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研究生:蕭妏倩
研究生(外文):Wun-Cian Shiau
論文名稱:血液透析患者動靜脈瘻管栓塞以經皮血管成形術和重建的相關因素探討
論文名稱(外文):Evaluation the Related Factors between Percutaneous Transluminal Angioplasty and Surgical Reconstruction after the Vascular Access Failure
指導教授:丘周萍丘周萍引用關係
指導教授(外文):Chou-Ping Chiou
學位類別:碩士
校院名稱:義守大學
系所名稱:醫務管理學系
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:2016
畢業學年度:104
語文別:中文
論文頁數:70
中文關鍵詞:尿毒症血液透析動靜脈瘻管經皮血管成形術糖尿病
外文關鍵詞:uremiahemodialysisA-V fistulapercutaneous angioplasty (PTA)diabetes mellitus
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根據美國腎臟登錄系統(USRDS)2013年報公佈最新的全球尿毒症排行,台灣每年新增加洗腎病患比率(發生率)已由2007年最高峰的424/每百萬人口降至361/每百萬人口,而透析病患佔總人口比率(盛行率)仍居高不下,由2007年的2285上升為每百萬人口2584人,血液透析病患必須仰賴血管通路進行血液透析治療,對病患而言血管通路可視為第二條生命線,本研究目的在於當瘻管發生問題時先發處置為PTA與手術成本相關之衡量,適當訂定瘻管重建手術與PTA治療的標準,降低瘻管失效率及降低維持成本,合理化健保支出。研究工具為SPSS22.0繁體中文版進行資料統計以運用羅吉斯迴歸及卡方檢定,發現性別與經皮血管成形術(PTA)無顯著,年齡與透析齡、有糖尿病HbA1c>5.5、人工血管(AVG)與動靜脈瘻管(AVF)栓塞比較、瘻管流速≦670cc/min較易栓塞,PTA(P<0.05)是顯著的,所以,此數據在未來定期監測紀錄動靜瘻管血液流量,得以訂定重建手術與PTA的治療標準,能合理化醫療支出及展延瘻管壽命及提升生活品質。

According to the United States Renal Data System 2013 annual report ,the global rankings of dialysis patients incidence rate ratio of Taiwan annual (2007-2013), from 424 fell to 361/ per million people, but hemodialysis patients relative to the total population (prevalence rate) is still high. Hemodialysis patients are from 2285 in 2007 rose to 2584/ per million people. Hemodialysis patients mainly rely on vascular access for treatment, the vascular access can be regarded as the second lifeline of patient.
The purpose of this study was to explore the cost and timing between PTA and surgery reconstruction, and making an appropriate guideline for PTA and surgery reconstruction. The aim is to reduce the failure rate of fistula and the maintenance cost, the rationalization of the health care expenditure.
Statistical tool for this research is SPSS 22.0, according to the results using logistic regression and chi square test for gender and PTA are no significant, but age, diabetes (HbA1c>5.5), the emboli of artificial vascular graft (AVG) and dynamic venous fistula tube (AVF), PTA cost is higher than rebuilding the fistula tube, fistula flow ≦670 cc/min easily embolism and PTA are significant (P<0.05).
In the future, we will be regular to monitor and record the blood flow of A-V fistula, and making a guideline for the surgery reconstruction and PTA, provide the rationalization of medical expenditure and extension the Life expectancy of fistula and enhance the quality of patients life.

謝辭……………………………………………………………………….i
中文摘要…………………………………………………………………ii
英文摘要………………………………………………………...………iii
目錄…………………………………………………………...…………iv
圖目錄…………………………………………………………...………vi
表目錄……………………………………………………………..……vii
第一章 緒論
第一節 研究背景與動機…………………………………………1
第二節 研究目的與重要性…………………………………...… 6
第三節 研究預期貢獻…………………...……………………… 7
第四節 研究流程…………………………...…………………… 8
第二章 文獻探討
第一節 血液透析人口與動靜脈瘻管 ………...……………….9
第二節 經皮血管成形術與血管重建…………..………………13
第三節 經皮血管成形術與血管重建之成本比較…………..…15
第四節 動靜脈瘻管流速與經皮血管成形術之相關……..……19
第五節 動靜脈瘻管流速與心臟功能之相關……………..……22
第六節 動靜脈瘻管與其他相關因子…………………………27
第三章 研究方法
第一節 研究設計與架構…………...…………………………30
第二節 研究假說………………..………………………………31
第三節 研究工具…………………..……………………………32
第四節 研究樣本與醫學倫理…………..………………………33
第四章 研究結果
第一節 基本資料分析………………….………….……………34
第二節 各變項結果分析………..………………………………36
第三節 假說分析與討論…………..………………………40
第五章 結論與建議
第一節 結論……………………..………………………………45
第二節 研究限制………………..………………………………46
第三節 後續研究建議……………..……………………………47
參考文獻
中文文獻……………………………………………………..……48
英文文獻………………………………………………………..…51
附錄
1.人體試驗委員會通過證明書…………..………..……………附-1

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