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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
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dc.contributor.advisor | 林珍芳(Zhen-Fang Lin) | |
dc.contributor.author | Yu-Wen Wang | en |
dc.contributor.author | 王昱文 | zh_TW |
dc.date.accessioned | 2021-06-15T12:39:29Z | - |
dc.date.available | 2026-12-31 | |
dc.date.copyright | 2016-08-26 | |
dc.date.issued | 2016 | |
dc.date.submitted | 2016-07-28 | |
dc.identifier.citation | 1. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology 2014;64:2246-80.
2. Nieuwlaat R, Capucci A, Camm AJ, et al. Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation. Eur Heart J 2005;26:2422-34. 3. Anter E, Callans DJ. Pharmacological and Electrical Conversion of Atrial Fibrillation to Sinus Rhythm Is Worth the Effort. Circulation 2009;120:1436-43. 4. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society 2014;130:2071-104. 5. Chen W-C, Chen W-C, Chen C-Y, et al. Amiodarone Use Is Associated With Increased Risk of Stroke in Patients With Nonvalvular Atrial Fibrillation: A Nationwide Population-Based Cohort Study. Medicine 2015;94:e849. 6. Falk RH. Rate Control Is Preferable to Rhythm Control in the Majority of Patients With Atrial Fibrillation. Circulation 2005;111:3141-50. 7. Olshansky B, Rosenfeld LE, Warner AL, et al. The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study: approaches to control rate in atrial fibrillation. J Am Coll Cardiol 2004;43:1201-8. 8. Hohnloser SH, Kuck KH. Randomized trial of rhythm or rate control in atrial fibrillation: the Pharmacological Intervention in Atrial Fibrillation Trial (PIAF). Eur Heart J 2001;22:801-2. 9. Qin D LG, Alam MB, Rattan R, Munir MB, Patel D, Khattak F, Adelstein E, Jain SK, Saba S. Mortality risk of long-term amiodarone therapy for atrial fibrillation patients without structural heart disease. Cardiol J 2015;22:622-9. 10. Gillis AM, Verma A, Talajic M, Nattel S, Dorian P. Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: Rate and Rhythm Management. Canadian Journal of Cardiology 2011;27:47-59. 11. Skanes AC, Healey JS, Cairns JA, et al. Focused 2012 Update of the Canadian Cardiovascular Society Atrial Fibrillation Guidelines: Recommendations for Stroke Prevention and Rate/Rhythm Control. Canadian Journal of Cardiology 2012;28:125-36. 12. Schotten U, Verheule S, Kirchhof P, Goette A. Pathophysiological Mechanisms of Atrial Fibrillation: A Translational Appraisal. Physiological Reviews 2011;91:265-325. 13. Sanoski CA BJ. The Arrhythmias. Pharmacotherapy: A Pathophysiologic Approach, 9th ed: New York: McGraw-Hill; 2014:207-44. 14. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 2014;129:837-47. 15. Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006;114:e257-354. 16. Chien K-L, Su T-C, Hsu H-C, et al. Atrial fibrillation prevalence, incidence and risk of stroke and all-cause death among Chinese. International Journal of Cardiology 2010;139:173-80. 17. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014;130:2071-104. 18. Calkins H, Brugada J, Packer DL, et al. HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Heart Rhythm 2007;4:816-61. 19. Hsieh F-I, Lien L-M, Chen S-T, et al. Get With The Guidelines-Stroke Performance Indicators: Surveillance of Stroke Care in the Taiwan Stroke Registry. Get With The Guidelines-Stroke in Taiwan 2010;122:1116-23. 20. Lin L-J, Cheng M-H, Lee C-H, Wung D-C, Cheng C-L, Kao Yang Y-H. Compliance with antithrombotic prescribing guidelines for patients with atrial fibrillation—A nationwide descriptive study in Taiwan. Clinical therapeutics 2008;30:1726-36. 21. Chao T-F, Liu C-J, Wang K-L, et al. Using the CHA2DS2-VASc Score for Refining Stroke Risk Stratification in ‘Low-Risk’ Asian Patients With Atrial Fibrillation. Journal of the American College of Cardiology 2014;64:1658-65. 22. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology 2013;62:e147-e239. 23. Chang S-S, Chang K-C, Wang Y-C, et al. Digoxin use is associated with increased risk of stroke in patients with non-valvular atrial fibrillation — a nationwide population-based cohort study. International Journal of Cardiology 2013;169:e26-e7. 24. Chirinos JA, Castrellon A, Zambrano JP, et al. Digoxin use is associated with increased platelet and endothelial cell activation in patients with nonvalvular atrial fibrillation. Heart Rhythm 2005;2:525-9. 25. Snow V, Weiss KB, LeFevre M, et al. Management of Newly Detected Atrial Fibrillation: A Clinical Practice Guideline from the American Academy of Family Physicians and the American College of Physicians. Annals of Internal Medicine 2003;139:1009-17. 26. Williams EMV. Classifying Antiarrhythmic Actions: By Facts or Speculation. The Journal of Clinical Pharmacology 1992;32:964-77. 27. Singla S, Karam P, Deshmukh AJ, Mehta J, Paydak H. Review of contemporary antiarrhythmic drug therapy for maintenance of sinus rhythm in atrial fibrillation. Journal of cardiovascular pharmacology and therapeutics 2012;17:12-20. 28. Su VY, Hu YW, Chou KT, et al. Amiodarone and the risk of cancer: a nationwide population-based study. Cancer 2013;119:1699-705. 29. Le Heuzey JY, De Ferrari GM, Radzik D, Santini M, Zhu J, Davy JM. A short-term, randomized, double-blind, parallel-group study to evaluate the efficacy and safety of dronedarone versus amiodarone in patients with persistent atrial fibrillation: the DIONYSOS study. Journal of cardiovascular electrophysiology 2010;21:597-605. 30. Connolly SJ, Camm AJ, Halperin JL, et al. Dronedarone in high-risk permanent atrial fibrillation. N Engl J Med 2011;365:2268-76. 31. Kober L, Torp-Pedersen C, McMurray JJ, et al. Increased mortality after dronedarone therapy for severe heart failure. N Engl J Med 2008;358:2678-87. 32. Khan AR, Khan S, Sheikh MA, Khuder S, Grubb B, Moukarbel GV. Catheter ablation and antiarrhythmic drug therapy as first- or second-line therapy in the management of atrial fibrillation: systematic review and meta-analysis. Circulation Arrhythmia and electrophysiology 2014;7:853-60. 33. Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm 2012;9:632-96.e21. 34. Lutomsky BA, Rostock T, Koops A, et al. Catheter ablation of paroxysmal atrial fibrillation improves cardiac function: a prospective study on the impact of atrial fibrillation ablation on left ventricular function assessed by magnetic resonance imaging. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2008;10:593-9. 35. Lee R, Jivan A, Kruse J, et al. Late Neurologic Events After Surgery for Atrial Fibrillation: Rare but Relevant. The Annals of Thoracic Surgery 2013;95:126-32. 36. Kawaguchi AT, Kosakai Y, Sasako Y, Eishi K, Nakano K, Kawashima Y. Risks and Benefits of Combined Maze Procedure for Atrial Fibrillation Associated With Organic Heart Disease1. Journal of the American College of Cardiology 1996;28:985-90. 37. Pet M, Robertson JO, Bailey M, et al. The impact of CHADS2 score on late stroke after the Cox maze procedure. The Journal of Thoracic and Cardiovascular Surgery 2013;146:85-9. 38. Curtis AB, Worley SJ, Adamson PB, et al. Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J Med 2013;368:1585-93. 39. Maisel WH. Left Atrial Appendage Occlusion — Closure or Just the Beginning? N Engl J Med 2009;360:2601-3. 40. Reddy VY, Sievert H, Halperin J, et al. Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial. Jama 2014;312:1988-98. 41. Holmes DR, Jr., Doshi SK, Kar S, et al. Left Atrial Appendage Closure as an Alternative to Warfarin for Stroke Prevention in Atrial Fibrillation: A Patient-Level Meta-Analysis. J Am Coll Cardiol 2015;65:2614-23. 42. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Archives of internal medicine 1994;154:1449-57. 43. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-51. 44. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011;365:883-91. 45. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011;365:981-92. 46. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2013;369:2093-104. 47. Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825-33. 48. Van Gelder IC, Hagens VE, Bosker HA, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 2002;347:1834-40. 49. Corley SD EA, DiMarco JP, Domanski MJ, Geller N, Greene HL, Josephson RA, Kellen JC, Klein RC, Krahn AD, Mickel M, Mitchell LB, Nelson JD, Rosenberg Y, Schron E, Shemanski L, Waldo AL, Wyse DG. Relationships Between Sinus Rhythm, Treatment, and Survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. Circulation 2004;109:1509-13. 50. Lafuente C, Valembois L, Bergmann JF, Belmin J. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev 2015:CD005049. 51. Echt DS, Liebson PR, Mitchell LB, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. N Engl J Med 1991;324:781-8. 52. Podrid PJ, Anderson JL. Safety and tolerability of long-term propafenone therapy for supraventricular tachyarrhythmias. The Propafenone Multicenter Study Group. Am J Cardiol 1996;78:430-4. 53. Roy D, Talajic M, Dorian P, et al. Amiodarone to prevent recurrence of atrial fibrillation. Canadian Trial of Atrial Fibrillation Investigators. N Engl J Med 2000;342:913-20. 54. Hohnloser SH, Crijns HJ, van Eickels M, et al. Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med 2009;360:668-78. 55. Piccini JP, Hasselblad V, Peterson ED, Washam JB, Califf RM, Kong DF. Comparative efficacy of dronedarone and amiodarone for the maintenance of sinus rhythm in patients with atrial fibrillation. J Am Coll Cardiol 2009;54:1089-95. 56. Berger M, Schweitzer P. Timing of thromboembolic events after electrical cardioversion of atrial fibrillation or flutter: a retrospective analysis. Am J Cardiol 1998;82:1545-7, A8. 57. Nagarakanti R, Ezekowitz MD, Oldgren J, et al. Dabigatran versus warfarin in patients with atrial fibrillation: an analysis of patients undergoing cardioversion. Circulation 2011;123:131-6. 58. Gentile F, Elhendy A, Khandheria BK, et al. Safety of electrical cardioversion in patients with atrial fibrillation. Mayo Clin Proc 2002;77:897-904. 59. Flaker G, Lopes RD, Hylek E, et al. Amiodarone, anticoagulation, and clinical events in patients with atrial fibrillation: insights from the ARISTOTLE trial. J Am Coll Cardiol 2014;64:1541-50. 60. Qin D, Leef G, Alam MB, et al. Comparative effectiveness of antiarrhythmic drugs for rhythm control of atrial fibrillation. J Cardiol 2016;67:471-6. 61. Lee C-H, Liu P-Y, Tsai L-M, et al. Characteristics of Hospitalized Patients with Atrial Fibrillation in Taiwan: A Nationwide Observation. The American Journal of Medicine 2007;120:819.e1-.e7. 62. Chiang C-E, Zhang S, Tse HF, Teo WS, Omar R, Sriratanasathavorn C. Atrial fibrillation management in Asia: From the Asian expert forum on atrial fibrillation. International Journal of Cardiology 2013;164:21-32. 63. Wang K-L, Wu C-H, Huang C-C, et al. Complexity of atrial fibrillation patients and management in Chinese ethnicity in routine daily practice: Insights from the RealiseAF Taiwanese cohort. Journal of Cardiology 2014;64:211-7. 64. Roy D, Talajic M, Dorian P, et al. Amiodarone to Prevent Recurrence of Atrial Fibrillation. N Engl J Med 2000;342:913-20. 65. Micromedex® 2.0. Truven Health Analytics, Greenwood Village, Colorado, USA. (Accessed Jun 14 2016, at http://www.micromedexsolutions.com/.) 66. Nademanee K HJ, Cannom DS, Goldreyer BN, Singh BN. Control of refractory life-threatening ventricular tachyarrhythmias by amiodarone. Am Heart J 1981;101:759-68. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/50407 | - |
dc.description.abstract | 研究背景:
心房顫動是造成缺血性中風的一個顯著危險因子,而心律控制(rhythm control)藥物可以改善心房顫動病人的症狀,然而過去針對心律控制藥物的研究多為比較其矯正心律的能力,但直接比較不同心律控制藥物對於心房顫動(AF: atrial fibrillation)病人在後續發生中風風險的差異尚未有充分的探究。 研究目的: 針對沒有結構性心臟病的新診斷心房顫動病人,使用不同種類心律控制藥物對於後續發生中風的風險是否有顯著不同。 研究方法: 本研究為回溯性世代研究(retrospective cohort study),以2005-2011年的臺灣健康保險資料庫做為資料來源,篩選新診斷且沒有結構性心臟病的心房顫動病人。根據病人在心房顫動診斷後第一次使用之心律控制藥物分組,並挑選出使用amiodarone以及propafenone的病人做為主要研究族群。同時為了減少選擇性偏差,也利用傾向分數(propensity score)進行比較組間的配對,建構類似隨機分派對照實驗(randomized controlled trial),最後以Cox proportional hazards regression model進行中風風險之分析。 研究結果 台灣在非結構性心臟病的新診斷AF病人中,最常使用的口服心律控制藥物為amiodarone,使用amiodarone的病人相較於使用propafenone的病人,有統計上顯著較高發生中風事件的風險。(HR =1.19; 95% CI:1.01 - 1.41; P=0.0435)。同時也發現在未併用口服抗凝血劑的次族群中有統計上顯著的差異(HR = 1.28; 95% CI:1.03-1.58; P=0.0245)。此外也發現在30天 (HR =2.28; 95% CI:1.33-3.918; p-value=0.0027)、60天 (60-day period : HR= 2.267; 95% CI:1.415-3.633; p-value=0.007)、90天 (90-day period : HR=2.385; 95% CI: 1.577-3.607; p-value<0.0001)與180天 (180-day period : HR=2.116; 95% CI:1.515-2.957; p-value<0.0001) 的追蹤期間內,皆有統計上顯著較高的中風發生風險。 結論 本研究發現對於沒有結構性心臟病的心房顫動病人,使用amiodarone相較於使用propafenone有較高的中風發生風險。在未併用口服抗凝血劑的心房顫動病人以及用藥後短期內,又有更加顯著的差異。 | zh_TW |
dc.description.abstract | Background
Atrial fibrillation (AF) is a significant risk factor for ischemic stroke. Rhythm control is an important treatment strategy which can significantly improve patients’ symptoms. However, the comparative effectiveness of rhythm control agents of risk of stroke in patients with AF remains unknown. Purpose To evaluate the comparative effectiveness of rhythm control agents on risk of stroke in patients with AF. Methods This study is a retrospective cohort study based on National Health Insurance Research Database (NHIRD) from 2005 to 2011. Newly diagnosed AF withoutstructural heart disease patients are included and grouped by type of rhythm control agent first prescribed following AF. To reduce selection bias, a propensity score matching approach was used to create matched cohorts similar to randomized controlled trial. Patients used amiodarone and propafenone are the main population this study focus on. Cox proportional hazards regression model was performed to estimate the risk of stroke in patients with AF. Results Among all the rhythm control agents, amiodarone remains the most frequently prescribed drug in Taiwan. After comparing amiodarone with propafenone, the application of amiodarone holds higher risk of stroke events in AF patients (HR=1.189; 95% CI: 1.005 - 1.406; P=0.0435). This result is similar in the subgroup which patients were not prescribed with oral anticoagulants (HR=1.276; 95% CI: 1.032 - 1.579; P=0.0245). Also, our results implied that there may have a higher risk which amiodarone were used to restore sinus rhythm in 30, 60, 90 and 180 days of follow up time period. Conclusion AF patients without structural heart disease who applied propafenone seems to have a lower risk on the occurrence of stroke events compared with patients used amiodarone. This effect was more significant in short-term period after amiodarone were used. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T12:39:29Z (GMT). No. of bitstreams: 1 ntu-105-R03451002-1.pdf: 2712065 bytes, checksum: 62345be7e1382b88b33a2054a2b26238 (MD5) Previous issue date: 2016 | en |
dc.description.tableofcontents | 目錄
口試委員會審定書 I 誌謝 II 中文摘要 III ABSTRACT V 目錄 VII 圖目錄 XIII 表目錄 XIV 第一章 前言 1 第二章 疾病簡介 2 2.1 流行病學 2 2.2 病理機轉 2 2.3 診斷及分類 3 2.4 危險因子 3 2.5 併發症 4 第三章 心房顫動之治療 5 3.1 心速控制 5 3.1.1 乙型受體阻斷劑 (β-blockers) 5 3.1.2 非DHP型鈣離子通道阻斷劑 (non-DHP CCBs) 6 3.1.3 毛地黃 (digoxin) 6 3.2 心律控制 7 3.2.1 藥品概論 7 3.3 非藥物治療 8 3.3.1 直流電極復律術 (direct-current cardioversion; DCC) 8 3.3.2 經導管燒灼術 (catheter ablation) 8 3.3.3 迷宮手術 (Maze procedures) 9 3.3.4 心臟節律器 (pacemaker) 9 3.4 中風與栓塞之預防 10 3.4.1 非藥物治療 10 3.4.1.1左心耳封堵手術 (left atrial appendage closure; LAAC) 10 3.4.2 藥物治療 10 第四章 文獻回顧 12 4.1心律控制 (RHYTHM CONTROL) 與心速控制 (RATE CONTROL) 12 4.2心律控制藥物間之比較 12 4.3心律控制藥物與中風的關係 14 第五章 研究目的 17 5.1 研究動機 17 5.2 研究重要性 17 第六章 研究方法 18 6.1 研究設計 18 6.2 資料來源 18 6.3 研究對象 19 6.3.1 納入條件 19 6.3.2 排除條件 19 6.4 基本資料 20 6.4.1 分組依據 20 6.4.2 研究期間 20 6.4.3 研究終點 20 6.4.4 共病症 20 6.4.5 併用藥品 21 6.4.6 CHA2DS2-VASc score 21 6.5 資料分析 22 6.5.1 整體心房顫動病人之心律控制藥物開方分析 22 6.6 統計分析 22 6.6.1 各研究分組之背景資料分析 22 6.6.2 傾向分數配對(propensity score matching) 22 6.6.3 回歸分析 23 6.6.4 敏感性分析 (sensitivity analysis) 23 6.6.5 顯著差異 24 6.6.6 研究流程圖 24 第七章 結果 25 7.1 心律控制藥物開方現況 25 7.2主要族群分析 25 7.2.1 族群基本特性 25 7.2.2 利用傾向分數(propensity score)配對後之結果及其分析 26 7.2.3 不同心律控制藥品與中風間之關係 26 7.3 次族群分析 27 7.3.1 次族群分析—65歲以下之病人 27 7.3.1.1 族群特性 27 7.3.1.2 利用傾向分數(propensity score)配對後之結果及其分析 27 7.3.1.3 不同心律控制藥品與中風間之關係 27 7.3.2 次族群分析—65至75歲之病人 28 7.3.2.1 族群特性 28 7.3.2.2 利用傾向分數(propensity score)配對後之結果及其分析 28 7.3.2.3 不同心律控制藥品與中風間之關係 28 7.3.3 次族群分析—75歲以上之病人 29 7.3.3.1 族群特性 29 7.3.3.2 利用傾向分數(propensity score)配對後之結果及其分析 29 7.3.3.3 不同心律控制藥品與中風間之關係 29 7.3.4 次族群分析—男性族群之病人 30 7.3.4.1 族群特性 30 7.3.4.2 利用傾向分數(propensity score)配對後之結果及其分析 30 7.3.4.3 不同心律控制藥品與中風間之關係 30 7.3.5 次族群分析—女性族群之病人 31 7.3.5.1 族群特性 31 7.3.5.2 利用傾向分數(propensity score)配對後之結果及其分析 31 7.3.5.3 不同心律控制藥品與中風間之關係 31 7.3.6 次族群分析—低風險族群之病人 (CHA2DS2-VASc score=0-1) 32 7.3.6.1 族群特性 32 7.3.6.2 利用傾向分數(propensity score)配對後之結果及其分析 32 7.3.6.3 不同心律控制藥品與中風間之關係 32 7.3.7 次族群分析—高風險族群之病人 (CHA2DS2-VASc score≥2) 32 7.3.7.1 族群特性 32 7.3.7.2 利用傾向分數(propensity score)配對後之結果及其分析 33 7.3.7.3 不同心律控制藥品與中風間之關係 33 7.3.8 次族群分析—併用口服抗凝血劑族群之病人 33 7.3.8.1 族群特性 33 7.3.8.2 利用傾向分數(propensity score)配對後之結果及其分析 34 7.3.8.3 不同心律控制藥品與中風間之關係 34 7.3.9 次族群分析—未併用口服抗凝血劑族群之病人 34 7.3.9.1 族群特性 34 7.3.9.2 利用傾向分數(propensity score)配對後之結果及其分析 34 7.3.9.3 不同心律控制藥品與中風間之關係 35 7.3.10 次族群分析—併用心速控制藥品族群之病人 35 7.3.10.1族群特性 35 7.3.10.2 利用傾向分數(propensity score)配對後之結果及其分析 35 7.3.10.3 不同心律控制藥品與中風間之關係 35 7.3.11 次族群分析—未併用心速控制藥品族群之病人 36 7.3.11.1族群特性 36 7.3.10.2 利用傾向分數(propensity score)配對後之結果及其分析 36 7.3.10.3 不同心律控制藥品與中風間之關係 36 7.4 敏感性分析 37 7.4.1 更改藥品暴露定義與分組 37 7.4.1.1 族群特性 37 7.4.1.2 利用傾向分數(propensity score)配對後之結果及其分析 37 7.4.1.3 不同心律控制藥品與中風間之關係 37 7.4.2 更改追蹤期間定義 38 7.4.2.1 不同心律控制藥品在固定追蹤時間內與中風間之關係 38 7.5 森林圖 (FOREST PLOT) 38 第八章 討論 39 8.1 台灣地區整體心房顫動病人特性 39 8.2心律控制藥物在非結構性心臟病的心房顫動病人發生中風風險討論 40 8.3 研究限制 41 8.4 研究優點 42 第九章 結論及未來方向 43 參考文獻 98 附錄 105 | |
dc.language.iso | zh-TW | |
dc.title | 心房顫動病人之心律控制藥物治療與中風風險之探討 | zh_TW |
dc.title | Rhythm Control Therapy and Risk of Stroke in Patients with Atrial Fibrillation:
A Nationwide Retrospective Cohort Study in Taiwan | en |
dc.type | Thesis | |
dc.date.schoolyear | 104-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 何?芳(Yunn-Fang Ho),王繼娟(Chi-Chuan Wang) | |
dc.subject.keyword | 心房顫動,心律控制,amiodarone,propafenone,中風, | zh_TW |
dc.subject.keyword | atrial fibrillation,rhythm control,amiodarone,propafenone,stroke, | en |
dc.relation.page | 107 | |
dc.identifier.doi | 10.6342/NTU201601537 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2016-07-28 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床藥學研究所 | zh_TW |
顯示於系所單位: | 臨床藥學研究所 |
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