臺灣博碩士論文加值系統

摘要
因現代人飲食習慣及生活作息改變，腦中風有逐漸年輕化，甚至有年齡往下降的趨勢發生。因此，現代人需調整飲食習慣及生活作息，以預防腦中風的觀念，取代治療腦中風的作為。根據衛生福利部統計處的報告，經統計國人106年十大死因，排序第四為腦血管疾病。
目前臺灣腦中風學會中臺灣腦中風登錄簡表資料，收集了臺灣民眾的中風紀錄，可以做腦中風發生率長期追蹤研究，且影響腦中風危險因子，以常見內分泌及代謝疾病進行分析，以高血壓、糖尿病、心臟病、高膽固醇此4項疾病分開探討。
基於此，本次研究以臺灣腦中風登錄資料庫為資料來源，使用民眾門診資料找出罹患腦中風患者，再運用統計方法，計算出腦中風患者與人口特性中性別、教育程度、職業、高血壓、糖尿病、高膽固醇、心臟病、年齡、BMI等之關聯性探討研究。
以臺灣腦中風登錄資料庫中資料，做為罹患腦中風者研究樣本，統計腦中風患者與人口特性中性別、教育程度、職業、高血壓、糖尿病、高膽固醇、心臟病、年齡、BMI等之關聯性，研究結果指出有危險誘發可能因子包含三高(高血壓、高血脂、糖尿病)比例比一般人高出許多，所以積極改善優質生活習慣與健康飲食應可降低發生腦中風罹患之風險機率，長期下來可以有效降低公共醫療資源的耗用，進而提高民眾健康，維持生活品質。

Abstract
Due to the changes in modern people's eating habits and lifestyle, the stroke has gradually become younger, and even the trend of age declines. Therefore, modern people need to adjust their eating habits and life routines to prevent the concept of stroke and replace the treatment of stroke. According to the report of the Statistics Department of the Ministry of Health and Welfare, according to the statistics of the top ten causes of death in 106 years, the fourth is cerebrovascular disease.
At present, the Taiwan Brain Stroke Association has a list of Taiwanese strokes and collected the strokes of the Taiwanese people. It can do long-term follow-up studies on the incidence of stroke, and affect the risk factors of stroke, and analyze them with common endocrine and metabolic diseases. Blood pressure, diabetes, heart disease, and high cholesterol are discussed separately.
Based on this, this study uses the Taiwan Brain Stroke Registry database as a source of information, uses the public outpatient data to identify patients with stroke, and then uses statistical methods to calculate the gender, education level, occupation, and highness of stroke patients and demographic characteristics. Study on the association of blood pressure, diabetes, high cholesterol, heart disease, age, BMI, etc.
Use Taiwan brain stroke to log in the database, as a sample of patients suffering from stroke, statistics on gender, education, occupation, hypertension, diabetes, high cholesterol, heart disease, age, BMI, etc. Relevance, the results of the study pointed out that the risk-induced possible factors including the three high (high blood pressure, high blood lipids, diabetes) ratio is much higher than the average person, so active improvement of quality living habits and healthy diet should reduce the risk of developing a stroke, In the long run, it can effectively reduce the consumption of public medical resources, thereby improving the health of the people and maintaining the quality of life.

目錄
中文摘要 i
英文摘要 ii
誌謝 iii
目錄 iv
表目錄 vi
圖目錄 vii

第一章 緒論 1
1.1 研究背景與動機 1
1.2 研究目的 2
1.3 研究步驟 2

第二章 文獻探討 4
2.1 中風定義 4
2.1.1 缺血性中風 4
2.1.2 出血性中風 6
2.1.3 症狀和體徵 6
2.2認識腦中風危險因素 8
2.2.1高血壓8
2.2.2糖尿病10
2.2.3心臟病 14
2.2.4高膽固醇 16

第三章 研究方法與架構 17
3.1研究資料來源與對象 17
3.2研究設計 19
3.3研究架構 22
3.4資料處理與分析方法 26

第四章 研究結果與討論 27
4.1描述性統計分析 27
4.2差異性統計分析(t檢定) 34
4.3關聯統計分析(卡方檢定) 35



第五章 結論與研究建議 40
5.1結論 40
5.1.1研究發現 40
5.1.2研究限制 41
5.2研究建議 41
參考文獻 43

表目錄
表3.3.1 變項譯碼 25
表4.1.1 罹患腦中風疾病樣本之性別分布情況 29
表4.1.2 罹患腦中風疾病樣本之年齡分布情況 29
表4.1.3 罹患腦中風疾病樣本之BMI分布情況 30
表4.1.4 罹患腦中風疾病樣本之教育程度分布情況 30
表4.1.5 罹患腦中風疾病樣本之職業分布情況 31
表4.1.6 罹患腦中風疾病樣本之相關因素分布情況 32
表4.2.1 離院情況在年齡與BMI上之差異分析摘要表 35
表4.3.1 性別與離院情況之交叉分析摘要表 36
表4.3.2 教育程度與離院情況之交叉分析摘要表 37
表4.3.3 高血壓與離院情況之交叉分析摘要表 37
表4.3.4 糖尿病與離院情況之交叉分析摘要表 38
表4.3.5 高膽固醇與離院情況之交叉分析摘要表 38
表4.3.6 心臟病與離院情況之交叉分析摘要表 39

圖目錄
圖3.1.1 臺灣腦中風學會網站http://www.stroke.org.tw/ 18
圖3.2.1 臺灣腦中風登錄簡表（正面） 20
圖3.2.2 臺灣腦中風登錄簡表（反面） 21
圖3.3.1 研究架構 22
圖3.4.1 資料處理流程 26

參考文獻
[1]你不可忽視的腦中風前兆，康健雜誌第72期。
[2]106年國人死因統計結果，衛生福利部統計處，2018年6月。
[3]每47分鐘就有1人死於腦中風 把握黃金3小時，中風是可控制的，衛生福利部統計處，2017年5月。
[4]連立明、陳威宏，認識腦中風，新光醫院文章，2018年7月。
[5]醫護人員腦中風教育手冊，衛生福利部國民健康署，2003年7月。
[6]What Is a Stroke?. National Heart, Lung, and Blood Institute.Mar 2014.
[7]What Are the Signs and Symptoms of a Stroke?. National Heart, Lung, and Blood Institute. Mar 2014.
[8]National Institute of Neurological Disorders and Stroke (NINDS). Stroke: Hope Through Research. National Institutes of Health. 1999.
[9]Ay H; Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ. An evidence-based causative classification system for acute ischemic stroke. Ann Neurol. 2005.
[10]Nor AM, McAllister C, Louw SJ, Agreement between ambulance paramedic- and physician-recorded neurological signs with Face Arm Speech Test (FAST) in acute stroke patients. Stroke. 2004.
[11]Carretero OA, Oparil S. Essential hypertension. Part I: Definition and etiology. Circulation. Jan. 2000.
[12]Vasan, RS; Beiser, A, Seshadri, S, Larson, MG, Kannel, WB, D'Agostino, RB, Levy, D. Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study.. JAMA: the journal of the American Medical Association. Feb 2002.
[13]He, FJ; MacGregor, GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes.. Journal of human hypertension. Jun. 2009.
[14]Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, Williams B, Ford GA. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens. 2006.
[15] Haslam DW, James WP. Obesity. Lancet. 2005.
[16]Sorof J, Daniels S. Obesity hypertension in children: a problem of epidemic proportions. Hypertension. Oct. 2002.
[17]O'Brien, Eoin; Beevers, D. G., Lip, Gregory Y. H. ABC of hypertension. London: BMJ Books. 2007.
[18]Gibson, Paul. Hypertension and Pregnancy. eMedicine Obstetrics and Gynecology. Medscape. July 2009.
[19]Global health risks: mortality and burden of disease attributable to selected major risks. (PDF). World Health Organization. 2009.
[20]Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. Dec 2002.
[21]Singer DR, Kite A. Management of hypertension in peripheral arterial disease: does the choice of drugs matter?. European Journal of Vascular and Endovascular Surgery. June 2008.
[22]About diabetes. World Health Organization. Apr. 2014.
[23]Diabetes Fact sheet N312,WHO,Oct.2013.
[24]糖尿病與我，衛生福利部國民健康署，2016年5月。
[25]Kitabchi, AE, Umpierrez, GE, Miles, JM, Fisher, JN. Hyperglycemic crises in adult patients with diabetes. Diabetes care. Jul 2009.
[26]Gardner David, Dolores, Shoback . Chapter 17. Greenspan's basic & clinical endocrinology 9th. New York: McGraw-Hill Medical. 2011.
[27]全球糖尿病報告，世界衛生組織，2016年4月。
[28]Latest diabetes figures paint grim global picture 網際網路檔案館的存檔。
[29]RSSDI textbook of diabetes mellitus. Rev. 2nd ed. New Delhi: Jaypee Brothers Medical Publishers. 2012.
[30]不胖也患糖尿病 國衛院：免疫發炎反應。
[31]蔡忠文，心臟病，健康報e報。
[32]Durrington, P. Dyslipidaemia. The Lancet. Aug.2003.
[33]Biggerstaff KD, Wooten JS. Understanding lipoproteins as transporters of cholesterol and other lipids. Adv Physiol Educ. Dec. 2004.
[34]Carmena R, Duriez P, Fruchart JC. Atherogenic lipoprotein particles in atherosclerosis. Circulation. June 2004.
[35]Kontush A, Chapman MJ. Antiatherogenic small, dense HDL--guardian angel of the arterial wall?. Nat Clin Pract Cardiovasc Med.Mar. 2006.
[36]Healthy diet - Fact sheet N°394. World Health Organization. Sept.2015.
[37]de Souza, RJ; Mente, A, Maroleanu, A, Cozma, AI, Ha, V, Kishibe, T; Uleryk, E, Budylowski, P, Schünemann, H, Beyene, J, Anand, SS. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies.. BMJ (Clinical research ed.). Aug. 2015.
[38] Ito MK, McGowan MP, Moriarty PM. Management of familial hypercholesterolemias in adult patients : recommendations from the nationalLipid association expert panel on Familial Hypercholesterolemia. J Clin Lipidol , June 2011.
[39]臺灣腦中風學會網站http://www.stroke.org.tw/