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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 何?芳 | |
dc.contributor.author | Kun-Lin Hsieh | en |
dc.contributor.author | 謝坤霖 | zh_TW |
dc.date.accessioned | 2021-06-17T00:38:33Z | - |
dc.date.available | 2017-03-02 | |
dc.date.copyright | 2012-03-02 | |
dc.date.issued | 2012 | |
dc.date.submitted | 2012-01-31 | |
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How to prevent contrast-induced nephropathy and manage risk patients: practical recommendations. Kidney Int Suppl 2006;69:S51-3. 71. Maddox TG. Adverse reactions to contrast material: recognition, prevention, and treatment. Am Fam Physician 2002;66:1229-34. 72. Brady HR, Singer GG. Acute renal failure. Lancet 1995;346:1533-40. 73. Koda-Kimble MA YI, Alldredge BK, et al. Applied Therapeutics: The clinical Use of Drugs. 9 ed.: New York: Lippincott Williams & Wilkins; 2009. 74. Pharmacptherapy: a pathophysiologic approach. 7 ed: The McGrew-Hill Companies, Inc.; 2007. 75. Hayton WL. Maturation and growth of renal function: dosing renally cleared drugs in children. AAPS PharmSci 2000;2:E3. 76. Iribarren C, Tekawa IS, Sidney S, Friedman GD. Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men. N Engl J Med 1999;340:1773-80. 77. Phisitkul K, Hegazy K, Chuahirun T, et al. Continued smoking exacerbates but cessation ameliorates progression of early type 2 diabetic nephropathy. Am J Med Sci 2008;335:284-91. 78. Shoukat S, Gowani SA, Jafferani A, Dhakam SH. Contrast-induced nephropathy in patients undergoing percutaneous coronary intervention. Cardiol Res Pract 2010;2010. 79. Rosovsky MA, Rusinek H, Berenstein A, Basak S, Setton A, Nelson PK. High-dose administration of nonionic contrast media: a retrospective review. Radiology 1996;200:119-22. 80. Solomon R. Letter to the Editor—Solomon about Laskey Study. In. Am Heart J; 2010:159: e7. 81. Shin DH, Choi DJ, Youn TJ, et al. Comparison of contrast-induced nephrotoxicity of iodixanol and iopromide in patients with renal insufficiency undergoing coronary angiography. Am J Cardiol 2011;108:189-94. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/66486 | - |
dc.description.abstract | 研究背景
臨床使用含碘顯影劑已逾半世紀,常做為影像檢查中的造影劑。在1950至1980年,藥品研發人員朝著非離子、低滲透壓的方向研發出數十種的顯影劑,其使用已逐漸降低病人的過敏及副作用。然而,自1980年至今,顯影劑並無突破性的發展,顯影劑引發腎損傷的發生率一直無法降低;因此藉由研究其危險因子和給予適當的預防藥品就相對重要。 研究目的 研究做電腦斷層攝影時使用含碘顯影劑引發腎損傷的危險因子以及預防藥品的適當給法,以降低顯影劑引發腎損傷的發生率;此外,中央健康保險局自2011年2月開始針對電腦斷層與血管攝影的病人給付非離子性顯影劑,本研究亦嘗試探討此政策是否有助降低腎損傷發生率。 研究方法 本研究對象為2010年5月以及2011年5月於某醫學中心接受電腦斷層攝影的住院病人。利用病歷回顧的方式收集2010年5月的病人相關資料,包括病人的基本資料、疾病史、身體狀況、併用藥品、使用顯影劑的種類和劑量以及預防腎損傷的處方等,且紀錄在給予顯影劑後的14天內病人的腎功能變化;並藉以分析顯影劑引發腎損傷的危險因子。以獨立樣本T檢定、卡方檢定、多元邏輯式迴歸分析(multiple logistic regression)等統計檢定分析各腎損傷危險因子的影響程度及腎損傷預防處方的效果。另外,本研究亦納入2011年5月之住院病人電腦斷層攝影資料,並將其顯影劑引發腎損傷之發生率與2010年5月的資料相比較,了解健保給付新政策的影響。 研究結果 本研究共納入2010年5月間接受電腦斷層攝影檢測之464位住院病人資料,其中有242位(52.2%)在檢測前、後有追蹤serum creatinine(sCr);在這242位病人中,有35位(14.5%)病人於注射含碘顯影劑之後發生急性腎損傷(sCr increase ≥ 0.5mg/dL or increase ≥ 25%)。 研究2010年5月病人於檢測後追蹤腎功能的影響因子分析,研究顯示,針對年齡較長者、血紅素值低或貧血者、baseline sCr與baseline BUN值越高者、疾病診斷數較多者、鬱血性心衰竭患者、冠狀動脈疾病、併用metformin�利尿劑�鈣離子阻斷劑�或具腎毒性藥品,醫師較會追蹤電腦斷層攝影後之腎功能。 2010年5月的病人中,有51位(11.0%)病人使用N-acetylcysteine做為腎損傷預防性處方;有236位(50.9%)的病人使用pre-hydration做為腎損傷預防性處方。研究發現,年齡較長者、BMI較低者、baseline sCr與baseline BUN值高者、血紅素值低者、疾病診斷數較多者、入院前已有腎臟疾病、冠狀動脈疾病、高血壓、併用metformin�利尿劑�digoxin�或具腎毒性藥品,醫師較會開立預防腎損傷的處方。 在檢測前、後有追蹤sCr的病人中,有35位(14.5%)使用顯影劑發生腎損傷,研究發現,疾病診斷數≥ 6、入院前已有腎臟疾病或腎功能較差、鬱血性心衰竭、血紅素值9 g/dL、併用metformin�利尿劑�抗心律不整藥品�digoxin�或具腎毒性藥品的病人易發生腎損傷。多元迴歸分析顯示,其顯影劑引發的腎損傷與疾病診斷數、入院前已有腎臟疾病、baseline sCr ≥1.3 mg/dL者、血紅素值9 g/dL、有藥品過敏史、併用具腎毒性藥品有關。 本研究另納入2011年5月間接受電腦斷層攝影檢測之631位住院病人資料,其中有400位(63.4%)在檢測後有追蹤腎功能;在這400位病人中,有39位(9.8%)在注射含碘顯影劑之後發生腎損傷。腎損傷發生率從14.5%(2010年5月)降至9.8%(2011年5月),其差異在統計上有達到顯著。 結論 電腦斷層攝影主要的病人族群為50-79歲,這個年齡層的病人在心血管及腎臟疾病大都比年輕人多。因此,評估病人的危險因子,降低引發腎損傷的危險因素,選擇非離子性顯影劑,並給予適當的預防用藥,可以使顯影劑造成的腎損傷發生率下降。 目前國際上針對做電腦斷層攝影的病人做危險因子的研究較少,因此本研究除了可以建立臺灣族群的資料,也可以供為電腦斷層攝影的病人做為預防顯影劑引發腎損傷的參考,協助達到降低顯影劑引發腎損傷的機率、及降低醫療成本。 | zh_TW |
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dc.description.tableofcontents | 致謝
中文摘要 Abstract 表目錄 圖目錄 縮寫名詞對照表 第一章 前言 1 第二章 文獻探討 3 第一節 含碘顯影劑簡介 3 一、含碘顯影劑發展簡史 3 二、含碘顯影劑之分類與物化特性 9 三、含碘顯影劑與其他藥品的交互做用 12 第二節 顯影劑引發腎損傷(CIN)簡介 13 一、顯影劑引發腎損傷定義 13 二、顯影劑引發腎損傷流行病學 14 三、顯影劑引發腎損傷的病理生理學 16 四、顯影劑引發腎損傷的危險因子探討 17 五、等滲透壓顯影劑與低滲透壓顯影劑對腎損傷的比較 21 六、預防顯影劑引發腎損傷之方法 22 七、顯影劑引發腎損傷的之處置 28 第三節 非離子性顯影劑的健保給付規定演變 29 第三章 研究目的 30 第四章 研究方法 31 第一節 研究設計 31 第二節 研究對象 32 第三節 資料收集 33 第四節 研究名詞定義 34 第五節 研究流程 36 第六節 統計方法 38 第五章 研究結果 39 第一節 病人基本資料 39 第二節 電腦斷層攝影後影響腎功能追蹤的原因分析 43 第三節 腎損傷預防性處方開方因子分析 48 第四節 顯影劑引發腎損傷的預測因子分析 57 第五節 健保對非離子顯影劑給付政策改變對腎損傷發生率之影響 72 第六章 討論 74 第一節 研究對象之納入與排除條件設定 74 第二節 斷層攝影後影響腎功能追蹤的因素 75 第三節 使用預防腎損傷藥品的因素 77 第四節 造成顯影劑引發腎損傷的因素 78 第五節 顯影劑引發腎損傷因素之臨床考量與應用 84 第六節 預防顯影劑引發腎損傷藥品使用案例 86 第七節 對於含碘顯影劑用於電腦斷層攝影的臨床路徑建議 87 第八節 研究限制 89 第七章 結論 90 第八章 未來研究方向 92 參考文獻 93 附錄 98 Ⅰ 病人資料紀錄表 98 Ⅱ 電腦斷層攝影檢查說明暨同意書(2009, 10, 15修正) 103 Ⅲ 電腦斷層攝影檢查說明暨同意書(2011, 11, 15修正) 105 Ⅳ 病人/家屬病情與治療說明及指導紀錄(2009, 11, 18修正) 107 Ⅴ 顯影劑施打前評估危險流程(2009, 10, 30修正) 108 Ⅵ 影像醫學部門診治療照會單(2004, 12, 27修正) 109 | |
dc.language.iso | zh-TW | |
dc.title | 住院病人電腦斷層攝影含碘顯影劑腎臟傷害危險因子分析 | zh_TW |
dc.title | Risk Factors for Iodinated Contrast Medium-Induced Nephropathy among Inpatients Underwent Computerized Tomography | en |
dc.type | Thesis | |
dc.date.schoolyear | 100-1 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 陳世杰 | |
dc.contributor.oralexamcommittee | 許銘能,陳瓊雪 | |
dc.subject.keyword | 顯影劑,非離子性,腎損傷,電腦斷層攝影,臺灣, | zh_TW |
dc.subject.keyword | contrast media,non-ionic,contrast induced nephropathy,computerized tomography,Taiwan, | en |
dc.relation.page | 109 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2012-01-31 | |
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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檔案 | 大小 | 格式 | |
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ntu-101-1.pdf 目前未授權公開取用 | 5.23 MB | Adobe PDF |
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