雖有許多的研究顯示精油的使用可能具有抗菌、鎮靜、幫助記憶等功效，但近年來使用精油所隱含之健康風險也越來越受到重視。研究顯示精油成分中含大量之揮發性有機物質 (VOCs)，且其中的萜烯類 (Terpenes)易與室內中臭氧等強氧化物質反應生成二次污染物，如甲醛與懸浮微粒等，皆為易導致健康危害之環境污染物。而芳療業者是常見的精油高暴露族群，其工作特性使其長時間並大量的接觸精油，且在密閉、通風不佳的室內工作環境易有污染物累積，進而加劇該族群可能之面臨健康風險。因此，本研究之主要目的為嘗試探討芳療從業人員之健康危害，以及芳療過程中精油產品的使用對於一般室內空氣品質之影響，尤其VOCs及其二次污染物的種類與逸散情況，並進一步了解影響該特定污染物濃度分布的可能因素為何。研究選定精油”高暴露”族群—芳療業者，首先於全國連鎖芳療業者進行代表性之問卷發放調查，以了解其員工之工作情形與健康狀況；進一步挑選代表性芳療職業場址，透過實地之環境暴露評估調查，探討芳療作業環境中VOCs與其二次污染物之種類與濃度分布情形，及對室內空氣品質之影響；此外，藉由在不同通風系統之建築室內環境調查，嘗試評估室內通風量對於芳療空間中污染物之移除效果，以作為該高風險職業族群之室內環境管理控制上的建議，減少可能的健康危害。
分析全國代表性健康問卷調查之數據時，利用多變項邏輯式迴歸分析，校正年齡、抽煙狀況、過敏情形、店址後，顯示暴露指標（工作資歷×平均每日服務人次×療程時間）較大之芳療師相較於較小者，有顯著較高的風險具有視力系統 (OR=3.09)、消化系統 (OR=3.00)與皮膚系統 (OR=2.98)等相關症狀之表現。進一步將芳療師的暴露指標大小依百分位 (percentile)分組進行趨勢檢定，顯示暴露指標越高者，具有視力系統、消化系統與皮膚系統相關症狀的風險值也顯著地隨之增加，尤其是該系統中特定之症狀，包含眼睛乾澀、上腹疼痛、皮膚容易發癢，皆呈現類似劑量效應之趨勢。
實地環境暴露評估結果顯示，在芳療師執行療程過程中，室內的總揮發有機物質 (TVOCs)與萜烯類 (Terpenes)之濃度確實顯著上升（療程前 vs. 療程過程平均值：TVOCs 505 vs. 659~781 ppb, Terpene 33~227 vs. 60~714 μg/m3 in C spa; TVOCs 209 vs. 245~251 ppb, Terpene 9~92 vs. 73~1727 μg/m3 in H spa）。且在低臭氧濃度的環境中 (16-22 ppb)，發現到粒徑小於100 nm之超細微粒濃度與甲醛的室內外比值有增加的趨勢。此外，本調查亦再次證實前期研究中所示，精油的確有抑制空氣細菌濃度的效果，但僅維持30分鐘。
本研究亦發現，在採用分離式冷氣系統之建築物內測得之各項污染物濃度均高於採用空氣調節箱 (AHU)系統之建物，且兩者污染物之間差距的相關性，可得一解釋力良好之關係式 (Y=2.643X-24.733，R2 = 0.785，p<0.001)，推測室內建築物特徵如空間體積之大小、新鮮外氣之引入量將近似等比例地影響污染物濃度累積的情形。
本研究發現特定之精油暴露族群-芳療師，其暴露指標較高者的確具有健康風險，尤其為視力、消化、皮膚系統部份；此外，本研究於實場環境內證實精油療程進行的過程中的確會貢獻於室內TVOCs與Terpene類濃度的增加，且在低臭氧的室內環境濃度下仍有二次污染物甲醛的濃度累積，以及超細微粒的產生及濃度增加。未來可進一步針對特定污染物進行暴露劑量效應關係之建立，及探討人體暴露、吸收、代謝、危害等機制並選取適當之通風系統並配合妥善的管理系統，以降低污染物的濃度，達到減低芳療師健康風險之目的。

Aromatherapy is a form of complementary medicine developed based on the historical experience of using essential oils, known to have anti-bacterial and sedative effects as well as maintaining work efficiency. While beneficial properties of using various essential oils have been claimed, few studies in literature have aimed to elucidate the potential health risks of essential oils. Studies have also shown that many volatile organic compounds from essential oils will react with various indoor oxidants to produce secondary pollutants like formaldehyde and ultra-fine particles; both are correlated with reporting adverse health effects. With a distinctive work pattern, the aromatherapists are exposed to high levels of various essential oils from work on a daily basis, and the often-small-in-size working environments with high air tightness are expected to result in accumulation of high VOCs concentrations emitted from the working materials which in turn tends to increase health risk of aromatherapists. This study therefore aimed to conduct an overall occupational health investigation on aromatherapy environments by using questionnaire survey and environmental measurements to (1) assess the potential health risk and the work pattern of aromatherapists, (2) assess other indoor air pollutants in workplace and their influence on levels of compounds emitted form essential oils, (3) compare the difference of pollutant removal rate between different ventilation systems.
The questionnaire survey data were analyzed by Multivariate Logistic Regress and adjusted for age, smoking, allergy history and store. For those aromatherapists with greater exposure index (working history×average number of customers served per day×average duration per therapy), a higher risk of reporting symptoms of eyesight system (OR=3.09), digestive system (OR=3.00) and skin system (OR=2.98) was found. Trend test showed that larger exposure index is likely to be associated with higher risk of reporting symptoms of eyesight, digestive and skin system, especially the dry eyes, the upper abdominal pain and the have an itch on skin.
The levels of TVOC and terpenes increased during the therapy time (Before therapy vs. therapy：TVOCs 505 vs. 659~781 ppb, Terpene 33~227 vs. 60~714 μg/m3 in C spa; TVOCs 209 vs. 245~251 ppb, Terpene 9~92 vs. 73~1727 μg/m3 in H spa). Even in the low ozone concentration environment (16-22 ppb), the levels of secondary products of terpenes/ozone reaction would also increase. The I/O ratio of formaldehyde and ultra-fine particles (diameter less than 100 nm) concentration increase during the therapy. Besides, this study verified that essential oils had an anti-bacteria effect, but the effect could only last for about 30 minutes.
The indoor air pollutant levels of the spa which had split air conditioner for ventilation were higher than the levels found in spa with AHU system, possibly due to its bringing in fresh air to dilute the indoor air pollutant levels. The space volumes of two spas were different by an average of about 4 times, and the pollutants levels appeared to correlate proportionately in an opposite direction.
In summary, this study has found that the aromatherapists with larger exposure index appeared to increase the health risk, especially in reporting eyesight and cardiovascular system problems. The levels of TVOC and terpenes rose during the therapy time. Even in the low ozone concentration environment (16-22 ppb), the levels of secondary products of terpenes/ozone reaction increase. The levels of indoor air pollutants were related to the ventilation volume. Future investigation should design to further analyze the dose-response relationship and human exposure, absorption, metabolism, and damage mechanisms.

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