臺灣博碩士論文加值系統

目的：本文在探討心電圖之QT 參數以及臨床表現和急診出血性腦中風病患預後之關連性。
方法：本文前瞻性收集在10個月中送至台北榮總急性腦出血病患，收集病患之心電圖並計算出QT參數以及其他相關臨床紀錄及數值。分析病人特徵及影響預後之因素。
結果：從2006年1月至10月總共有93位病患收案並追蹤，昏迷指數較低者，死亡率較高(p <0.01)。 而在未能存活組別（Non-survival group）發現病患白血球以及收縮壓都較高(p = 0.04)。 但是QT參數和存活率，無統計學上之意義 (all p >0.05)。但在存活組中發現在治療28天後仍需臥床者，年齡較大(p = 0.01)，且QT max（p = 0.04）以及QTc max (p <0.01)都較延長。
結論:昏迷指數較低，白血球以或收縮壓上升可預測急性出血腦中風病患的死亡率會較高。而在病患年齡較大，QTc max、QT max 延長時，功能性恢復較差。

Background: This prospective study was performed to evaluate the prognostic prediction value of QT parameters and clinical characteristics exhibited by patients with acute hemorrhagic stroke at the time of presenting to the emergency department (ED).
Methods: One hundred sixty-six patients admitted to the ED of the Taipei-Veterans General Hospital from January 2006 to October 2006 because of acute hemorrhagic stroke were enrolled. Glasgow Coma Scale (GCS) scores between 3 and 8 were taken to indicate severe neurological deficits. QT parameters (QT max, QT min, QT dispersion, QTc max, QTc min, QTc dispersion) and other pertinent clinical variables were determined on admission. Logistic regression model was applied to evaluate prognostic prediction values.
Results: Mortality was higher among stroke patients with low GCS scores (p <0.01). Leukocyte counts and systolic blood pressures were significantly higher among non-surviving patients (p = 0.04). No association was found between QT parameters and mortality (all p >0.05). Among survivors, post-hospitalization bed confinement was required for those significantly older (p = 0.01) and with higher QT max and QTc max values in multivariate analyses (p = 0.04 and p <0.01, respectively).
Conclusions: Low GCS scores, increased leukocyte counts, and elevated systolic blood pressures predict increased mortality for subjects with acute hemorrhagic stroke. Advanced age and prolongations in QTc and QT max at the time of stroke predicted poor functional recovery for these subjects.

摘要.....................................................1
中文摘要.................................................2
英文摘要.................................................3
第一章 緒論..............................................5
1.1 出血性腦中風....................................6
1.2 腦出血嚴重度評分................................7
1.3 心電圖 QT 參數..................................8
1.4 心電圖 QT 參數與顱內出血病患預後關聯性..........10
1.5 研究目的.......................................11
1.6 圖表...........................................12
第二章 材料與方法.......................................23
2.1 研究族群與設計.................................24
2.2 資料收集與定義.................................24
2.3 資料分析與統計.................................26
第三章 結果.............................................28
3.1 圖表......................................... 32
第四章 討論............................................46
第五章 結論............................................51
參考文獻...............................................53
附錄...................................................60
本研究相關之個人著作...................................61

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