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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 陳佳慧 | zh_TW |
dc.contributor.advisor | Chia-Hui Chen | en |
dc.contributor.author | 楊雅貞 | zh_TW |
dc.contributor.author | Yea-Jen Yang | en |
dc.date.accessioned | 2021-06-17T08:23:04Z | - |
dc.date.available | 2023-11-22 | - |
dc.date.copyright | 2019-08-27 | - |
dc.date.issued | 2019 | - |
dc.date.submitted | 2002-01-01 | - |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/74177 | - |
dc.description.abstract | 研究動機
心臟植入式電子裝置(Cardiovascular Implantable Electronic Device, CIED)術後併發的囊袋感染與心內膜炎,皆會影響病患心臟疾病的預後,甚至死亡。本研究描述單一醫學中心五年內CIED術後感染的發生率和CIED感染的相關因素。 研究方法 本研究為病歷回溯性研究,以病歷查核方式連續收案五年(2010年1月至2014年12月)在台北某醫學中心接受CIED手術的1890位患者。以描述性統計、獨立樣本檢定,及卡方檢定比較CIED感染組與未感染組,並依據感染發生的時間分為早期感染(<30天)、晚期感染(1-12個月),與延遲感染(>12個月),比較早期、晚期,與延遲感染的差異並分析感染相關因素。 研究結果 根據1686位有效樣本,52.8%為男性,年齡約74 ± 17歲,70.8%為首次植入手術,術後3.2%有囊袋血腫,2.8%有早期再手術,平均追蹤3.2 ± 1.7年CIED感染發生率為2.4%,92.7%為局部囊袋感染,高手術量組(n > 200)的感染發生率較低(1.8%)。感染時間分布,以延遲感染最多,佔16人(39%)、晚期感染15人(36.6%),早期感染10人(24.4%)。 CIED感染的相關因素,比較感染組(n = 41)與未感染組(n = 1645),感染組較年輕(71 ± 21 vs. 74 ± 17, p = 0.03),男性較多(68.3 % vs. 52.4%, p = 0.04),12.2%有CIED感染病史(p < 0.01),12.2%有活動性癌症(p < 0.01),較高比例為第二次以上手術(46.3% vs. 28.8%, p = 0.01),平均手術次數較多(2.4 ± 1.9 vs. 1.4 ± 0.6, p < 0.01),術後有22%出現囊袋血腫(p < 0.01),及19.5%接受早期再介入治療(P < 0.01)。比較早期、晚期,與延遲感染組的差異,早期感染組除了體重過重(Body Mass Index, BMI:26.8 ± 7, p = 0.01)外,有50%病患有術後囊袋血腫(p = 0.03),並有50%病患接受過早期再介入治療(p < 0.01)。感染個案分析發現29.4%(n = 12)患者有局部囊袋的皮膚問題,其中有2/3(n = 8)為延遲感染組患者,12.2%(n = 5)患者體內有感染源存在,19.6%(n = 8)有術後囊袋血腫,而有22%(n = 9)接受過早期或再次手術。 結論 CIED感染的發生率2.4%,高於國際平均的感染發生率1.3%。建議應及早確認感染相關危險因素、減少非必要的CIED手術、預防囊袋血腫發生及系統性感染,並積極處理皮膚問題,以降低感染發生率。 | zh_TW |
dc.description.abstract | Background: Cardiovascular Implantable Electronic Device (CIED) related pocket infection and endocarditis affect patients’ prognosis and even caused death. This study described the incidence of 5-year CIED infection and to explore the risk factors and symptom presentation of CIED infection at a single medical center in Northern Taiwan.
Methods: A retrospective study using medical chart reviews included 1890 consecutive patients who underwent CIED surgery from January 2010 to December 2014 at a medical center in Taipei. Descriptive and bivariate statistics were used to describe and compare the differences between infected and non-infected groups. The CIED infection was further stratified by time of infection occurred: early-infection (< 30 days of surgery), late-infection (1-12 months), and delayed-infection (>12 months). Risk factors and symptom presentation were also explored by comparing these three stratified infected groups. Results: In total, 1686 qualified subjects were included in this study with 52.8% were males. With a median age of 74 ± 17 years, 70.8% of subjects were first implants, 3.2% had pocket hematoma after operation, and 2.8% had early re-intervention. With the average follow-up years of 3.2 ± 1.7, the CIED infection incidence was 2.4%. Among those, 92.7% had local pocket infections. Stratified by surgeons’ operation volume, incidences varied with only 1.8% in the high-volume (>200 surgeries performed) group. Stratified by time of infection occurred, 39% (n=16) had delayed infection, 36.6% (n=15) had late infection, and 24.4% (n=10) had early infection. Comparing the infected (n=41) and non-infected (n=1645) groups, the infected group was younger, (median age 71 ± 21 vs. 74 ± 17 years for non-infected; p = 0.03), had more males (68.3 % vs. 52.4%; p = 0.04) and higher rates of comorbidities (i.e., 12.2% had a history of CIED infection, and 12.2% had active cancer). They were also more likely to have reoperation (46.3% vs. 28.8%; p = 0.01), received more operations (2.4 ± 1.9 vs. 1.4 ± 0.6 operations; p < 0.01), experienced a high rate of pocket hematoma (22%; p < 0.01), and up to 19.5% (n = 8) had received early re-intervention (p < 0.01). Stratified by time of infection occurred, the early-infected group was more likely be overweight (Body Mass Index, BMI: 26.8 ± 7, p = 0.01), more highly to have pocket hematoma (50%; p = 0.03), and more likely to receive early re-intervention (50%; p < 0.01). As to the presentation of infection, 19.5%(n=8)had pocket hematoma and 29.4% (n=12)had local skin problems with two-third of these subjects (n=8) were in the delay-infected group. On the other end, 12.2% had identifiable infective source in the body. As to the clinical intervention, 22%(n=9)received re-intervention. Conclusion: The incidence of CIED infection in this study was 2.4%, which is higher than the international benchmark of 1.3%. To reduce the incidence of CIED infection, risk factors should be further identified; unnecessary CIED procedures should be avoided; pocket hematoma, systemic infection, and local skin problems should be actively managed. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T08:23:04Z (GMT). No. of bitstreams: 1 ntu-108-R02426014-1.pdf: 2223318 bytes, checksum: a78b3bc7e9da2e223b84640da21fe9fe (MD5) Previous issue date: 2019 | en |
dc.description.tableofcontents | 口試委員會審定書……………………………………………………………………..1
中文摘要………………………………………………………………………………..2 英文摘要………………………………………………………………………………..4 第一章 緒論 第一節 研究背景與重要性………………………………………………………9 第二節 研究目的…………………………………………………………...……10 第三節 研究問題……………………………………………………………...…10 第四節 名詞解釋……………………………………………………………...…10 第二章 文獻查證 第一節CIED感染之診斷……………………………………………………......11 第二節CIED感染之處置……………..................................................................13 第三節CIED感染之相關危險因素……………………………………….….....14 第三章 研究方法 第一節 研究架構…………………………………………………………….…..27 第二節 研究設計………………………………………………………….……..28 第三節 研究場所及對象………………………………………………….……..28 第四節 研究工具…………………………………………………………….…..29 第五節 資料收集流程……………………………………………………….…..32 第六節 研究倫理考量……………………………………………………….…..33 第七節 資料處理與分析…………………………………………………….…..33 第四章 研究結果 第一節 CIED手術病患之特性…………………………….………….………...35 第二節 CIED感染組與未感染組之特性………………….………………..…..38 第三節 CIED手術操作者之手術量與感染發生率………….……………..…..42 第四節 CIED感染組依感染時間分組之特性…………………………….…..43 第五節 CIED感染組之病程分析………………………………………….…..52 第六節 CIED感染組之個案分析………………………………………….…..63 第五章 討論 第一節 CIED感染的發生情形………………………………………………...73 第二節 CIED感染相關危險因素…….………………………………………..76 第六章 結論與建議 第一節 結論………………………………………………………………...…..81 第二節 研究限制與未來研究建議………………………………………...…..83 參考文獻………………………………………………...……………………………84 圖 目 錄 圖一 研究架構………………………………………………………………………..27 圖二 收案流程圖……………………………………………………………………..32 圖三 CIED感染的細菌培養結果長條圖………………………………………..…..58 表 目 錄 表一 病患基本資料之病歷查核表……………………………....…………………..29 表二 病患基本屬性與手術特性之病歷查核表……………………………………..30 表三 CIED感染患者病程之病歷查核表……………..……………………………..31 表四 描述性統計的變項、測量尺度,及描述分析………………………………..34 表五 CIED手術病患之特性……………………………………………………..…..36 表六 CIED感染組與未感染組之特性比較……………………………………..…..39 表七 CIED手術操作者之手術量與感染發生率………………………………..…..42 表八 CIED感染發生的時間……………………..…………………………………..43 表九 CIED感染組依感染時間分組之特性比較………………………………..…..44 表十 CIED早期感染組之感染特徵……..………………….……………………….47 表十一 CIED晚期感染組之感染特徵……..………………………………………..48 表十二 CIED延遲感染組之感染特徵……..…………………………………… ….50 表十三 CIED感染的類型…………………………..………………………………..52 表十四 CIED感染的局部臨床症狀表現…………………………..………………..53 表十五 CIED感染的系統性臨床症狀表現……………………………………..…..55 表十六 CIED感染的局部傷口細菌培養結果………………………..……………..57 表十七 CIED感染的血液細菌培養結果………………..…………………………..57 表十八 CIED感染的處置與復發……………………..……………………………..60 表十九 CIED感染的追蹤結果…………………………………………..…………..61 表二十 CIED感染的死亡病患分析……………………..…………………………..62 表二十一 CIED感染組的個案相關感染因素分析………………………………....64 表二十二 CIED早期感染組之感染過程描述及相關因素分析 …………………..65 表二十三 CIED晚期感染組之感染過程描述及相關因素分析………..…………..67 表二十四 CIED延遲感染組之感染過程描述及相關因素分析………………..…..70 | - |
dc.language.iso | zh_TW | - |
dc.title | 心臟植入式電子裝置感染之相關危險因素探討-以北部某醫學中心為例 | zh_TW |
dc.title | Risk Factors Associated with Cardiovascular Implantable Electronic Device Infection: The Review in a Medical Center in Northern Taiwan | en |
dc.type | Thesis | - |
dc.date.schoolyear | 107-2 | - |
dc.description.degree | 碩士 | - |
dc.contributor.oralexamcommittee | 盛望徽;劉言彬 | zh_TW |
dc.contributor.oralexamcommittee | Wang-Huei Sheng;Yen-Bin Liu | en |
dc.subject.keyword | 心臟植入式電子裝置,感染,危險因素, | zh_TW |
dc.subject.keyword | Cardiovascular implantable electronic device (CIED),infection,risk factor, | en |
dc.relation.page | 96 | - |
dc.identifier.doi | 10.6342/NTU201903063 | - |
dc.rights.note | 未授權 | - |
dc.date.accepted | 2019-08-14 | - |
dc.contributor.author-college | 醫學院 | - |
dc.contributor.author-dept | 護理學研究所 | - |
顯示於系所單位: | 護理學系所 |
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