臺灣博碩士論文加值系統

背景：腦中風自1972年起皆占台灣十大死因前三位，尤其年輕型腦中風更占所有中風族群的13.72%，三年內再次中風的發生比例高達27.3%。持續的治療與危險因子的控制應可以預防腦中風復發，然國內外文獻針對年輕中風型病患就醫持續性及危險因子的控制與中風復發相關性研究仍顯不足。
目的：探討年輕型腦中風病患就醫持續性及危險因子的控制與中風復發之相關性。
方法：本研究採次級資料分析法，為回溯性世代研究，以國家衛生研究院「全民健康保險資料庫」隨機抽樣百萬歸人檔為資料來源，分別篩選出西元2005、2006及2007年間，百萬承保檔資料中的住院及門診檔，初次腦中風(ICD-9：430-438)，且年齡為15-45歲之病患，持續追蹤三年，並計算出其就醫持續性指標(Continuity of care, COC)數值。採用SAS 9.2軟體，進行描述性統計及羅吉斯迴歸模式(Logistic regression)分析。以羅吉斯式迴歸模式控制病患性別、危險因子、中風類型及住院天數，來估計年輕型腦中風病患不同的就醫持續性與復發間之勝算。
結果：從健保資料庫的研究結果顯示「就醫持續性」高並無法有效預防年輕型腦中風的復發，然而是否患有高血壓、高血脂、糖尿病者，才是影響復發的重要關鍵，如何預防及有效控制慢性病的危險因子才是預防年輕型中風復發的重要因素。
結論與實務應用：雖然就醫持續性高，未能有效預防年輕型腦中風復發，然而年輕型腦中風病患伴有高血壓、高血脂或糖尿病者與復發間有重要相關，因此慢性病的疾病控制品質相關資訊應該納入健保資料庫中，以利未來進一步了解國內預防年輕型腦中風復發的重要因素，可以作為醫療團隊提供適切預防與治療之參考。

Background: The mortality of stroke is the top three in Taiwan since 1972. The proportion of young stroke is 13.72%, and the proportion of recurrent stroke occurs up to 30%. Continued treatment and control can prevent stroke recurrence. It is lack of research regarding the relationship between continuity of care and recurrence in young stroke patients.
Objective: To explore the correlations of continuity of care, risk factors of young stroke, and recurrent stroke in Taiwanese young stroke patients.
Method: This study is a secondary analysis, and retrospective longitudinal cohort study. "National Health Insurance database" is the analysis source. Data was analyzed using SAS 9.2 statistical software. Descriptive statistic and logistic regression analyses were conducted. The controlled variables included gender, risk factors, stroke type and length of hospital stay. Samples were selected from the NHI database between 2005-2010 years BC and first stroke (ICD-9: 430-438). Moreover, the age of the patients was 15-45 years old. Continuity of care (COC) index was used to measure the continuity of care for young stroke. Multiple logistic regression analysis was then applied to estimate the association between continuity of care and the recurrence of young stroke.
Result: The results show that the higher "continuity of care" cannot prevent the recurrence of young stroke. The important risk factors are high blood pressure, high cholesterol, and diabetes. These factors were associated with affect recurrence. How to effectively prevent and control chronic disease risk factors is an important factor in the prevention of young stroke recurrence.
Conclusion: Conclusion: Although the higher "continuity of care" cannot prevent the recurrence of young stroke, but there are significant correlations of hypertension, high cholesterol, and diabetes and the recurrences among young stroke patients. Therefore, the management of chronic diseases should be included in health insurance database to provide health practitioners important information about preventing stroke recurrence. The results of this study may help health professionals improve treatment and recurrence prevention.

目錄
前言-----------------------------------------------------------------------------1
文獻查證------------------------------------------------------------------------2
（一）年輕型腦中風的流行病學--------------------------------------------------------2
（二）年輕型腦中風復發率及危險因子---------------------------------------------------3
（三）就醫持續性的相關文獻---------------------------------------------------------4
（四）健保資料庫介紹和評論---------------------------------------------------------6
方法-----------------------------------------------------------------------------8
一、研究設計與研究對象-------------------------------------------------------------8
二、個案篩選與資料處理-------------------------------------------------------------8
三、變項定義及測量----------------------------------------------------------------9
四、研究倫理--------------------------------------------------------------------11
五、統計方法--------------------------------------------------------------------12
結果----------------------------------------------------------------------------13
一、研究對象的病人特性------------------------------------------------------------13
二、研究對象的健康相關因素--------------------------------------------------------14
三、年輕型腦中風復發之模式分析-----------------------------------------------------15
討論----------------------------------------------------------------------------18
一、年輕型腦中風的流行病學特性-----------------------------------------------------18
二、年輕型腦中風病患復發的相關因素--------------------------------------------------19
三、就醫持續性與中風復發之相關性----------------------------------------------------21
四、研究限制與建議---------------------------------------------------------------22
參考文獻-------------------------------------------------------------------------23


表目錄
表一、年輕型腦中風病患之病人特性 -----------------------------------------------------36
表二、年輕型腦中風病患之健康相關因素--------------------------------------------------37
表三、就醫持續性與年輕型腦中風復發之羅吉斯迴歸分析---------------------------------------38


圖目錄
圖一、年輕型腦中風持續就醫情形與中風再復發相關性之研究架構圖-------------------------------34
圖二、 研究樣本篩選流程圖-----------------------------------------------------------35


附錄
附錄、人體試驗委員會同意免審證明書----------------------------------------------------39

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