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研究生:林立婷
研究生(外文):Li-Ting Lin
論文名稱:以軌跡分組探討復健時機與中風不活動相關併發症
論文名稱(外文):A Group Trajectory Analysis on the Association betweens Timing of Rehabilitation and Immobility-related Complications
指導教授:錢慶文錢慶文引用關係
指導教授(外文):Ching-Wen Chien
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:35
中文關鍵詞:腦中風復健合併症全民健保
外文關鍵詞:StrokeRehabilitationComorbiditiesNational Health Insurance
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研究目的
  中風患者透過復健可以減少併發症的產生,擁有比較好的生活品質,但早期復健和中風預後的相關性仍未有證據支持。本研究擬探討「復健時機與中風不活動相關併發症之關係」。

研究方法
  研究對象為2005年初次因腦中風住院,並於因初次腦中風住院後一年產生併發症的病人,共計14,844人。以群體軌跡模型觀察在不同時間點所蒐集到的併發症資料來分析早期復健和中風病人預後的相關,利用軌跡分組及多元邏輯斯迴歸,計算調整健康狀態等相關變項後之勝算比(Odds Ratio, OR)檢定與信賴區間(Confidence interval, CI),觀察各組別的相對危險性。

研究結果
  將病患開始復健的時間點分4組「住院7日內、住院超過7日、住院14日內、住院超過14日」,顯示越早開始復健,越容易出現在併發症發生次數漸低的組別。年齡每增加1歲,越不容易出現在併發症發生次數漸低的組別。中風嚴重度輕的患者,越容易出現在併發症發生次數漸低的組別。缺血型腦中風較出血型腦中風容易出現在併發症發生次數漸低的組別。合併症中有無高血壓、糖尿病、高血脂部分影響併發症發生次數的組別。(在多元邏輯斯迴歸分析呈現顯著的關聯性)。

結論
  住院7日內做復健和因不活動相關的併發症有關,年紀越輕的患者、中風的嚴重度低、缺血型中風患者較易併發症發生的次數較低。合併症中,在併發症發生次數漸低組有無高血壓是有影響力,在較低和較高的分組比較,糖尿病也有正面的影響,但高血脂卻有負面的影響力。
Research purpose
Stroke patients can achieve reduced complications through rehabilitation and thereby achieve a better quality of life. However, there is still a lack of evidence supporting the correlation between early rehabilitation and stroke prognosis. The purpose of this research is to study the association between the timing of rehabilitation and immobility-related complications.

Research method
The research subjects are patients who were initially hospitalized due to stroke in the year 2005 and had complications within one year after the initial hospitalization, totaling 14,844 patients. A group-based trajectory model was used to analyze the correlation between early rehabilitation and stroke prognosis based on the complication data collected at different time points. The Odds Ratio (OR) test and the Confidence Interval (CI) of the relevant correlated variables, such as health status, was calculated by trajectory grouping and multinomial logistic regression after the adjustment of the variables; the relative risk of each group was further observed.

Research results
The categorization is based on the timing of the start of rehabilitation (within 7 days, more than 7 days, within 14 days, and more than 14 days after hospitalization.) The results indicated that patients who start rehabilitation earlier have a better chance of being in a group with decreasing complication occurrence. With every additional year of patient age, the patient has a lower chance of appearing in the decreasing complication occurrence group. The results also indicated that patients with milder stroke severity had a greater chance of appearing in the decreasing complication occurrence groups and that ischemic stroke patients are more likely to appear in the decreasing complication occurrence group than hemorrhagic stroke patients. Additionally, the existence of hypertension, diabetes, and high cholesterol among the comorbidities partially influences the grouping of complication occurrence (multinomial logistic regression analysis showing significant correlation).

Conclusion
Rehabilitation within 7 days of hospitalization is related to immobility-related complications. Younger patients, patients with milder stroke severity, and ischemic stroke patients have reduced complication occurrence. With regard to comorbidities, there is an influence of the presence or absence of hypertension in the lower occurrence group. Comparing the lower and higher complication occurrence groups, diabetes has positive impact, while high cholesterol has negative impact.
目錄
誌謝 i
中文摘要 ii
英文摘要 iv
目錄 vi
表目錄 viii
圖目錄 ix
第一章 緒論 1
第二章 研究方法 3
第一節 研究架構 3
第二節 資料來源 4
第三節 樣本選取 5
第四節 研究變項 7
第五節 分析方法 9
第三章 研究結果 10
第四章 研究討論 20
第五章 結論與建議 23
第一節 結論 23
第二節 建議 24
第三節 研究限制 25
參考文獻 26

表目錄
表1 2005年初次腦中風者基本特性分布 5
表2 研究變項與操作型定義 7
表3 研究樣本特性資料分析 13
表4 多元邏輯斯迴歸分析 18

圖目錄
圖1 研究架構 3
圖2 軌跡分組(LOGIT MODEL) 10
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