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研究生:黃曉玲
研究生(外文):Hsiao Ling Huang
論文名稱:預測神經科重症加護病房之初次急性缺血性腦中風病人六個月內死亡相關因素之探討
論文名稱(外文):Predictors of death within six months in acute first-ever ischemic stroke patients admitted to the Neurological Intensive Care Unit (NICU)
指導教授:唐婉如唐婉如引用關係
指導教授(外文):W. R. Tang
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:2009
畢業學年度:97
論文頁數:123
中文關鍵詞:腦血管疾病(Cerebrovascular accidentCVA)或腦中風(Stroke)病情進展(Prognosis)神經內科重症加護病房 (Neurological intensive care unitICU)
外文關鍵詞:Cerebrovascular accident (CVA) or StrokePrognosisDeathNeurological Intensive Care Unit (NICU)
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  • 被引用被引用:3
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  • 收藏至我的研究室書目清單書目收藏:2
摘要
本研究目的在預測神經科重症加護病房的初次急性腦中風病患六個月內死亡與否之相關指標,採回顧病歷方式進行研究,以北部某醫學中心之初次急性缺血性腦中風之住院病患共150人為研究對象,以描述性與推論性統計方法進行資料分析,研究結果發現:.一、神經加護病房的初次急性缺血性腦中風病患六個月內之死亡率為32.7﹪。二、邏輯斯迴歸分析結果顯示女性、心臟病史、昏迷、昏迷持續超過三天、吞嚥困難、電腦斷層攝影結果、住院當天巴氏指數、置入氣管內管並使用呼吸器者、到院七天內之白血球總數和血糖值、合併症總數、初次急性缺血性腦中風發病時有無意識不清、及住院天數等為預測初次急性腦中風六個月內死亡與否之重要因子。三、複迴歸分析結果顯示昏迷、昏迷持續超過三天、有無吞嚥困難、電腦斷層攝影結果(梗塞位置、梗塞範圍)、住院天數為預測神經內科重症加護病房初次急性缺血性腦中風病患存活天數之最佳預測模式,共可解釋存活天數 55.0%之總變異量,其中住院天數為預測存活天數之重要因子。結論:本研究結果可提供臨床醫護人員對神經科加護病房的初次急性缺血性腦中風病患六個月內死亡與否與存活天數預測之指引,期望透過精確的病情進展評估,對臺灣非癌症病患接受安寧療護的政策發展有所貢獻。
Abstract
This study aims to evaluate the risk factors of mortality within six months in patients with first-ever ischemic stroke who were hospitalized to the Neurological Intensive Care Unit (NICU). We retrospectively reviewed the medical records of 150 consecutive such cases in a Medical Center in northern Taiwan. The following findings were found according to descriptive and inferential analyses: 1) Mortality rate within six months in acute first-ever ischemic stroke admitted to NICU was 32.7%. 2) Logistic regression analysis showed that female patients, and the status of cardiovascular disease history, coma , persistent coma for over three days, dysphagia, computed tomographic (CT) findings, Barthel Index on admission, intubation with mechanical ventilation, the white blood cell account within 7 days of admission , the blood sugar level within 7 days of admission, total complications, impaired consciousness as stroke onset symptom and length of hospital stay were the significant predictors of mortality. 3) Among Multiple regression analysis found that coma, continuous coma for over three days, dysphagia, CT findings (location and size of infarction), and length of hospital stay were the best models to predict 55.0% of the variance on the survival days in six months. In which, length of hospital stay was the significant predictor. Conclusion: This study provides guidance for predicting mortality (or survival) in six months in patients with first-ever ischemic stroke admitted to NICU. Hospice Palliative Care may be applicable to stroke patients with grave prognosis in the furure.
目 錄
指導教授推薦書…………………………………………………………………….
口試委員會審定書……….....……………………………………….……
授權書……………………………………………………………………….iii
誌謝……………………………………………………………………….iv
中文摘要………………………………………………………………..v
英文摘要………………………………………………………………….vii
目錄…………..…………………………………………………….ix
第一章 緒論……………………………………………………………………1
第一節 研究背景及重要性………………………………………………………1
第二節 研究目的………………………………………………………3
第三節 名詞定義…………………………………………………………3
第二章 文獻查證………………………………………………….. 4
第一節 腦血管疾病概況…………………………………………………… 4
第二節 腦中風預後的重要指標…………………………………………………5
第三章 研究方法…………………………………………………………….17
第一節 研究架構…………………………………………..……………… 17
第二節 研究設計及研究對象……………………………………………... 19
第三節 研究工具…………………………………………………...……. 20
第四節 資料收集方法………………………………………………………. 27
第五節 資料分析方法…………………………………………………….. 29
第四章 研究結果………………………………………………………. 32
第一節 病患基本資料………………………………………………... 32
第二節 病患生命徵象………………………………………………... 35
第三節 中風嚴重程度………………………………………….. ….. 35
第四節 實驗室檢查……………………………………………… ... 40
第五節 理學檢查………………………………………….. ………. 42
第六節 CVA合併症…………………………………………….…... 42
第七節 就醫狀況…………………………………………….……... 44
第八節 研究變項與死亡之推論性統計分析………………….…... 44
第九節 初次急性缺血性腦中風病患六個月內死亡與否之多變量分析…56
第五章 討論………………………………………………………....65
第一節 討論神經科加護病房之初次急性缺血性腦中風病患六個月內之死亡率.................................................66
第二節討論神經科加護病房之初次急性缺血性腦中風病患六個月內死亡與否和基本人口學變項之相關性…….……………. …………………..67
第三節描述神經科加護病房初次急性缺血性腦中風病患六個月內死亡與否與中風嚴重程度之相關性……………………………………………69
第四節探討神經科加護病房之初次急性缺血性腦中風病患六個月內死亡之最佳的迴歸模式………………………………………………………75
第六章結論與建議……………………………………………………77
第一節結論…………………………………………………………………….77
第二節研究限制…………………………………………………….…………78
第三節研究結果之應用及對未來之建議…………………………………….79
參考文獻…………………………………………………………………….……82
附錄………………………………………………………………………………97
圖表目錄
圖一 研究架構…………………………………………………… 18
表4.1人口學特徵性………………………………………………32
表4-2生命徵象之平均值與標準…………………………………34
表4-3中風嚴重程度(一)…………………………………………36
表4-4中風嚴重程度(二)…………………………………………37
表4-5實驗室檢查描述性分析……………………………………40
表4-6理學檢查…………………………………………………….41
表4-7 CVA合併症…………………………………………………42
表4-8就醫狀況…………………………………………………….43
表4-9人口學資料與死亡與否之單變量分析……………………44
表4-10生命徵象與死亡與否之單變量分析……………………..46
表4-11中風嚴重程度與死亡與否之單變量分析………………...48
表4-12實驗室檢查與死亡與否之單變量分析……………..……51
表4-13理學檢查與死亡與否之單變量分析……………..…...52
表4-14CVA合併症與死亡與否之單變量分析…………..………53
表4-15就醫狀態與死亡與否之單變量分析…………..…………55
表4-16 邏輯式迴歸分析結果…………..………………………...57
表4-17 控制年齡與性別之情形之第一種預測存活天數複迴歸模式分析…60
表4-18 控制年齡與性別情形下之第二種預測存活天數複迴歸模式分析…63
表4-19控制年齡與性別情形下之第三種預測存活天數複迴歸模式分析…64
附 錄
附錄一急性腦中風病患死亡指標量表………………………...97
附件二美國國衛院腦中風評估表(NIHSS)…………………… 105
附件三格拉斯哥昏迷量表(Glasgow coma scale; GCS)…….107
附件四巴氏指標Barthel Index………………………………….108
附錄五改良式中風等級量表(Modified Rankin Scale; mRS)….109
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