(3.238.174.50) 您好!臺灣時間:2021/04/17 03:41
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:林欣欣
研究生(外文):Lin,Hsin-Hsin
論文名稱:生活型態改變對冠狀動脈繞道手術後危險因子監控成效之探討
論文名稱(外文):The life style change of the effects of risk factors for patients after coronary artery bypass graft
指導教授:蔡芸芳
學位類別:碩士
校院名稱:長庚大學
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:125
中文關鍵詞:治療性生活型態冠狀動脈繞道術危險因子
外文關鍵詞:Therapeutic lifestyle changecoronary artery bypass graftrisk factor
相關次數:
  • 被引用被引用:1
  • 點閱點閱:200
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:2
本研究目的在探討治療性生活型態改變(Therapeutic Lifestyle Changes, TLC)衛教方式,對冠狀動脈繞道手術後病人的危險因子監控之成效。研究架構依據美國心臟學會與歐洲心臟協會已確認冠心症的危險因子而成。本研究為縱貫式設計採類實驗性研究,針對北部某醫學中心之心臟外科接受冠狀動脈繞道手術之病人作為收案對象,對照組共37人接受常規衛教,實驗組共36人接受常規衛教與TLC衛教,並追蹤出院後第一個月與出院後第三個月對危險因子的影響。
研究結果發現,以重覆測量變異數分析(repeated measures)顯示兩組的吸煙量、高血壓、身體活動頻率、與飲食習慣隨時間的改變而跟著改變。以獨立T檢定分析顯示:高血脂症與糖尿病血糖控制術前與出院後第一個月的改變量上,實驗組較對照組明顯改善;吸煙量、飲食習慣與飲酒在出院後第一個月獲成效;高血壓、身體活動頻率在出院後第三個月獲成效,並達統計上顯著差異。由此可見,TLC衛教方式對危險因子控制之成效。
因此,在未來臨床上,將TLC衛教方式做為心臟病病人控制危險因子之指引,並將TLC衛教納入病房團體衛教內容。將TLC衛教加入術後心臟復健計劃可有效修正心臟病危險因子,以及促進術後恢復。
The purpose of this study was to explore the behavioral and clinical impact of a therapeutic lifestyle change (TLC) intervention on the risk factors associated with patients receiving coronary artery bypass grafting (CABG) surgery. Recently, lifestyle modification to decrease cardiovascular disease risk has been reaffirmed by both the American Heart Association and European Society of Cardiology. Patients who received CABG surgery in a single medical center were distributed into two groups using convenience sampling technique. Routine postoperative rehabilitation program was used in the control group (n=37) while TLC program was added to the experimental group (n=36). The measures of behavioral and clinical impact were compared for pre-, 1 month and 3 months after discharge.
The results revealed that the amount of the cigarette smoking, blood pressure control, frequency of physical activities and dietary behavior were modified in both groups. Using independent t-test, it was found that the differences of blood lipid profile and fasting sugar between preoperative and one month after discharge measurements attained statistically significant, and the experiment group had even greater differences (p<0.05). Similar findings were also noted in the changes of cigarette smoking, dietary behavior and alcohol consumption. Three month after discharge, blood pressure control and frequency of physical activities in the experiment group reached a higher level of statistically significant difference as compared to those of the control group.
In summary, the results suggested that guidelines for patients with cardiovascular disease should stress and support implementation of and adherence to therapeutic lifestyle changes besides drug therapy. The postoperative cardiac rehabilitation program should include the TLC intervention. Implementation of TLC into post-operative cardiac rehabilitation program can effectively modify cardiac risk factors and may improve postoperative recovery and prognosis.
指導教授推薦書
口試委員會審定書
長庚大學授權書.......................................................ⅲ
誌謝................................................................ⅳ
中文摘要............................................................ⅵ
英文摘要............................................................ⅶ
目錄................................................................ⅸ
圖表目錄............................................................85
第一章 前言........................................................1
第一節 研究動機與重要性......................................1
第二節 研究目的.............................................2
第三節 名詞解釋.............................................3
第二章 文獻查證.....................................................5
第一節 冠狀動脈與冠狀動脈心臟病...............................5
第二節 冠狀動脈繞道手術..................................... 6
第三節 心血管疾病危險因子之探討...............................8
第四節 危險因子與行為修正的關係..............................17
第五節 冠狀動脈繞道術後與危險因子的關係.......................18
第六節 生活型態治療與冠心症危險因子之關係.....................19
第七節 文獻總結............................................21
第八節 研究架構........................................... 26
第九節 研究問題..................... ......................27
第十節 研究假設........................................... 28
第三章 研究方法....................................................29
第一節 研究設計........................................... 29
第二節 研究對象及地點.......................................29
第三節 研究工具............................................30
第四節 資料收集流程........................................ 33
第五節 資料處理與分析.......................................34
第四章 研究結果....................................................36
第一節 研究對象之屬性.......................................36
第二節 吸煙................................................37
第三節 高血脂症............................................38
第四節 高血壓..............................................39
第五節 糖尿病..............................................41
第六節 肥胖或體重過重.......................................43
第七節 身體活動頻率.........................................44
第八節 飲食型態.............................................47
第九節 飲酒................................................52
第十節 藥物................................................53
第五章 討論.......................................................60
第一節 個案屬性之比較.......................................60
第二節 介入措施對危險因子控制之成效...........................61
第六章 結論.......................................................68
第一節 治療性生活型態改變對冠狀動脈繞道手術後病人的危險因子
改變成效............................................ 68
第二節 建議............................................... 70
第三節 研究限制與建議.......................................71
參考文獻............................................................73
附錄...............................................................113

圖表目錄
圖一 介入措施對CABG後危險因子監控之概念架構.............................26
表一 成年人大於18歲之血壓分類........................................ 86
表4-1 研究人數流失一覽表..............................................87
表4-2 研究對象之屬性..................................................88
表4-3 兩組病人吸煙量、SBP、 DBP、BMI 、WHR、運動頻率與運動時間之
比較...........................................................89
表4-4 兩組病人之變異數分析..................................................................90
表4-5 兩組Cholesterol、TG、HbA1C與Sugar之比較.........................91
表 4-6 兩組病人運動頻率與運動時間之變異數分析............................92
表 4-7 各組運動型式之比較.............................................93
表 4-8 兩組運動型式之比較.............................................94
表 4-9 兩組素食與烹調習慣之比較........................................95
表 4-10兩組病人飲食習慣之比較..........................................97
表 4-11兩組病人飲食習慣之變異數分析..................................................................98
表4-12 兩組AUDIT-C之得分比較........................................ 99
表4-13 對照組心臟用藥之比較..........................................100
表4-14 實驗組心臟用藥之比較......................................... 101
表4-15 兩組心臟用藥之比較............................................102
表4-16兩組抗高血壓藥物之比較..........................................103
表4-17 兩組病人高血壓藥物之變異數分析.................................................................104
表4-18 兩組糖尿病用藥之比較 ........................................ 105
圖4-1兩組吸煙量術前,出院後第一個月與出院後第三個月之比較................106
圖4-2 兩組收縮壓術前,出院後第一個月與出院後第三個月之比較...............107
圖4-3 兩組舒張壓術前,出院後第一個月與出院後第三個月之比較...............107
圖4-4 兩組BMI術前,出院後第一個月與出院後第三個月之比較..................108
圖4-5 兩組WHR術前,出院後第一個月與出院後第三個月之比較..................108
圖4-6 兩組運動頻率術前,出院後第一個月與出院後第三個月之比較..............109
圖4-7 兩組運動時間術前,出院後第一個月與出院後第三個月之比較..............109
圖4-8 兩組高膽固醇飲食術前,出院後第一個月與出院後第三個月之比較..........110
圖4-9 兩組高鈉飲食術前,出院後第一個月與出院後第三個月之比較..............110
圖4-10 兩組低膽固醇低鈉飲食術前,出院後第一個月與出院後第三個月之比較......111
圖4-11 兩組飲食習慣比較直方圖.........................................111
圖4-12兩組抗高血壓藥物術前,出院後第一個月與出院後第三個月之
比較...............................................................112
圖4-13兩組糖尿病用藥之比較.................................................................112
(一)中文部份
王文豐(2001)•運動與冠狀動脈心臟病之相關探討•中華體育,14(4),107-114。
行政院衛生署:衛生統計資訊網,死因統計結果摘要,2005。
行政院衛生署•90年度全國健康訪問調查•2001。
杜幸芳、馬素華、黃明達、莊峻鍠 (1998) • 衛教合併行為修正策略對糖尿病人代謝控制的影響•台灣醫學,2(1),8-17。
李碧霞(2001)•中年人運動階段、身體活動及其影響因素之研究~以臺北市中山區居民為例(博士論文,國立臺灣師範大學,2001)。全國博碩士論文資訊網,89NTNU0483018。
林慧君、侯嘉殷、周友三、蔡正河(2004)•適度飲酒與冠狀動脈心臟病風險•臺灣醫學,8(2),241-252。
許寬立、曾春典(2004)•冠狀動脈疾病介入性療法之近況•臺北市醫師公會會刊,48(7),80-82。
張敬仁、張文道、張文翰、蔡森蔚、周崇頌、陳妍蒨等人(2003)•以生活型態調整探討減重及健康相關生活品質之改善•臺灣衛誌,22(4),308-316。
陳素惠、梁靜祝(2000)•從行為修正的觀點看高脂血症•護理雜誌,47(1),63-68。
黃素珍、王建慰(1999)•冠狀動脈心臟病患者體適能活動之研究•蘭陽學報,201-207。
楊雀戀、章樂綺(2003)•高血脂症飲食新觀念•臨床醫學,52(6),422-428。
蔡青青(1994)•危險因素監控衛教對冠狀動脈繞道手術病人活動進展效益之初步探討(碩士論文,長庚醫工學院,1994)。全國博碩士論文資訊網,MC83-0020。
(二)英文部份
American Heart Association. (2005) Heart disease and stroke statistics-2005 Update. Dallas, Texas: American Heart Association.
Agarwal, D. P. (2002). Cardioprotective effects of light moderate consumption of alcohol: Review of putative mechanisms. Alcohol & Alcoholism, 37(5), 409-415.
Allen, J. K. (1999). Coronary risk factors in women one year after coronary artery bypass grafting. Journal of Women’s Health & Gender-Based Medicine, 8(5), 617-622.
Appel, L. J., Moore, T. J., Obarzanek, E., Vollmer, W. M., Svetkey, L. P., & Sacks, F. M. et al. (1997). A clinical trial of the effects of dietary patterns on blood pressure. The New England of Journal Medicine, 336(16), 1117-1124.
Artininian, N. T., & Duggan, C. H. (1995). Sex difference in patient recovery patterns after coronary artery bypass surgery. Heart & Lung, 24(6), 483- 494.
Backer, D. G., Ambrosioni, E., Borch-Johnsen, K., Brotons, C., Cifkona, R., & Dallongeville, J. et al. (2003). European guidelines on cardiovascular disease prevent in clinical practice. European Journal of Cardiovascular Prevention & Rehabilitation, 10 (supp 1), S1-S78.
Barnason, S., & Zimmerman, L. (1995). A comparison of patient teaching outcomes among postoperative coronary artery bypass graft (CABG) patients. Progress in Cardiovascular Nursing, 10 (4), 11-20.
Benzer, W., Platter, M., Oldridge, N. B., Schwann, H., Machreich, K., & Kullich, W. et al. (2007). Short-term patient-reported outcomes after different exercise-based cardiac rehabilitation programmes. European Journal of Cardiovascular Prevention & Rehabilitation. 14(3), 441-447.
Castelli, W. P. (1986a). The triglyceride issue: A review from Framingham. American Heart Journal, 112(2), 432-437.
Castelli, W. P. (1986b). A population at risk: Prevalence of high cholesterol levels in hypertensive patients in the Framingham study. The American Journal of Medicine, 80(2), S23-S32.
Castelli, W. P. (1992). Epideminology of triglycerides: A review from Framingham. American Journal of Cardiology, 70(19), 3-9.
Centers for Disease Control and Prevention. (2006, Jan 11). Prevention Works: Strategies for a heart–healthy and stroke–Free America. Atlanta, GA: Author. Retrieved Jan 23, 2006 from the World Wide Web: http://www.cdc.gov/nccdphp/publications/aag/cvh.htm
Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., & Izzo, J. L. et al. (2003). The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 Report. The Journal of the American Medical Association, 289(19), 2560- 2571.
Cleeman, I. J. (1993). Summary of the second report of the National Cholesterol Education Program (NCEP) expert panel on detect, evaluation, and treatment of high blood cholesterol in adult (adult treatment panel II). The Journal of American Medical Association, 269(23), 3015-3023.
Cleeman, I. J. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detect, evaluation, and treatment of high blood cholesterol in adult (adult treatment panel III). The Journal of American Medical Association, 285(19), 2486-2497.
Daubenmier, J. J., Weidner, G., Sumner, M. D., Mendell, N., Merritt-Worden, T. & Studley, J. et al. (2007). The contribution of changes in diet, exercise, and stress management to changes in coronary risk in women and men in the multisite cardiac lifestyle intervention program. Annals of Behavioral Medicine, 33(1), 57-68.
Deedwania, P. (2001). Global risk assessment in the presympto- matic patient. American Journal of Cardiology, 88 (suppl), 17J-22J.
Eagle, K. A., Guyton, R. A., Davidoff, R., Edward, F. H., Ewy, G. A., & Gardner, T. J. et al. (2004). ACC/AHA 2004 Guideline update for coronary artery bypass graft surgery: Summary article. Circulation, 110(9), 1168-1176.
Ernesto, B. M., & Carlos, B. M. (2003). Diabetes Mellitus and related disorders. In Green, B. G., Harris, S. I., Lin, A. G., & Moylan, C. K. (31th ed), The Washington Manual of Medical Therapeutics. (pp.470-487). Philadelphia: LWW
Fellows, J. L., Trosclair, A., Adams, E. K., & Rivera, C. C. (2002). Annual smoking-attributable mortality, years of potential life lost, and economic costs-united States, 1995-1999. Morbidity and Mortality Weekly Report, 51(14), 300-303.
Fontaine, R. K., Redden, T. D., Wang, C., Westfall, O. A., & Allison, B. D. (2003). Years of life lost due to obesity. The Journal of American Medical Association, 289(2). 187-193.
Fields, E. L., Burt, L. V., Cutler, A. J., Hughes, J., Roccella, J. E., & Sorlie, P. (2004). The burden of adult hypertension in the United States 1999 to 2000. Hypertension, 44(4), 398-404.
Ford, S. E., Giles, H. W., & Dietz, H. W. (2002). Prevalence of the metabolic syndrome among US adults: Findings from the third national health and nutrition examination Survey. The Journal of American Medical Association, 287 (3), 3356-359.
Foreyt, J. P., Goodrick, G. K., Reeves, R. S., Raynaud, A. S., Darnell, L., & Brown, A. H. et al. (1993). Response of free-living adults to behavioral treatment of obesity: Attrition and compliance to exercise. Behavior Therapy, 24(4), 659-669.
Fruchart, J. C., Nierman, M. C., Stroes, E. S. G., Kastelein, J. J. P., & Duriez, P. (2004). New risk factors for atherosclerosis and patient risk assessment. Circulation, 109(supp III), 15-19.
Gibbons, R. J., Abrams, J., Chatterjee, K., Daley, J., Deedwania, P. C., & Douglas, J. S. et al. (2003). ACC/AHA 2002 guideline update for the managementof patient with chronic stable angina-summary article: A report of the American College of Cardiology/ American Heart Association task force on practice guidelines (Committee on the management of patients with chronic stable angina). Circulation, 107(1), 149-158.
Goldenberg, I., Jonas, M., Tenenbaum, A., Boyko, V., Matetzky, S., & Shotan, A. et al. (2003). Current smoking, smoke cessation and the risk of sudden cardiac death in patients with coronary artery disease. Archives of Internal Medicine, 163(19), 2301-2305.
Grundy, M. S., Becker, D., Clark, T. L., Cooper, S. R., Denke, A. M., & Howard, J. W. et al. (2001) National cholesterol education program expert panel on detection, evaluation, and treatment of high blood cholesterol in adult (adult treatment panel III). National Institutes of health.
Harland, J., White, M., & Drinkwater, C. (1999). The Newcastle exercise project: A randomized controlled trial of methods to promote physical activity in primary care. British Medical Journal, 319(7213), 828-832.
Hojnacki, J. L., Deschenes, R. N., & Cleuttebrown, J. E. (1991). Effect of drinking pattern on plasma lipoproteins and body weight. Atherosclerosis, 88(1), 49-59.
Hubert, H. B., Feinleib, M., McNamara, P. M., & Castelli, W. (1983). Obesity as an independent risk factor for cardiovascular disease: A 26-yearfollow-up of participants in the Framingham Heart Study. Circulation, 67(5), 968-977.
Jeppesen, J., Hein, H. O., & Suadicani, P. (1998). Triglyceride concentration and ischemic heart disease: An eight-year follow-up in the Copenhagen Male Study. Circulation, 97(11), 1029-1036.
Jousilahti, P., Vartiainen, E., Tuomilehto, J., & Puska, P. (1999). Sex, age, cardiovascular risk factors, and coronary heart disease. A prospective follow-up study of 14786 middle-ages men and women in Finland. Circulation, 99(9), 1165-1172.
Lieberman, H. E., & Burkle, J. (2001). Myocardial Revascularization. In Noble, J. (3rd ed), Textbook of Primary Care Medicine (pp.570-578). St.Louis: Mosby.
Lilly, S. L. (2001). Ischemic Heart Disease. In Noble, J. (3rd ed), Textbook of Primary Care Medicine (pp.545-578). St. Louis: Mosby.
Lunsford, B. R., & Lunsford, T. R. (1995). Research Forum-The Research Sample, Part II: Sample size. Journal of Prosthetics and Orthotics, 7(4), 137-141.
Mann, J.I., Tipene-Leach, D.C., Pahau, H.L., Joseph, N. R., Abel, S., & McAuley, K.A. et al. (2006). Insulin resistance and impaired glucose metabolism in a predominantly Maori community. Diabetes Research & Clinical Practice, 72(1), 68-74.
Mazzeo, S. R., Cavanagh, P., Evans, J. W., Fiatarone, M., Hagberg, J., & McAuley, E. et al. (1998). Exercise and physical activity for older adults. Medicine & Science in Sports & Exercise, 30(6), 992-1008.
Miller, E. R. 3rd, Erlinger, T. P., Young, D. R., Jehn, M., Charleston, J., & Rhodes, D. et al. (2002). Result of the diet, exercise, and weight loss intervention trial (DEW-IT). Hypertension, 40(5), 612-618.
Mukamal, K. J., Jadhar, P. P., & Agostino, R. B. (2001). Alcohol consumption and hemostatic factors analysis of the Framingham offspring cohort. Circulation, 104(12), 1367-1379.
Mukamal, K. J., Girotra, S., & Mittleman, M. A. (2006). Alcohol consumption, atherosclerotic progression, and prognosis among patients with coronary artery bypass grafts. American Heart Journal, 151(2), 368-372.
Mukamal, K. J., Chung, H., Jenny, N. S., Kuller, L. H., Longstreth, W. T., & Mittleman, M.A. et al. (2006). Alcohol consumption and risk of coronary heart disease in older adults: the cardiovascular health study. Journal of the American Geriatrics Society. 54(1), 30-37.
Pafferty, P. A., Reeves, J. M., McGee, B. H., & Pivarnik, M. J. (2000). Physical activity patterns among walkers and compliance with public health recommendations. Medicine & Science in Sports & Exercise, 34(8), 1255-1261.
Papathanasiou, A., Milionis, H., Toumpoulis, I., Kalantzi, K., Katsouras, C., & Pappas, K. et al. (2007). Smoking cessation is associated with reduced long-term mortality and the need for repeat interventions after coronary artery bypass grafting. European Journal of Cardiovascular Prevention & Rehabilitation, 14(3), 448-450.
Reddy, K. K., Rao, A. P., & Reddy, T. P. (2002). Socioeconomic status and the prevalence of coronary heart disease risk factors. Asia Pacific Journal of Clinical Nutrition, 11(2), 98-103.
Penckofer, S., & Llewellyn, J. (1989). Adherence to risk-factor instructions one year following coronary artery bypass surgery. Journal of Cardiovascular Nursing, 3(3), 10-24.
Renfro, J., Miller, M., & Meredith, P. (2000). Cardiovascular health. In Meredith, P. V. & Horan, N. M., Adult Primary Care (pp. 267-349). Philadelphia: W. B. Saunders Company.
Rhodes, K. S., Bookstein, L. C., Aaronson, L. S., Mercer, N. M., & Orringer, C. (1996). Intensive nutrition counseling enhances outcomes of National Cholesterol Education Program dietary therapy. Journal of the American Dietetic Association, 96(10), 1003-1010.
Safeer, R. S., & Ugalat, P. S. (2002). Cholesterol treatment guideline update. American of Family Physician, 65(5), 871-880.
Salmon, B. (2001). Difference between men and women in compliance with risk factor reduction: Before and after coronary artery bypass surgery. Journal of Vascular Nursing, 19(3), 73-79.
Sarkin, A. J., Nichols, F. J., Sallis, F. J., & Calfas, J. K. (2000). Self-report measures and scoring protocols affect prevalence estimates of meeting physical activity guidelines. Medicine & Science in Sports & Exercise, 32 (10), 149-156.
Sebo, P., Abetel, G., Stalder, H., & Bovier, P. A. (2006). Importance of lifestyle counselling by primary care physicians for diabetic patients. Swiss Medical Weekly, 136(35-36), 566-573.
Seidel, M. H., Ball, W. J., Dains, E. J., & Benedict, W. G. (2003). Mosby’s Guide to Physical Examination (5th ed). St. Louis: Mosby.
Sim, I., Gupta, M., McDonald, K., Bourassa, G. M., & Hlatky, A. M. (1995). A Meta-analysis of randomized trials comparing coronary artery bypass grafting with percutaneous transluminal coronary angioplasty in multivessel coronary artery disease. The American Journal of Cardiology, 76(14), 1025-1029.
Solomon, J. A., & Gersh, J. B. (1998). Management of chronic stable angina: medical therapy, percutaneous transliminal coronary angioplasty, and coronary artery bypass graft surgery. Annals of Internal Medicine, 128(3), 216-223.
Sungun, M., Us, M.H., Ulusoy, R.E., Keskin, O., Pocan, S., & Inan, K. et al. (2006). The effects of lipid-lowering therapy on graft patency in coronary bypass surgery patients. Heart Surgery Forum, 9(3), E626-629.
Tan, E-S., Meer, J., Kam, P. J., Dunselman, P. H. J. M., Mulder, B. J. M., & Ascoop, C. A. P. L. et al. (1999). Worse clinical outcome but similar graft patency in women versus men one year after coronary artery bypass graft surgery owing to an excess of exposed risk factors in women. Journal of the American College of Cardiology, 34(6), 1760-1768.
Tatoulis, J., Buxton, F. B., & Fuller, A. J. (2004). Patencies of 2,127 arterial to coronary conduits over 15 years. Annunal of Thoracic Surgery, 77(1), 93-101.
Tsai, M. C., Tsai, Y. F., Chen, C. Y. & Liu, C. Y. (2005). Alcohol use disorders indentification test (AUDIT): establishment of cut-off scores in a hospitalized Chinese population. Alcoholism: Clinical & Experimental Research, 29(1), 53-57.
Wu, H. Y., Hueng, G. G., Lee, G. C., Lee, S. G., & Tsai, C. S. (1999). Coronary artery bypass surgery in a 24-year-old man: A case report and review of literature. Journal of Medicine Science, 20 (3), 157-163.
Yates, B. C. (1987). Gender differences in compliance behavior and health perceptions of coronary bypass surgery patients. Progressive Cardiovascular Nursing, 2(3), 105-112.
Yusuf, S., Zucker, D., Peduzzi, P., Fisher, D. L., Takaro, T., & Kennedy, W. J. et al. (1994). Effect of coronary artery bypass graft surgery on survival: Overview of 10-year results from randomized trials by the coronary artery bypass graft surgery trialist’s collaboration. Lancet, 344(8922), 563- 570.
Zakhari, S., & Gordis, E. (1999). Moderate drinking and cardiovascular health. Professional Association of American Physicans, 111(2), 148-158.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
系統版面圖檔 系統版面圖檔