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研究生:陳彥勳
研究生(外文):Yen-Hsun Chen
論文名稱:接受成功立即性冠狀動脈介入治療之ST 波段上升急性心肌梗塞病人早期出院之特徵
論文名稱(外文):Characteristics of patients early discharged with acute ST segment elevation myocardial infarction undergoing successful primary percutaneous coronary intervention
指導教授:紀宗呈紀宗呈引用關係
指導教授(外文):Tzong-Cherng Chi
學位類別:碩士
校院名稱:長榮大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:63
中文關鍵詞:冠狀動脈心肌梗塞早期出院
外文關鍵詞:myocardial infarctionprimary percutaneous coronary intervention
相關次數:
  • 被引用被引用:2
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  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
研究目的:
本研究的目的乃是為了探查接受成功立即性經皮導管冠狀動脈血管成形術治療病人,能安全且早期 (小於4天) 出院的特質。

研究方法:
在三十九所醫院彙集的急性冠心症全方位登錄 (ACS Full Spectrum Registry) 資料中,前瞻性地蒐集並評估ST 波段上升急性心肌梗塞且經成功立即性經皮導管冠狀動脈介入性治療 (Primary Percutaneous Coronary Intervention),並安全早期出院病人的資料及特徵。分析並比較早期出院及晚期出院病人組之間的差異。

研究結果:
自2008年10 月至2010 年1 月,總共有1089 位病人經診斷為急性ST波段上升急性心肌梗塞,而且接受了立即性血管介入性治療。在早期出院組 (小於等於4天) 有255位病人,晚期出院組 (大於4天) 有 834 位病人。平均住院天數上,早期出院組病人為3.19 ± 0.66天,晚期出院組病人為8.13 ± 8.54天。
早期出院組有較低的罹患高血壓比率,只藉飲食控制的糖尿病患者比率也比較多。早期出院組病人至急診就診時,有較低的Killip分級,發生心因性休克或急性肺水腫的比率相對比較低。在病灶動脈的分布方面,晚期出院組有較高比率的左主幹冠狀動脈病灶。早期出院組病人在住院中,有相對較低的心室心率不整、急性腎衰竭及心因性休克比率。
在十二個月的病例追蹤時,兩組病人在死亡、再住院、心肌梗塞、接受血管再通術、及中風各方面的風險及發生率,都沒有統計上顯著的差別。

結論:
在醫師審慎的評估下,對於ST 波段上升急性心肌梗塞,且經成功立即性經皮導管冠狀動脈介入性治療的病人,能安全早期出院;和晚期出院病人比較下,並不會增加綜合心血管事件的風險和發生率。



目 錄 I
圖 目 錄 IV
表 目 錄 V
英文縮寫 VII
中文摘要 VIII
英文摘要 X
壹、導論
1.1 研究動機 1
1.2 研究重要性 3
1.3 研究目標 3
貳、文獻查證 5
2.1 冠狀動脈解剖學及生理功能 5
2.2 冠狀動脈心臟病之病態生理學 7
2.2.1 動脈粥樣硬化的血管損傷反應理論 7
2.2.2 動脈粥樣硬化過程發炎反應的角色 8
2.3 心肌梗塞 9
2.3.1病因 9
2.3.2臨床症狀 10
2.3.3診斷 10
2.3.4嚴重度分級 11
2.3.5 治療 11
參、研究材料與方法 13
3.1研究設計 13
3.2研究對象 14
3.3定義急性心肌梗塞 14
3.4統計分析 14
肆、研究結果 16
4.1患者的基本特質 16
4.2風險層級評估 16
4.3急診表現 17
4.4再灌流治療 18
4.5住院中處置 18
4.6藥物 19
4.7住院中預後 20
4.8追蹤結果 20
4.9單變數Cox模式分析 21
4.10多變數Cox迴歸模式分析 22
伍、討論 23
陸、結論 27
柒、參考文獻 28
捌、圖 32
玖、表 34
拾、附圖 54
附圖1. 冠狀動脈 54
附圖2. 冠狀動脈解剖構造 55
附圖3. 動脈粥樣硬化過程 56
附圖4. 心電圖之12導極 57
附圖5.心肌缺氧ST 波段變化 58
附圖6. 急性前壁心肌梗塞心電圖實例 59
附圖7. 急性前壁心肌梗塞之冠狀動脈血管攝影實例 60
附圖8. 球囊導管置放金屬支架 61
拾壹、附表 62
附表1. 急性心肌梗塞 Killip 分級 62
附表2. TIMI 血流分級 63
附表3. TIMI 出血分級 63
圖 目 錄
Fig 1.收案流程圖 32
Fig 2 心因性死亡/心因性再住院累計發生率 33
Fig 3中風/心肌梗塞/接受血管再通術累計發生率 33
表 目 錄
Table 1. 患者基本特質 34
Table 2. 風險層級評估 35
Table 3 急診表現 37
Table 4. 心肌酵素值 39
Table 5. 合併住院診斷 40
Table 6. 再灌流治療 40
Table 7. 住院中處置 41
Table 8. 梗塞血管分布及阻塞程度 42
Table 9. 治療病灶數及支架種類 43
Table 10. 心臟超音波檢查及主動脈幫浦 44
Table 11. 使用藥物 45
Table 12. 住院中預後 46
Table 13. 住院天數 47
Table 14. 三個月追蹤預後 48
Table 15. 六個月追蹤預後 49
Table 16. 九個月追蹤預後 50
Table 17. 十二個月追蹤預後 51
Table 18. Univariate Cox model for Death/ Rehospitalization 52
Table 19. Multivariate Cox Model 53



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