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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 張淑惠(Shu-Hui Chang) | |
| dc.contributor.author | Keng-Chu Ko | en |
| dc.contributor.author | 柯畊竹 | zh_TW |
| dc.date.accessioned | 2021-05-13T08:41:13Z | - |
| dc.date.available | 2021-01-01 | |
| dc.date.available | 2021-05-13T08:41:13Z | - |
| dc.date.copyright | 2017-09-14 | |
| dc.date.issued | 2016 | |
| dc.date.submitted | 2017-08-14 | |
| dc.identifier.citation | 1. Yang Li. Acute Kidney Injury in Asia. Kidney Dis. 2, 95–102 (2016).
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Nephrol. 2, 623–630 (2007). 30. nhi. 94年度第6次「全民健康保險醫療給付協議會議」會議紀錄. 94年度第6次「全民健康保險醫療給付協議會議」會議紀錄 31. Ricci, Z. et al. Practice patterns in the management of acute renal failure in the critically ill patient: An international survey. Nephrol. Dial. Transplant. 21, 690–696 (2006). 32. Uchino, S. The epidemiology of acute renal failure in the world. Curr. Opin. Crit. Care 12, 538–543 (2006). 33. Kim, S. H., Seo, B. S. &Koh, S. O. Renal Replacement Therapies on the Outcomes of Acute Renal Failure Patients in ICU. Korean J. Anesthesiol. 46, 593 (2004). 34. Iwagami, M. et al. Choice of renal replacement therapy modality in intensive care units: Data from a Japanese Nationwide Administrative Claim Database. J. Crit. Care 30, 381–385 (2015). 35. Thongprayoon, C., Cheungpasitporn, W. &Ahmed, A. H. Trends in the use of renal replacement therapy modality in intensive care unit: a 7 year study. Ren. Fail. 37, 1444–7 (2015). 36. John, S. et al. Effects of continuous haemofiltration vs intermittent haemodialysis on systemic haemodynamics and splanchnic regional perfusion in septic shock patients: a prospective, randomized clinical trial. Nephrol Dial Transpl. 16, 320–327 (2001). 37. Mehta, R. L. et al. A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int. 60, 1154–1163 (2001). 38. Gasparović, V., Filipović-Grcić, I., Merkler, M. &Pisl, Z. Continuous renal replacement therapy (CRRT) or intermittent hemodialysis (IHD)--what is the procedure of choice in critically ill patients? Ren. Fail. 25, 855–862 (2003). 39. Augustine, J. J., Sandy, D., Seifert, T. H. &Paganini, E. P. A randomized controlled trial comparing intermittent with continuous dialysis in patients with ARF. Am. J. Kidney Dis. 44, 1000–1007 (2004). 40. Uehlinger, D. E. et al. Comparison of continuous and intermittent renal replacement therapy for acute renal failure. Nephrol. Dial. Transplant. 20, 1630–1637 (2005). 41. Bagshaw, S. M., Berthiaume, L. R., Delaney, A. &Bellomo, R. Continuous versus intermittent renal replacement therapy for critically ill patients with acute kidney injury: a meta-analysis. Crit. Care Med. 36, 610–617 (2008). 42. Schefold, J. C. et al. The effect of continuous versus intermittent renal replacement therapy on the outcome of critically ill patients with acute renal failure (CONVINT): a prospective randomized controlled trial. Crit. Care 18, R11 (2014). 43. Wald, R. et al. The Association Between Renal Replacement Therapy Modality and Long-Term Outcomes Among Critically Ill Adults With Acute Kidney Injury: A Retrospective Cohort Study. Crit. Care Med. 42, 1–10 (2013). 44. Nash, D. M., Przech, S., Wald, R. &O’Reilly, D. Systematic review and meta-analysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit. J. Crit. Care 41, 138–144 (2017). 45. Pérez-Fernández, X. et al. Clinical variables associated with poor outcome from sepsis-associated acute kidney injury and the relationship with timing of initiation of renal replacement therapy. J. Crit. Care 40, 154–160 (2017). 46. Bellomo, R. et al. Acute kidney injury in sepsis. Intensive Care Medicine 43, 816–828 (2017). 47. Bellomo, R., Wan, L. &May, C. Vasoactive drugs and acute kidney injury. Crit. Care Med. 36, S179–S186 (2008). 48. Chou, C.-Y. et al. Norepinephrine and hospital mortality in critically ill patients undergoing continuous renal replacement therapy. Artif. Organs 35, E11-7 (2011). 49. Russell, J. A. et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N. Engl. J. Med. 358, 877–87 (2008). 50. Schwarze, M. L. et al. Development of a list of high-risk operations for patients 65 years and older. JAMA Surg 150, 325–331 (2015). 51. Chen, Y. S. et al. Preliminary result of an algorithm to select proper ventricular assist devices for high-risk patients with extracorporeal membrane oxygenation support. J. Hear. Lung Transplant. 20, 850–857 (2001). 52. WHO. WHOCC - Definition and general considerations. WHO Collaborating Centre for Drug Statistics Methodology (WHOCC) 2014, (2009). | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/4049 | - |
| dc.description.abstract | 背景與研究目的
連續性腎臟替代療法是加護病房中針對急性腎損傷病患重要的治療工具，本研究目的在藉由健保資料庫資料了解加護病房連續性腎臟替代療法的本土性流行病學資料及其存活特性。 研究方法 利用2005-2013年間的健保資料庫資料，探討加護病房中連續性性腎臟替代療法的使用情況與病患特性，以住院死亡及28天死亡為主要結果，入院時間至死亡為存活時間，若出院未死亡或超過28天未死亡則視為設限;並利用Cox比例風險模式 (Cox proportional hazards models) 進行單變項分析及多變項分析，並利用共享脆弱模式 (shared frailty model) 調整未知因素之影響，探討連續性腎臟替代療法對於加護病房病患預後的影響、不同模式的連續性腎臟替代療法對於加護病房病患預後的比較以及升壓劑對於加護病房病患及連續性腎臟替代療法病患預後的影響。 結果 在2005-2013年間，全國執行連續性腎臟替代療法的次數在2005-2010年間有顯著增加，之後維持大致相同的趨勢，各縣市間的執行率則有顯著差異。 連續性腎臟替代療法和加護病房患者的死亡風險增加有關，經調整干擾因子後，住院死亡風險比為1.367 (95%信賴區間: 1.347-1.387)。升壓劑使用上，每日每增加10 defined daily doses (DDD) 的升壓劑使用，住院死亡風險比為1.002 (95%信賴區間: 1.001-1.004)。而升壓劑使用的種類由一種到四種以上，其住院死亡風險比分別為4.754 (95%信賴區間: 4.694-4.814)、14.189 (95%信賴區間: 14.020-14.361)、21.222 (95%信賴區間: 20.959-21.488) 和21.847 (95%信賴區間: 21.450-22.252)。 在連續性腎臟替代療法的族群中，continuous veno-venous hemofiltration (CVVH) 和continuous veno-venous hemodialysis (CCVVHD)為主要模式，此二模式的住院死亡風險差異並不顯著 (CVVH vs. CVVHD 風險比: 0.970，95%信賴區間: 0.937-1.003)。每日每增加10 DDD的升壓劑使用，其住院死亡風險比為1.002 (95%信賴區間: 1.001-1.004)。由一種升壓劑到四種以上升壓劑使用，其死亡風險比分別為3.608 (95%信賴區間: 3.114-4.181)、6.372 (95%信賴區間: 5.538-7.331)、8.280 (95%信賴區間: 7.203-9.518) 和8.022 (95%信賴區間6.966-9.238)。 結論： 連續性腎臟替代療法的執行隨地區別有所不同。在所有加護病房的患者中，有接受連續性腎臟替代療法的病患有較高的死亡風險。CVVH及CVVHD在住院死亡風險上並沒有顯著差異。而升壓劑的種類在所有加護病房病患及有接受連續性腎臟替代療法的病患中，其對死亡風險的影響較升壓劑總量來的大。 | zh_TW |
| dc.description.abstract | Background and purposes
Continuous renal replacement therapy (CRRT) is an important tool for treatment of acute kidney injury in intensive care units (ICU) .The aim of the study is to explore epidemiologic characteristics of CRRT and its impact of the inpatient survival outcomes in Taiwan. Methods We analyzed data extracted from national health insurance research database (NHIRD) from 2005-2013 to investigate demographic data and outcomes of ICU patients. The primary endpoints were in-hospital mortality; and the corresponding censoring events were defined as survival to discharge or survival of the 28th day or discharge. The observed survival time was then from admission to either the primary endpoint or censoring. The impacts of CRRT on the mortality of ICU patients and the effects of vasoactive agents on ICU patients receiving CRRT were studied using the Cox proportional hazard models in the univariable and multivariable analyses. Results The incidence of CRRT increased from 2005 to 2010 and kept at a stable level from then on. The incidences of practice were quite different between different counties. CRRT was associated with a higher in-hospital mortality of ICU patients. The adjusted hazard ratio (aHR) of CRRT and non-CRRT group was 1.367 (95% CI: 1.347-1.387). In all ICU patients, every 10 defined daily doses (DDD) increase of daily vasoactive agent usage was associated with aHR of 1.002 (95%CI: 1.001-1.004). The risk of in-hospital mortality increased as the number of the types of applied vasoactive agents increased. From one type of vasoactive agents to 4 types, the aHRs were 4.754 (95%CI: 4.694-4.814) , 14.189 (95%CI: 14.020-14.361), 21.222 (95%CI: 20.959-21.488), and 21.847 (95%CI: 21.450-22.252), respectively. For patients receiving CRRT, there is no significant difference between CVVH and CVVHD groups (CVVH vs. CVVHD, aHR: 0.970, 95%CI: 0.937-1.003). Every 10 DDD increase of daily vasoactive agent usage was associated with a higher risk of in-hospital mortality (aHR=1.002,(95%CI: 1.001-1.004). The risk of in-hospital mortality also increased as kinds of vasoactive agents for treatment increased. From 1 kind of vasoactive agents to 4 kinds, aHRs were 3.608 (95%CI: 3.114-4.181), 6.372 (95%CI: 5.538-7.331), 8.280 (95%CI: 7.203-9.518), and 8.022 (95%CI: 6.966-9.238), respectively. Conclusion The incidence of CRRT usage was different between counties. In all ICU patients, those who received CRRT had a higher risk of in-hospital mortality. The number of types of vasoactive agents had a strong effect on the risk of in-hospital mortality than the total dosage of vasoactive agents for all ICU patients and CRRT patients. | en |
| dc.description.provenance | Made available in DSpace on 2021-05-13T08:41:13Z (GMT). No. of bitstreams: 1 ntu-105-R00847026-1.pdf: 2587095 bytes, checksum: 3352a662c3fd6c1a90e45820be73ab46 (MD5) Previous issue date: 2016 | en |
| dc.description.tableofcontents | 誌謝 i
中文摘要 ii Abstract iv 目錄 1 表目錄 4 圖目錄 5 第一章 導論 6 1-1實習單位簡介 6 1-2 研究動機與問題 6 1-2-1 研究動機 6 1-2-2 研究目的 9 第二章 文獻回顧 10 2-1 加護病房中的急性腎損傷與腎臟替代療法 10 2-2連續性腎臟替代療法 12 2-3不同時間點的連續性腎臟替代療法執行狀況 13 2-4 連續性腎臟替代療法和間歇性血液透析(Intermittent Hemodialysis)的比較 15 2-5 影響連續性腎臟替代療法預後的因素 17 2-6 升壓劑對連續性腎臟替代療法預後的影響 19 第三章 研究方法 21 3-1研究對象與倫理問題 21 3-1-1 研究對象 21 3-1-2 研究倫理 21 3-2資料處理 21 3-2-1 資料來源 21 3-2-2資料處理流程 23 3-3 統計方法 25 第四章 研究結果與分析 27 4-1 基本資料分析 27 4-1-1 加護病房中接受CRRT病患及沒有接受CRRT病患的特性比較 27 4-1-2 接受連續性腎臟替代療法的患者中，接受CVVH 和CVVHD 患者特性比較 28 4-2 地區和年份別連續性腎臟替代療法執行率 29 4-2-1 地區別的連續性腎臟替代療法執行率 29 4-2-2 年份別的連續性腎臟替代療法執行率 29 4-3 存活結果 30 4-4單變項Cox存活分析結果 31 4-4-1所有加護病房族群的粗風險比(crude hazard ratio) 31 4-4-2 連續性腎臟替代療法族群的粗風險比 32 4-5 多變項Cox存活分析結果 35 4-5-1 所有加護病房病患分析結果 35 4-5-2 所有加護病房患者納入脆弱變數的多變項存活分析 36 4-5-3 接受連續性腎臟替代療法患者的分析 39 4-5-4 納入脆弱變數於連續性腎臟替代療法的族群 40 4-6個別升壓劑使用的多變項Cox分析 41 4-6-1所有族群的個別升壓劑多變項分析 41 4-6-2連續性腎臟替代療法族群的個別升壓劑多變項分析 41 第五章 討論 42 5-1 研究結果討論 42 5-1-1 連續性腎臟替代療法的敘述性流行病學 42 5-1-2 連續性腎臟替代療法的預後 43 5-1-3 不同腎臟替代療法模式對於連續性腎臟替代療法預後的影響 43 5-1-4 連續性腎臟替代療法和間歇性血液透析比值的涵義 44 5-1-5 升壓劑和連續性腎臟替代療法的關係 45 5-1-6 其他和連續性腎臟替代療法預後有關的因素 46 5-2 研究優勢與限制 47 5-2-1 研究優勢 47 5-2-2 研究限制 48 5-3 未來研究展望 50 參考資料 76 附件1. 健保資料庫擷取資料代碼表 80 附件2. 篩選Charlson Coborbidity Index 的診斷代碼 81 附件3. 重大手術清單 83 附件4. 市售升壓劑藥品碼及建議每日劑量(Defined Daily Dose,DDD) 87 附件5. 縣市別的Random Effect 結果 89 附件6. 未納入存活分析族群的特性 90 | |
| dc.language.iso | zh-TW | |
| dc.subject | 共享脆弱模式 | zh_TW |
| dc.subject | 全民健保資料庫 | zh_TW |
| dc.subject | 連續性腎臟替代療法 | zh_TW |
| dc.subject | 加護病房 | zh_TW |
| dc.subject | 升壓劑 | zh_TW |
| dc.subject | 存活分析 | zh_TW |
| dc.subject | Shared frailty model | en |
| dc.subject | Vasoactive agents | en |
| dc.subject | Survival analysis | en |
| dc.subject | National Health Insurance Research Database | en |
| dc.subject | Continuous renal replacement therapy | en |
| dc.subject | Intensive care units | en |
| dc.title | 運用全民健康保險資料庫進行連續性腎臟替代療法的預後研究 | zh_TW |
| dc.title | Analysis of Outcomes of Continuous Renal Replacement Therapy Using Taiwan National Health Insurance Research Database | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 105-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 簡國龍(Kuo-Liong Chien),邱炳芳(Ping-Fang Chiu) | |
| dc.subject.keyword | 全民健保資料庫,連續性腎臟替代療法,加護病房,升壓劑,存活分析,共享脆弱模式, | zh_TW |
| dc.subject.keyword | National Health Insurance Research Database,Continuous renal replacement therapy,Intensive care units,Vasoactive agents,Survival analysis,Shared frailty model, | en |
| dc.relation.page | 90 | |
| dc.identifier.doi | 10.6342/NTU201702923 | |
| dc.rights.note | 同意授權(全球公開) | |
| dc.date.accepted | 2017-08-14 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 公共衛生碩士學位學程 | zh_TW |
| 顯示於系所單位： | 公共衛生碩士學位學程 | |
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| ntu-105-1.pdf | 2.53 MB | Adobe PDF | 檢視/開啟 |
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