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研究生:黃欣薇
研究生(外文):Shin-Wei Huang
論文名稱:血清鉀離子、血壓與急性腦中風指標之相關探討
論文名稱(外文):The Correlation of Serum Potassium, Blood Pressure and Parameters of Acute Stroke
指導教授:廖佩珊廖佩珊引用關係張寓智張寓智引用關係
指導教授(外文):Pei-San LiaoYeu-Jhy Chang
學位類別:碩士
校院名稱:輔仁大學
系所名稱:應用統計學研究所
學門:數學及統計學門
學類:統計學類
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:35
中文關鍵詞:血清鉀離子血壓急性腦中風Hausman LM檢定統計量
外文關鍵詞:Serum PotassiumBlood PressureAcute StrokeHausman LM Test
相關次數:
  • 被引用被引用:3
  • 點閱點閱:476
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:1
本研究以北部某醫學中心急性腦中風住院病患為研究對象,目的在於了解病患到院時之血清鉀離子濃度、血壓反應和腦中風嚴重度之間的影響關係。797筆取自個案醫院腦中風登錄系統且符合收案標準及勘誤過的樣本資料,經Hausman LM檢定後可得到以下的結果:一、血清鉀離子與血壓皆為急性腦中風嚴重程度的獨立且直接影響因子;二、急性血壓反應與腦中風嚴重程度具有統計顯著的正相關,但血清鉀離子對急性腦中風嚴重程度的影響則不具統計顯著性。由於本研究樣本變數測量採腦中風病人急性期時之測度水準,此衡量方式與過去有所差異,且樣本也具有某種偏態性、追蹤期間不夠長、或者沒有對實驗的控制因素進行良好的控制,導致某些發現無法得到與前人一致的研究結論,因此在解釋應用時須謹慎小心。
The purpose of this study was to clarify the relationships among serum potassium level, response of blood pressure, and the stroke parameters (severity) of acute stroke inpatients at Emergency Room in one Medical Center of the North Taiwan. After cleaning the data, there were 797 patients fulfilled the enrolled criteria. The major method of data analysis was Hausman LM test. The most important findings were: 1. Serum potassium level and blood pressure were independent and direct factors for the presentation of acute stroke parameters; 2. the response of blood pressure was positively correlated with acute stroke parameters with statistical significance. However, the correlation of serum potassium level and acute stroke parameters was statistical insignificance. Because of different parameters measured in acute stage of stroke patients from those of previous studies, some deviated sample distribution, shorter follow-up period, and maybe uncontrolled confounding factors, some results were inconsistent with the previous reports. Interpretation and application of the results should be careful.
目 錄
目錄------------------------------------------------------------------------------------Ⅰ
表次------------------------------------------------------------------------------------Ⅱ
圖次------------------------------------------------------------------------------------Ⅱ
附錄次---------------------------------------------------------------------------------Ⅱ
第 一 章 緒論 ------------------------------------------------------------------------1
第一節 研究背景與動機-----------------------------------------------------------1
第二節 研究流程--------------------------------------------------------------------3
第 二 章 文獻探討 ------------------------------------------------------------------4
第一節 腦中風及其相關指標 -----------------------------------------------------4
第二節 血壓、腦中風及鉀離子相關文獻探討---------------------------------5
第三節 研究問題---------------------------------------------------------------------6
第 三 章 研究方法-------------------------------------------------------------------7
第ㄧ節 樣本資料---------------------------------------------------------------------7
第二節 研究變數 --------------------------------------------------------------------7
第三節 資料分析方法 --------------------------------------------------------------8
第 四 章 實證結果------------------------------------------------------------------10
第一節 樣本特性分析-------------------------------------------------------------10
第二節 差異分析-------------------------------------------------------------------10
第三節 血壓對腦中風影響之分析----------------------------------------------11
第四節 血壓是否為內生變數之探討-------------------------------------------13
第五節 血壓與血清鉀離子對腦中風之影響探討----------------------------15
第 五 章 結論與限制--------------------------------------------------------------17
参考文獻-----------------------------------------------------------------------------19
附表 ----------------------------------------------------------------------------------22
附錄-----------------------------------------------------------------------------------32

表 次
表1:樣本篩選過程---------------------------------------------------------------22
表2:單變量敘述統計------------------------------------------------------------23
表3:以美國國衛院腦中風量表總分分群檢定------------------------------24
表4:以巴氏量表總分分群檢定------------------------------------------------25
表5:多元迴歸模式―血壓對腦中風指標之影響---------------------------26
表6:血壓與血清鉀離子檢定---------------------------------------------------28
表7:Hausman外生性檢測程序----------------------------------------------29
表8:多元迴歸模式―血壓與血清鉀離子對腦中風指標之影響---------30




圖 次
圖1:研究流程圖--------------------------------------------------------------------3




附 錄 次

附錄一:美國國衛院腦中風量表-----------------------------------------------32
附錄二:巴氏量表-----------------------------------------------------------------34
附錄三:急性腦中風住院個案的相關資料-----------------------------------35
1. WHO. WHO Steps Stroke Manual. 2006年10月31日取自 http://www.who.int/chp/steps/Manual.pdf。

2.行政院衛生署:衛生統計資訊網。2006年10月31日取自http://www.doh.gov.tw/statistic/data/死因摘要/94年/表18.xls。

3.劉祥仁,「腦血管疾病」,收錄於臨床神經學,張寓智等(編),台北:合計圖書出版社,2002年,頁229-261。

4. Arima H, Chalmers J. Secondary prevention of stroke by blood pressure-lowering treatment. Curr Hypertens Rep. 2006;8:317-23.

5. Bornstein N, Silvestrelli G, Caso V, et al. Arterial hypertension and stroke prevention: an update. Clin Exp Hypertens. 2006;28:317-26.

6. Kannel WB. Blood pressure as a cardiovascular risk factor: prevention and treatment. JAMA. 1996;275:1571-6.

7. Volpe M, Dedhiya SD. Physicians, patients, and public knowledge and perception regarding hypertension and stroke: a review of survey studies. Curr Med Res Opin. 2006;22:1319-30.

8. Wolf-Maier K, Cooper RS, Banegas JR, et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA. 2003;289:2363-9.

9. Devroey D, Van Casteren V, Buntinx F. Lower stroke death rates in patients receiving blood pressure lowering therapy before the onset of a stroke. Cent Eur J Public Health. 2005;13:176-9.

10. Sartori M, Benetton V, Carraro AM, et al. Blood pressure in acute ischemic stroke and mortality: a study with noninvasive blood pressure monitoring. Blood Press Monit. 2006;11:199-205.

11. Diener HC. Blood pressure control: stroke and stroke prevention. J Renin Angiotensin Aldosterone Syst. 2005;6(Suppl 1):S8-S11.

12.McDonald KC, Blackwell JC, Meurer LN. What lifestyle changes should we recommend for the patient with newly diagnosed hypertension? J Fam Pract. 2006;55:991-3.

13. Geleijnse JM, Witteman JC, Bak AA, et al. Reduction in blood pressure with a low sodium, high potassium, high magnesium salt in older subjects with mild to moderate hypertension. BMJ. 1994;309:436-40.

14. Geleijnse JM, Kok FJ, Grobbee DE. Blood pressure response to changes in sodium and potassium intake: a metaregression analysis of randomised trials. J Hum Hypertens. 2003;17:471-80.

15. Ascherio A, Rimm EB, Hernan MA, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation. 1998;98:1198-204.

16. Fang J, Madhavan S, Alderman MH. Dietary potassium intake and stroke mortality. Stroke. 2000;31:1532-7.

17. Pedelty L, Gorelick PB. Update on the management of hypertension to prevent stroke. Curr Treat Options Neurol. 2006;8:486-95.

18. O'Brien AA, Rajkumar C, Bulpitt CJ. Blood pressure lowering for the primary and secondary prevention of stroke: treatment of hypertension reduces the risk of stroke. J Cardiovasc Risk. 1999;6:203-5.

19. Neal B, MacMahon S, Chapman N. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists' Collaboration. Lancet. 2000;356:1955-64.

20. Tobian L. High-potassium diets markedly protect against stroke deaths and kidney disease in hypertensive rats, an echo from prehistoric days. J Hypertens. 1986;4(Suppl):S67-76.

21. Tobian L, Jahner TM, Johnson MA. Atherosclerotic cholesterol ester deposition is markedly reduced with a high-potassium diet. J Hypertens. 1989;7(Suppl):S244-5.

22. Tobian L, Jahner TM, Johnson MA. High K diets markedly reduce atherosclerotic cholesterol ester deposition in aortas of rats with hypercholesterolemia and hypertension. Am J Hypertens. 1990;3:133-5.

23. Sugimoto T, Tobian L, Ganguli MC. High potassium diets protect against dysfunction of endothelial cells in stroke-prone spontaneously hypertensive rats. Hypertension. 1988;11:579-85.

24. Ishimitsu T, Tobian L, Sugimoto K, et al. High potassium diets reduce macrophage adherence to the vascular wall in stroke-prone spontaneously hypertensive rats. J Vasc Res. 1995;32:406-12.

25.Dorrance AM, Pollock DM, Romanko OP, et al. A High Potassium Diet Reduces Infarct Size and Improves Vascular Structure in Hypertensive Rats. Am J Physiol Regul Integr Comp Physiol. 2007;292:R415-22.


26. Tuekpe MK, Todoriki H, Sasaki S, et al. Potassium excretion in healthy Japanese women was increased by a dietary intervention utilizing home-parcel delivery of
Okinawan vegetables. Hypertens Res. 2006;29:389-96.

27. Langford HG. Potassium in hypertension. Postgrad Med. 1983;73:227-33.

28. Bazzano LA, He J, Ogden LG, et al. Dietary potassium intake and risk of stroke in US men and women: National Health and Nutrition Examination Survey I epidemiologic follow-up study. Stroke. 2001;32:1473-80.

29. Smith NL, Lemaitre RN, Heckbert SR, et al. Serum potassium and stroke risk among treated hypertensive adults. Am J Hypertens. 2003;16:806-13.

30. Khaw KT, Barrett-Connor E. Dietary potassium and stroke-associated mortality. A 12-year prospective population study. N Engl J Med. 1987;316:235-40.

31. Gariballa SE, Robinson TG, Fotherby MD. Hypokalemia and potassium excretion in stroke patients. J Am Geriatr Soc. 1997;45:1454-58.

32. Fang J, Madhavan S, Cohen H, et al. Serum potassium and cardiovascular mortality. J Gen Intern Med. 2000;15:885-90.

33. Walsh CR, Larson MG, Vasan RS, et al. Serum potassium is not associated with blood pressure tracking in the Framingham Heart Study. Am J Hypertens. 2002;15:130-6.

34. Walsh CR, Larson MG, Leip EP, et al. Serum potassium and risk of cardiovascular disease: the Framingham heart study. Arch Intern Med. 2002;162:1007-12.

35. Dickinson HO, Nicolson DJ, Campbell F, et al. Potassium supplementation for the management of primary hypertension in adults. Cochrane Database Syst Rev. 2006;3:CD004641.
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