒適的平衡。對於住院病患而言，因為醫療需要，其服裝要求必須方便脫穿，而以手術服為主，無法因應溫度的變化而任意增減衣物。而其在住院期間大多. 1.

(14) 躺在床上休養，活動量也大幅降低，無法藉由活動量來調節身體的溫度。而且住院病患因身體較為虛弱，代謝量降低，導致調節體溫的機能變差，生理上無法針對熱環境地變化快速做出反應。所以應充分了解其熱舒適性的需求，藉由適合病患的室內物理環境因子來維持熱交換的機制。在設計上，不同的場所因為用途不同，其使用者的年齡、性別以及主要活動也不同，因此對於熱舒適應有不同的要求，所以空調工程師必須充分了解各種場所使用者不同的熱舒適性要求。但多數的設計者還是（1）. 直接引用 ASHRAE Standard 55. 所推薦的熱舒適範圍作為設計的準則，. 作為辦公室、住宅以及教室空調的參考標準，而在病房的空調設計上也是採用同樣的標準。於 1992 年所提出的 ASHRAE Standard 55，主要是根據北美或歐洲的青壯年族群在實驗室的環境控制艙內的實驗結果所制定的。但其主要的實驗對象主要是以大學生為主，與主要以 40 歲以上較高齡族群為主的住院病患並不相同，而且住院病患的身體狀況也比大學生虛弱。而在目前的實測研究中，多數實測調查對象的年齡範圍在 18-64 歲之間，主要都以青壯年族群為主，調查的場所也以辦公室、教室以及住宅為限。一般辦公室、教室以及住宅的使用者，以來幾乎每天都只有白天或晚上會生活在這些環境裡，很少有一整天的居留，而且這樣的居住模式會持續很長的一段時間。可是住院病患除生病之外，幾乎不會住在病房內，大多沒有很長期的居留，且住院期間全天留在病房內，所以. 2.

(15) 他們的居住行為與其他辦公室、教室以及住宅的居住者並不相同。因此， ASHRAE Standard 55 所制定的推薦標準可否直接適用在明顯不同於調查對象的族群，仍然需要進行進一步的現場實測調查。本研究是要藉由實測研究與統計分析了解住院病患的熱舒適要求條件是否與一般人相同，確定病患對熱舒適的需求條件，找到病患的熱接受範圍、中性溫度與喜好溫度，並與 ASHRAE Standard 55 做比較以檢驗是否適合應用於病房環境。. 第二節文獻剖析建築物居住者的熱舒適研究方式可以分為兩種：（1）實驗室（2）現場調查。第一種方法最早是由 Fanger. （2）. 在 1970 年的時候提出的，其實驗. 的方法是在實驗室中架設一環境模擬艙以模擬欲檢測的環境。Fanger 是（3）. 以辦公室的環境為模擬的對象，ASHRAE Standard 55 以及 ISO 7730. 主要就是根據該方法的結果訂定的。這種方法的優點，在於研究者可以高度控制可影響熱感知的環境因子，而研究者也可以決定參數的相對影響。此外，藉由控制熱環境，研究者可以研究相同的受測者在不同季節的熱舒適狀況，這縮小了使用不同統計樣本所造成的資料誤差。而缺點是特殊環境以及控制所需的儀器設備以及技術人員都是十分昂貴的。而且，因為實驗對象必須要到實驗室進行實驗，對於一些無法到實驗室者（如病人、年老者等），該方法並不適用。 3.

(16) 近年來利用環境模擬艙的方式進行的研究包括 Fanger 在 1975 年. （4）. 調查一般大學生的喜好溫度以及 1977 年 5 調查冬泳選手和冷凍儲藏室中（）. （6）. 的肉類包裝者的喜好溫度；1979 年 Gonzalez. 在康乃狄克州長達五天的（7）. 熱浪中調查短時間的熱適應性；1990 年 Chung 和 Tong 位年輕中國人為對象調查氣候適應性；1991 年 De Dear. （8）. 在香港以 134. 在新加坡對大. （9）. 學生的喜好溫度進行調查； Fountain 在 1993 年. 對空氣流動跟熱舒適. （10）. 關係的研究以及 1994 年 Humphreys. （11）. 對短期居住行為的熱舒適調查；在 1994 年. 以馬來西亞人為對象，搭設實驗艙分別模擬馬來西亞以及（12）. 倫敦的氣候以了解其熱舒適；1995 年 Xu. 觀感受影響的調查；以及 2001 年徐筱琪. 對於高空氣濕度對舒適的主. （13）. 針對空調辦公室舒適度的調. 查等。第二種方法最常用於決定熱舒適狀況的研究上，實驗的方式是將現場實測與問卷調查結合。以較簡單、較便宜的儀器量測環境的變數，同時配合經過設計的問卷了解居住者對於室內環境的反應，問卷調查與現場實測是同時進行的。從問卷中得到的資料，與實測的結果相結合，可以更能了解整個環境狀況對於熱舒適的影響。這個方法的優點在於可以適應不同的工作及居住環境，反應不同受測對象對環境適應性的問題。不受限於實驗室，這種研究方式可以包含不同的建築型式、空調系統或居住者的影響，甚至也適用於一些無法到實驗室的受測對象。. 4.

(17) （14）. 近年來使用現場實測調查的研究包括 1991 年 De Dear. 調查了新加. （15）. 在 1992 年對泰. 坡自然通風的居住型大樓以及空調的辦公大樓；Busch. 國曼谷的辦公室環境進行的調查；1994 年 De Dear 以及 Fountain. （16）. 洲東北部的 Townsville 調查了使用空調的辦公大樓；1998 年 Kwok. 在澳. （17）. 在. （18）. 夏威夷對中學空調及自然通風教室進行調查；1998 年 Karyono. 在雅加. （19）. 達對辦公室大樓進行研究；1998 年 Daniel. 對香港的辦公室環境進行調. （20）. 查；2001 年 Kwok. 在拉斯維加斯地區針對老人院中年齡高於 65 歲的（21）. 老人進行的研究；2002 年 Wong. 在新加坡對中學學校 15 間自然通風（22）. 教室裡學生和老師的研究；2003 年 Kwok. 在日本對中學學校的空調以. 及自然通風教室進行的研究；以及 2004 年黃瑞隆. （23）. 對台灣大學空調以. 及自然通風教室進行的研究等。從這些文獻中可以發現其研究的對象主要都是以青壯年族群為主，而調查的環境大多都是辦公室或是教室，但對於不同於這些調查環境以及調查對象的族群－如醫院及住院病患－的調查結果仍然不足，近年來對醫院環境進行研究的文獻只有兩篇。1977 年 Smith. （24）. 對醫院病房區的. 病人熱舒適度進行調查，以了解病人熱舒適的最佳穩定情形。實驗的對象是針對一般空調外科病房的 209 個病人，男女比例約各佔一半，男性年齡在 12~78 歲之間，女性年齡在 10~79 歲之間。實驗方式採現場實測以及問卷調查同時進行的方式，物理測定的場所是在主要病房區，量測. 5.

(18) 了乾球溫度、黑球溫度、溼球溫度以及風速，架設的高度分別為 10 公分、 80 公分以及 160 公分，大約相當於地板、病床以及病患坐在床上時頭的高度。所得到的溫度在 21.5℃~22℃，相對溼度為 30％~70％，而輻射溫度測得的結果與氣溫差不多。但在此研究中只詢問了病人的 TSV 熱感覺，而並未詢問熱喜好以及熱接受度。對於病人的中性溫度、喜好溫度以及熱接受度範圍也缺乏調查，而是將受訪者分成（1）投寒冷、涼和微涼（2）微暖、暖和炎熱（3）寒冷和涼（4）炎熱和暖四個族群，然後分別作迴歸。此外，所測得的數據也未與 ASHRAE Standard 55 所建議的範圍做比較。 2005 年 Hashiguchi. （25）. 在日本福岡的一間醫院，對病人以及包括護. 士、護士助理的醫院員工進行熱環境和主觀反應的調查。實驗主要在冬天進行，採用的方式是現場實測與問卷調查同時進行，物理測定的主要場所是在病房、護理站以及走廊，架設的高度為 0.6 公尺以及 1.1 公尺。總共對 36 位病人以及 45 位員工進行問卷調查，研究的結果顯示病房內的平均溫度範圍為 20℃~23℃，有超過七成的病人覺得病房內的環境是舒適的，測得的相對溼度低於 40％，有過低的現象，所以多數的病人以及員工都有皮膚乾燥以及口渴的症狀。但是在本篇研究當中，並未探討病人的中性溫度、喜好溫度和熱接受範圍，對於病人的熱舒適只探討 TSV 熱感覺，沒有詢問熱接受度以及熱喜好，也缺少與 ASHRAE Standard 55. 6.