臺灣博碩士論文加值系統

早期接受治療對於急性心肌梗塞病患是重要的，其包含穩定心肌以及改善預後。本研究旨在了解不同類型急性心肌梗塞病患延遲就醫相關因素，收案期間自2015年6月1日至2016年1月31日，收集臺北市某醫學中心登錄診斷碼（410.9）之病人，其依循症狀反應問卷並輔以病歷資料進行資料收集。研究資料以IBM SPSS 20.0 統計軟體進行資料分析：描述性統計將依循次數分佈、百分比、平均值以及標準差等；推論性統計則包含：獨立樣本t檢定、單因子變異數分析、Pearson相關積差分析等，其所獲得之分析結果（p < 0.05）將進入多元迴歸分析。
本研究共收集201位病患（平均年齡65.1歲，男性佔79.6%），其S-T段上升之心肌梗塞（STEMI）佔125位；非S-T段上升之心肌梗塞（NSTEMI）佔76位。從症狀開始到決定就醫時間，STEMI平均就醫時間為23.8小時（0.4~739.5）；NSTEMI為46.6小時（0.5~459.5）（p < 0.05）。延遲就醫相關因素中，若以罹患高血壓（p < 0.05）；症狀呈現為非典型胸悶（p < 0.05）以及無明顯之輻射痛（p < 0.01），其社會連結以及認知情緒部分則以家人或主要照顧者作為就醫之主要決策者（p 0.05）、自我未察覺不適為心臟問題者（p 0.01）、沒有意識到症狀的嚴重性（p < 0.001）以及疼痛指數低者（p < 0.001），皆為STEMI病患延遲就醫之相關可能因素。NSTEMI則以罹患糖尿病（p 0.05）、未罹患慢性阻塞性肺疾病（p < 0.01），以及自我未察覺為心臟問題（p 0.01）、擔心就醫後會發生的事（p < 0.05）以及症狀斷續發生（p < 0.05）等做為延遲就醫之相關因素。最後，進入多元迴歸預測分析，STEMI以高血壓、輻射痛、就醫決策者以及沒有意識到症狀的嚴重性；NSTEMI則以性別、自覺問題做為最終影響延遲就醫之相關預測因子。
盼藉以研究結果提供臨床護理師針對急性心肌梗塞延遲就醫病患之辨識敏感度，留心觀察病情變化之即刻性，並針對病患及其主要照顧者加強心血管疾病概念與症狀辨識能力，避免缺乏正確訊息而錯失治療的契機。

Early medical treatment is important for saving myocardium and improving prognosis in patients with AMI. In this study we aimed to sort out the factors associated with the delay in seeking treatment in patients with AMI. The demographic and relevant clinical data were recorded. Univariate analysis was first done. Those reaching P < 0.05 were then included in multiple regression analysis.
A total of 201 patients (mean age 65.1 years old, male 79.6%) were included. There were 125 patients with STEMI and 76 with NSTEMI. The time from symptom onset to medical treatment was 23.8 (0.4~739.5) h for STEMI and 46.6 (0.5~459.5) h for NSTEMI (P < 0.05). In univariate analysis, history of HTN (P < 0.05), absence of chest pain or tightness (P < 0.05), no typical radiation pain (P < 0.01), no awareness of the symptoms due to heart problems (P < 0.01), lower symptom severity (P < 0.001), lower pain score (P < 0.001), and families or care givers instead of the patient him/herself as the decision maker (P < 0.05) were associated with longer time to seeking treatment in patients with STEMI. For NSTEMI, DM (P < 0.05), absence of COPD (P < 0.01), no awareness of the symptoms due to heart problems (P < 0.01), concerns about the result of seeking medical help (P < 0.05), and fluctuations of the symptoms (P < 0.05) were associated. In multiple regression analysis, HTN, absence of radiation pain, low symptom severity, and families or care givers as the decision maker serve as independent factors for delay in seeking treatment. For NSTEMI, female gender and low symptom severity were independently associated.
In conclusion, multiple factors were significantly associated with the delay in seeking treatment. Patient and public education focusing on these factors should be launched in order to shorten the time of delay in these patients.

中文摘要 ……………………………………………………………………… i
英文摘要 ……………………………………………………………………… ii
目次 ……………………………………………………………………………iii
表次 …………………………………………………………………………… v
圖次 ……………………………………………………………………………vi
第一章 緒論
第一節 研究背景與動機 …………………………………………………… 1
第二節 研究目的與研究假設 ……………………………………………… 4
第三節 名詞界定 …………………………………………………………… 5
第二章 文獻探討
第一節 心肌梗塞 …………………………………………………………… 7
第二節 延遲就醫行為 ………………………………………………………12
第三節 影響延遲就醫相關因素 ……………………………………………16
第四節 延遲就醫與預後之影響 ……………………………………………20
第三章 研究方法
第一節 研究架構 ……………………………………………………………21
第二節 研究對象及設計 ……………………………………………………22
第三節 研究工具 ……………………………………………………………24
第四節 資料收集 ……………………………………………………………26
第五節 資料整理與統計分析 ………………………………………………28
第六節 研究倫理考量 ………………………………………………………29
第四章 研究結果
第一節 不同類型急性心肌梗塞病患基本特性與延遲就醫情形 …………30
第二節 不同類型急性心肌梗塞病患延遲就醫之相關因素探討 …………37
第三節 不同類型急性心肌梗塞病患延遲就醫預後之相關性 ……………47
第五章 討論
第一節 不同類型急性心肌梗塞病患基本特性與延遲就醫情形 …………50
第二節 不同類型急性心肌梗塞病患延遲就醫之相關因素探討 …………52
第三節 不同類型急性心肌梗塞病患延遲就醫預後之相關性 ……………55
第六章 結論與建議
第一節 結論 …………………………………………………………………56
第二節 護理上的應用 ………………………………………………………57
第三節 研究限制與建議 ……………………………………………………59
參考文獻
中文部分 ……………………………………………………………………60
英文部分 ……………………………………………………………………61
附件
附件一 症狀反應問卷授權書 ……………………………………………..68
附件二 病歷資料 …………………………………………………………..69
附件三 症狀反應問卷 ……………………………………………………..71

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