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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 陳佳慧(Chai-Hui Chen) | |
| dc.contributor.author | Pei-Yu Hao | en |
| dc.contributor.author | 郝培宇 | zh_TW |
| dc.date.accessioned | 2021-06-15T13:32:58Z | - |
| dc.date.available | 2021-02-26 | |
| dc.date.copyright | 2016-02-26 | |
| dc.date.issued | 2016 | |
| dc.date.submitted | 2016-02-02 | |
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/51401 | - |
| dc.description.abstract | 研究動機:
冠狀動脈繞道手術後的心房震顫(Postoperative Atrial Fibrillation; POAF)發生率約 30%，心房震顫發生容易導致缺血性中風，間接影響病人心臟手術的預後。本研究將探討 POAF 的發生和術後一年內缺血性中風之間的關聯性。 研究方法: 本研究是回溯性的病歷回顧研究，以病歷查核表收集台北某醫學中心 2012年 2 月至 2014 年 10 月間，由單一位主治醫師所執行的冠狀動脈繞道手術病人的基本資料、過去病史、POAF 與否、POAF 病程發展及術後一年內缺血性中風發生的情形。排除術前有心房震顫病史的病人，總收案人數為 195 人(男性163 人)，以年齡、eGFR、左心室射出功率(Left Ventricular Ejection Fraction)、術後升壓劑使用的劑量及呼吸器持續使用時間五個變項，觀察對 POAF 的預測度。再以羅吉斯迴歸分析 POAF 對中風風險的預測度為何。 研究結果 本研究病人平均年齡為 63.84±9.86 歲，男性佔 83.58%。POAF 的發生率為24.1%，好發時間為術後第一天，多在 24 小時內緩解，約 22%會復發。POAF病人有較高的住院中死亡率及中風率(8.5% VS 2.7%,p<0.01；6.4% VS 1.4%, p=0.057)。單變量分析結果發現 CHA2DS2-VASC分數對 POAF 有顯著的預測度(OR:1.32, p<0.01)。CHA2DS2-VASC分數及 POAF 對術後一年內的缺血性中風風險預測度並不佳(OR:1.37,p=0.16、OR:1.95, p=0.37)；而左心室射出功率對術後一年內的缺血性中風風險有顯著的預測度(OR:0.91, p<0.01)。 結論 對於冠狀動脈繞道手術術後的病人，POAF 及 CHA2DS2-VASC分數對術後一年的缺血性中風預測度均不佳，建議發展此族群適用的中風風險預測指標；本研究提出左心室射出功率對術後一年內的缺血性中風風險有顯著的預測度 (OR:0.911, p<0.01)。 | zh_TW |
| dc.description.provenance | Made available in DSpace on 2021-06-15T13:32:58Z (GMT). No. of bitstreams: 1 ntu-105-R99426002-1.pdf: 4282594 bytes, checksum: 965ac8828ba2d052c0fd380de9189280 (MD5) Previous issue date: 2016 | en |
| dc.description.tableofcontents | 中文摘要 I
英文摘要 II 誌謝 III 第一章 緒論 1 第一節 研究背景與重要性 1 第二節 研究目的 2 第三節 研究問題 2 第四節 名詞解釋 2 第二章 文獻查證 3 第一節 心房震顫的定義分類與心電圖的表現形態 3 第二節 心臟術後發生心房震顫(POSTOPERATIVE ATRIAL FIBRILLATION; POAF)的病理生理學 5 第三節 9 冠狀動脈繞道手術(CORONARY ARTERY BYPASS GRAFT; CABG)術後心房震顫(POSTOPERATIVE ATRIAL FIBRILLATION; POAF)的發生率及相關因子 9 第四節 POAF和缺血性中風的關聯 11 第五節 影響CABG術後發生POAF的因素 13 第三章 研究方法 16 第一節 研究架構 16 第二節 研究設計 16 第三節 研究對象及場所 17 第四節 研究工具 17 第五節 資料收集流程 18 第六節 研究倫理考量 18 第七節 資料處理及分析 19 第四章 研究結果 22 第一節 研究對象基本屬性和手術特性 22 第二節 POAF病程分析 27 第三節 POAF病人特性 30 第四節 冠狀動脈繞道手術術後一年內發生缺血性中風情形 34 第五節 POAF對術後一年發生缺血性中風的迴歸分析 41 第五章 討論 44 第一節 POAF的發生情形 44 第二節 POAF病人特性探討 45 第三節 POAF對術後一年內缺血性中風的影響 48 第四節 POAF族群中風率的探討 49 第六章 結論與建議 52 第一節 結論 52 第二節 研究限制與未來研究建議 54 參考資料 55 附錄 63 附錄一 臺大醫院倫理委員會通過函 63 附錄二 病歷查核表 65 | |
| dc.language.iso | zh-TW | |
| dc.subject | 缺血性中風 | zh_TW |
| dc.subject | 冠狀動脈繞道手術 | zh_TW |
| dc.subject | 缺血性中風 | zh_TW |
| dc.subject | 冠狀動脈繞道手術 | zh_TW |
| dc.subject | 心房震顫 | zh_TW |
| dc.subject | 心房震顫 | zh_TW |
| dc.subject | CABG | en |
| dc.subject | CABG | en |
| dc.subject | POAF | en |
| dc.subject | Ischemic stroke | en |
| dc.subject | POAF | en |
| dc.subject | Ischemic stroke | en |
| dc.title | 冠狀動脈繞道手術後心房震顫
與術後一年缺血性中風發生率之探討 | zh_TW |
| dc.title | Postoperative Atrial Fibrillation and One-year Ischemic Stroke Incidence in Patient Undergoing
Coronary Artery Bypass Grafting Surgery | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 104-1 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 許榮彬(Ron-Bin Hsu),劉言彬(Yen-Bin Liu) | |
| dc.subject.keyword | 冠狀動脈繞道手術,心房震顫,缺血性中風, | zh_TW |
| dc.subject.keyword | CABG,POAF,Ischemic stroke, | en |
| dc.relation.page | 69 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2016-02-02 | |
| dc.contributor.author-college | 醫學院 | zh_TW |
| dc.contributor.author-dept | 護理學研究所 | zh_TW |
| 顯示於系所單位： | 護理學系所 | |
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