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研究生:蕭春香
論文名稱:小兒先天性心臟病危險因子之探討
論文名稱(外文):Study of risk factor of congenital heart disease in children
指導教授:張永源張永源引用關係
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
論文頁數:117
中文關鍵詞:先天性心臟病
相關次數:
  • 被引用被引用:3
  • 點閱點閱:242
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  • 收藏至我的研究室書目清單書目收藏:1
本研究係以配對病例對照研究法,選擇1998-2001年出生嬰兒,經高雄榮民總醫院心臟科專科醫師以理學及心臟超音波檢查,診斷為先天性心臟病之病患210名為研究對象病例組,並該院小兒科門診同期非先天性心臟病之病患,採一對一之配對性別與年齡共得210名為研究之對照組,並以編製之結構式問卷,統一由專人負責個案選取,及問卷分發與收集,經研究對象之家屬填寫問卷,相互比較結果。
本研究旨在探討先天性心臟病之危險因子。多變量條件對數迴歸分析( conditional logistic regression analysis)則被用以分析先天性心臟病之可能的危險因子。
結果顯示,單變量分析中外祖父( p = 0.039)或親屬中具有先天性心臟病之病史者( p = 0.02)、流行性感冒感染( p = 0.036)、醬菜( p = 0.035)、使用安全期避孕者( p = 0.041)、懷孕時感覺愉快者( p = 0.04),病例組與對照組具有顯著差異,多變量條件對數迴歸分析(conditional logistic regression analysis),控制可能的干擾因子之後,僅有食用醬菜其相對得先天性小兒心臟病危險性是沒有食用者的2.24倍( OR = 2.24;95% CI = 1.005-4.990),考慮共線性問題去除醬菜變項,則懷孕期感覺愉快者相對危險性是非感覺愉快者的0.64倍( OR = 0.64;95% CI = 0.416-0.990),家族中具有病史者相對危險性是沒有者的1.98倍( OR = 1.98;95% CI = 1.043-3.769)亦具有顯著差異。
先天性心臟病為先天性缺陷的主要疾病之一,且國內對其危險因子的探討甚少,本研究可做為相關研究的先驅性研究。
A matched-paired case-control study was designed for the exploration of risk factores in congenital heart disease of babies. 420 babies who were given births during 1998 — 2001 period were included in this study. 210 newborn babies who were diagnosed with physical examination and echocardiography as congenital heart disease patients by cardiologists in Kaohsiung Veterans Hospital. Another 210 selected matched-paired non-heart diseased babies whose ages and genders were paired with the study group from the pediatric of the hospital were used as control group. A specially designed structured questionnaire was applied to all babies’ caretakers by trained personnel.
The purposes of this study were to probe the risk factors of congenital heart disease. The probable risk factors of congenital heart disease were analyzed with multiple variable conditional logistic regression.
The results showed that the following factors were significantly different between case group and control group: grandfather of mother’s side ( p = 0.039) or other relatives ( p = 0.02) had heart disease history; flu infection during pregnancy ( p = 0.036); pickled vegetable intake ( p = 0.035); contraception with safety period method ( p = 0.041) and pleasant pregnancy ( p = 0.04). After controlling probable confounding factors, only pickled vegetable intake showed 2.24 times riskier ( OR = 2.24;95% CI = 1.005 - 4.990) in multiple variable conditional logistic regression. Considering collinear interference, the relative risk for pleasant pregnancy is 0.64 times (OR = 0.64; 95% CI = 0.416 — 0.990) in comparison with unpleasant pregnancy when pickled vegetable intake variable is removed. Those with congenital heart disease family history are 1.98 times riskier than those without (OR = 1.98; 95% CI = 1.043 — 3.769). The difference is significant.
Congenital heart disease is one of congenital defects, but there are few domestic studies on its risk factors. This study could be a pioneer study on relevant fields.
目 錄 頁碼
中文摘要 1
英文摘要 3
第一章 緒 論
第一節 研究背景 5
第二節 研究之重要性 6
第三節 研究目的 6
第二章 文獻探討
第一節 先天性心臟病概述 7
第二節 先天性心臟病之發生率、盛行率、死亡率 11
第三節 病因學 15
第三章 材料及方法
第一節 研究假設 32
第二節 研究概念架構 32
第三節 研究設計 32
第四節 資料收集 33
第五節 資料處理與統計分析 35
第四章 結 果
第一節 單變量分析 41
第二節 多變量分析 54
第五章 討 論
第一節 方法學 69
第二節 危險因子 70
第三節 研究限制 74
第六章 結論與建議
第一節 結論 75
第二節 建議 77
參考文獻 78
附錄一ICD9先天性心臟病疾病名稱 92
附錄二樣本數估計 96
附錄三先天性心臟病危險因子探討問卷 97
附錄四職業標準分類 101
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