臺灣博碩士論文加值系統

心臟性疾病危害國人的生命及健康甚鉅。心臟性疾病雖病因複雜，但經過醫學界多年的努力後，目前已知道心臟性疾病與許多危險因子有關。本研究的主要目的是針對男性急性心肌梗塞存活者夜間睡眠發作與其他危險因子作相關性探討。
研究方法是採橫斷式研究，病歷回溯自2004年至2007年間，在花蓮慈濟醫院住院之男性AMI存活者，總計152名。研究樣本分為兩組，24名夜間睡眠發作存活者及128名非夜間睡眠發作存活者。由病歷中收集各項健康狀況的資料，如：疾病發作時刻、身體質量指數、高血壓、糖尿病、年紀、族群、物質使用、血脂值等作為研究變項，研究分析各項資料與夜間睡眠發作的關係。
研究結果發現，原住民的個案在夜間睡眠發作的比例（29.2%），高於在非夜間睡眠發作（7.0%），並具有顯著統計意義（p = 0.001）。夜間睡眠發作者於吸菸、肥胖危險因子部份的比例，皆高於非夜間睡眠發作者，並具有顯著差異（p = 0.04及0.004）。另外發現，低密度脂蛋白膽固醇的平均值顯著高於非夜間睡眠發作者，p = 0.01。
結論顯示，肥胖及族群差異是獨立預測因子，原住民病例於夜間睡眠中發作是漢人的6.33倍罹病勝算比，BMI≧27肥胖病例於夜間睡眠中發作是BMI＜27的3.57倍罹病勝算比，而HDL-c≧40則為保護因子。
關鍵字：急性心肌梗塞、危險因子、族群

Heart diseases have significant impact on health. Although there are complicate causes of heart diseases, many studies have shown that heart diseases are correlated with many risk factors. The purpose of this study is to explore that AMI onset at night sleep in male subjects is correlated with some risk factors.
Material and Method: cross-sectional case control method was applied to this study. Through chart review, the clinical data and substances (cigarette smoking) used were collected from 2004 to 2007 at Tzu-Chi general hospital. Subjects were classified into two groups. There are two groups of research objects accounted for 152 subjects. The first group is 24 male AMI subjects onset at night sleep. The second group is 128 male AMI subjects onset at other time. We analyzed the relationship between related variables such as time of onset, the body mass index (BMI), hypertension (HBP), diabetes (DM), age, ethnicity, substances used (cigarette smoking), and lipid profile.
Results: There is significant difference (p=0.001) in Indigenous who onset at night sleep (29.2%) compared to those onset at other time (7.0%).The results shown that male AMI subjects who onset at night sleep has higher proportions of smoking, obesity compared to subjects onset at other time(p=0.04, 0.004). Those male AMI subjects who onset at night sleep has higher mean of LDL-c compared to subjects onset at other time (p=0.01).
Conclusions：In conclusion, that obesity and ethnicity is the independent determinants of AMI onset at night sleep. The Indigenous had 6.33 fold at risk in AMI onset at night sleep as compared with the Hans, the BMI≧27（obesity）had 3.57 fold at risk in AMI onset at night sleep as compared with the BMI＜27, and HDL-c≧40 is the protect factor.

Key word: acute myocardial infarction, risk factor, ethnicity.

摘要…………………………………………………………………………………….I
Abstract………………………………………………………………………………..II
目錄…………………………………………………………………………………..IV
表目次………………………………………………………………………..............VI
第一章 緒論…………………………………………………………………………..1
第一節 研究背景及動機………………………………………………………..1
第二節 研究目的與議題………………………………………………………..3
一、研究目的………………………………………………………………3
二、研究議題………………………………………………………………3
第三節 名詞界定………………………………………………………………..4
急性心肌梗塞疾病定義………………………………………4
族群……………………………………………………………4
吸菸……………………………………………………………4
身體質量指數…………………………………………………5
高血壓症………………………………………………………5
糖尿病症………………………………………………………5
高血脂症………………………………………………………5
第二章 文獻查證……………………………………………………………………..7
第一節 急性心肌梗塞疾病（AMI）…………………………………………..7
第二節 探討危險因子與AMI疾病之理學影響與相關研究…………………8
一、生理面向……………………………………………………………..8
1.族群………………………………………………….......................8
2.肥胖..……………………………………………….......................11
3.高血壓…………………………………………………………….11
4.糖尿病…………………………………………………………….12
5.高血脂…………………………………………………………….12
二、心理面向……………………………………………………………13
1.情緒或精神壓力………………………………………………….13
2.A型性格與工作過勞…………………………………………….14
三、物理面向……………………………………………………………14
1.運動……………………………………………………………….14
2.季節、氣溫變化與好發時間………………………………….….15
四、化學面向…………………………………………………………..…17
1.吸菸……………………………………………………………….17
第三章 材料與方法…………………………………………………………………19
第一節 研究架構………………………………………………………………19
一、研究方法……………………………………………………………19
二、研究假設……………………………………………………………19
1.研究對象………………………………………...….…………….19
2.資料收集………………………………………………………….20
第二節 分析方法………………………………………………………………20
第四章 研究結果……………………………………………………………………21
第一節 非夜間睡眠發作者與夜間睡眠發作者之危險因子相關分析………21
第二節 族群別、肥胖、高血脂及吸菸與心血管疾病危險因子之相關分析…24
第三節 夜間睡眠發作者之預測指標因子分析………………………………40
第五章 討論與結論…………………………………………………………………42
第一節 討論……………………………………………………………………42
第二節 結論……………………………………………………………………45
第三節 研究限制………………………………………………………………46
第四節 應用與建議……………………………………………………………47
第六章 參考文獻……………………………………………………........................48




表 目 次

Table 1非夜間睡眠發作者與夜間睡眠發作者之危險因子相關分析……………23
Table 2非夜間睡眠發作者之族群別與心血管疾病危險因子相關分析…………25
Table 3夜間睡眠發作者之族群別與心血管疾病危險因子相關分析……………27
Table 4非夜間睡眠發作者之肥胖症與心血管疾病危險因子相關分析…………29
Table 5夜間睡眠發作者之肥胖症與心血管疾病危險因子相關分析……………31
Table 6非夜間睡眠發作者之高血脂症與心血管疾病危險因子相關分析………33
Table 7夜間睡眠發作者之高血脂症與心血管疾病危險因子相關分析…………35
Table 8非夜間睡眠發作者吸菸與心血管疾病危險因子相關分析………………37
Table 9夜間睡眠發作者吸菸與心血管疾病危險因子相關分析…………………39
Table 10夜間睡眠發作者之預測指標因子分析……………………………………41

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