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研究生:賴小慧
研究生(外文):Sow-Fei Lai
論文名稱:急性冠心症患者於急性期使用ß-拮抗劑對於阻止左心室重塑之臨床經驗
論文名稱(外文):A study of the use of β-blocker in acute stage of acute coronary syndromes in the prevention of left ventricular remodeling
指導教授:詹道明詹道明引用關係
指導教授(外文):Thau-Ming Cham
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:藥學研究所碩士在職專班
學門:醫藥衛生學門
學類:藥學學類
論文種類:學術論文
論文出版年:2004
畢業學年度:93
語文別:中文
論文頁數:73
中文關鍵詞:左心室舒張期末容積左心室排出分數心室重塑
外文關鍵詞:left ventricular ejection fractionremodelingleft ventricular end diastolic volume
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研究目的:測定Carvedilol,第三代ß-抗拮劑對急性冠心症病患的心臟保護作用
方法:病患來自屏東寶建醫院心臟內科,研究組之病患在胸痛症狀後六小時內開始給予Carvedilol,在急性期及三個月後,心臟超音波追蹤記錄:左心室舒張末期容積,左心室收縮期末容積及左心室排出分數。
結果:三個月後之追蹤比較,經由Analysis of variance (ANOVA)得知,左心室排出分數(left ventricular ejection fraction,LVEF)研究組高於對照組,P值為0.0435(P<0.05) 有統計學上之意義,但兩組於左心室舒張期末容積(left ventricular end diastolic volume,LVEDV)方面,沒有統計學意義上之差別。
結論:於急性冠心症早期開始投予Carvedilol有減低心室重塑之效果。
Objective: The aim of this study was to determine the cardiac protective effects of carvedilol, a third generation beta-adrenergic blocker, in acute stage of acute coronary syndromes.
Methods: Patients from Department of Cardiology, Pao Chien Hospital were recruited for this echocardiographic study. In the study group patients started with carvedilol 6 hours within chest pain attack. Echocardiography, measuring left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),left ventricular ejection fraction (LVEF) were performed then and repeated after 3 months.
Results: At 3 months, left ventricular ejection fraction was significantly rise in the carvedilol group (P=0.0435) (ANOVA). Left ventricular end diastolic volume was not statistically different between the two groups.
Conclusions: Early administration of carvedilol in Acute Coronary Syndromes results in attenuation of left ventricular remodeling.
表次目錄……………………………………………………… I
圖次目錄……………………………………………………… III
中文摘要……………………………………………………… V
英文摘要……………………………………………………… VI

本文
壹、緒論……………………………………………………… 1
一、疾病介紹…………………………………………… 1
二、國內外過去相關研究探討………………………… 7
三、研究背景及目的…………………………………… 9
四、藥物介紹…………………………………………… 18
貳、研究方法及資料收集…………………………………… 26
一、病患條件…………………………………………… 26
1)收入條件…………………………………………… 30
2)排除條件…………………………………………… 30
二、研究期間…………………………………………… 30
三、研究方法…………………………………………… 30
1)病患之資料………………………………………… 32
2)病患之過去病史…………………………………… 34
3)病患伴隨的治療…………………………………… 35
4)病患急性冠心症之分類…………………………… 37
5)心臟超音波檢查…………………………………… 38
6)統計分析方法……………………………………… 38
四、危險評估…………………………………………… 38
五、名詞解釋…………………………………………… 39
六、監測心室重塑之參數……………………………… 40
參、研究結果………………………………………………… 44
一、研究樣本基本資料統計分析結果………………… 44
二、研究樣本心跳及血壓之分析……………………… 49
三、研究樣本左心室功能及容量之分析……………… 53
肆、討論……………………………………………………… 60
一、安全性評估………………………………………… 60
二、臨床上之意義……………………………………… 61
三、Carvedilol之劑量………………………………… 64
四、研究限制…………………………………………… 65
伍、結論……………………………………………………… 67
伍、參考文獻………………………………………………… 68

表次目錄
表一、第三代ß-拮抗劑對心室重塑之療效………………… 17
表二、第一、二、三代ß-抗拮劑代表性藥物……………… 21
表三、病患基本資料………………………………………… 33
表四、病患過去病史………………………………………… 34
表五、發作時合併治療……………………………………… 36
表六、急性冠心症分類……………………………………… 37
表七、病患基本資料庫……………………………………… 46
表八、研究組(T: Treatment)與對照組(C: Control)治療前與治療三個月後所測得之心跳(HR)值差。(ANOVA檢定)………………………………………… 52
表九、 研究組(T: Treatment)與對照組(C: Control)治療前與治療三個月後所測得之左心室排出分數(LVEF)值差。(ANOVA檢定)…………………………………………… 55
表十、 研究組(T: Treatment)與對照組(C: Control)治療前與治療三個月後所測得之左心室舒張期末容積(LVEDV)值差。 (ANOVA檢定)………………………………… 57
表十一、研究組(T: Treatment)與對照組(C: Control)治療前與治療三個月後所測得之左心室收縮期末容積(LVESV) 值差。 (ANOVA定)…………………………………… 59

圖次目錄

圖一、急性冠心症之範圍……………………………………… 2
圖二、急性冠心症病理生理機轉……………………………… 3
圖三、急性冠心症候群之診斷及治療流程圖………………… 5
圖四、心肌梗塞後心室之重塑過程…………………………… 10
圖五、心肌梗塞後使用ß-腎上腺素接受器拮抗劑流程圖…… 11
圖六、心肌細胞鈣離子運作機轉……………………………… 13
圖七、心臟β-腎上腺素系統………………………………… 14
圖八、心肌壞死之生化機轉…………………………………… 15
圖九、第一、二、三代ß-抗拮劑代表性藥物化學結構圖… 20
圖十、不穩定型心絞痛心電圖判讀…………………………… 27
圖十一、非ST段升高心肌梗塞心電圖判讀………………… 28
圖十二、ST-段升高心肌梗塞心電圖判讀…………………… 29
圖十三、研究方法流程圖…………………………………… 31
圖十四、左心室2D超音波圖(左心室舒張期末容積) ……… 41
圖十五、左心室2D超音波圖(左心室收縮期末容積) ……… 42
圖十六、左心室M-mode 心臟超音波測量…………………… 43
圖十七、對照與治療組所測得之收縮壓與舒張壓………… 50
圖十八、研究組(Treatment)與對照組(Control)治療前與治療三個月後所測得之心跳值…………… 51
圖十九、 研究組(Treatment)與對照組(Control)治療前與治療三個月後所測得之左心室排出分數值………………………………………………… 54
圖二十、 研究組(Treatment)與對照組(Control)治療前與治療三個月後所測得之左心室舒張期末容積值………………………………………………… 56
圖二十一、研究組(Treatment)與對照組(Control)治療前與治療三個月後所測得之左心室收縮期末容積………………………………………………… 58
圖二十二、心室重塑導致心室收縮期功能不彰±心室舒張期功能不…………………………………………………… 63
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