冠狀動脈粥狀硬化(atherosclerosis)常造成心肌缺血或梗塞疾病，臨床上可使用各種方法進行診斷。本研究利用都卜勒心臟超音波進行心室壁掃描，並由動態影像判斷心室收縮或舒張異常，藉心導管氣球擴張術的使用，用以判斷都卜勒心臟超音波掃描與冠狀動脈粥狀硬化判讀的相關性。針對新竹某區域醫院心臟血管中心常規的心導管診療個案，自2014.01.01至2015.12.31共收集485例患者納入本回顧性研究，男性302名、女性183名，臨床上使用Philips IE33配置S5-1型經胸心臟探頭，當心臟超音波動態影像顯現心肌收縮異常時，未進行氣球擴張術處理與進行氣球擴張術處理的心導管術的比例分別為44%與56%，但病人若進行心導管檢查，且同時利用氣球擴張術處理時，此時都卜勒心臟超音波影像異常則高達94%。都卜勒心臟超音波與心導管氣球擴張術，其相關性由皮爾森卡方檢定＞10，費雪精確檢定p值＜0.05，具統計學上的顯著性。亦即進行都卜勒心臟超音波動態影像發現異常，可作為醫師判斷是否需進行心導管氣球擴張術的重要依據。

Coronary atherosclerosis often cause myocardial ischemia or infarction, and various methods can be used in clinical diagnosis of myocardial disease. This study evaluates ventricular motion abnormalities by using Doppler echocardiography scan from the resulting dynamic image of ventricular systolic or diastolic abnormalities. The abnormalities were then follow-up on cardiac catheterization with or without balloon dilatation, we aim to evaluate whether Doppler echocardiography scan can be used to interpret the criticality and risk of coronary atherosclerosis. Against a Hsinchu cardiovascular routine cardiac catheterization center, we retrospectively collected 485 cases, 302 male, 183 female, from 2014.01.01 to 2015.12.31. Philips IE33 ultrasound scanner configuring with the S5-1 transthoracic cardiac probe was used to echocardiographic scan. When myocardial motion appears abnormalities, patients treated with or without balloon dilatation in cardiac catheterization were of 44% and 56%, respectively. However, if the patients were cardiac catheterization with balloon dilatation treatment, then abnormal Doppler echocardiography is as high as 94%. Doppler echocardiography and cardiac catheterization balloon dilatation, its relevance high correlation with a statistically significant by chi-squared test (X2> 10) and Fisher exact test (p <0.05). The Doppler echocardiography can afford a myocardial abnormal evaluation as an important tool to perform a cardiac catheterization balloon dilatation.

目 錄 頁次
口試委員審定書…………………………………………………Ⅰ
誌謝………………………………………………………………Ⅱ
中文摘要…………………………………………………………Ⅲ
英文摘要…………………………………………………………Ⅳ
目錄………………………………………………………………Ⅴ
圖目錄……………………………………………………………Ⅵ
表目錄……………………………………………………………Ⅶ
第一章 緒論………………………………………………………1
1.1 前言………………………………………………………… 1
1.2 研究目的…………………………………………………… 2
1.3 文獻回顧……………………………………………………3
1.4 研究架構…………………………………………………… 5
第二章 基礎理論………………………………………………… 6
2.1 心臟血管…………………………………………………… 6
2.2 動脈粥狀硬化………………………………………………6
2.3 致病因子……………………………………………………8
2.3.1 高血脂……………………………………………………8
2.3.2 抽菸…………………………………………………… 9
2.3.3 高血壓……………………………………………………9
2.3.4 高血糖和糖尿病…………………………………………10
2.3.5 家族史………………………………………………… 10
2.3.6 肥胖………………………………………………………10
2.4診斷方法簡介…………………………………………………11
2.4.1履帶式跑步機運動心電圖測試………………………… 11
2.4.2 心肌血流灌注閃爍攝影…………………………………11
2.4.3 心臟超音波………………………………………………12
2.4.4多切冠狀動脈電腦斷層攝影…………………………… 14
2.4.5 心導管檢查………………………………………………14
第三章 材料與方法………………………………………………15
3.1 超音波掃描儀……………………………………………… 15
3.2 數位心血管攝影儀………………………………………… 15
3.3 取樣人數…………………………………………………… 17
3.4 統計分析…………………………………………………… 17
第四章結果與討論…………………………………………………18
4.1 臨床表徵與處置………………………………………………18
4.2 分析與討論…………………………………………………… 26
第五章 結 論……………………………………………………… 29
參考文獻………………………………………………………………30

一、英文部分
1.Carr, J.J., Crouse, J.R., Goff, D.C., et al., Evaluation of subsecond gated
helical CT for quantification of coronary artery calcium and comparison with
electron beam CT. AJR Am J Roentgenol. 2000 Apr;174(4):915-921.
2.Chaikhouni A, Gehani AA, Horak J, etal: Coronary angiography in Oatar: the
first ten years. Angiology 1998; 49:625-630.
3.Davis K, Kennedy JW, Kemp HG Jr,et al.,: Complications of coronary
arteriography. Circulation 1979; 59:1105-1112.
4.Einstein, A. J., Moser, K.W. , Thompson, R.C., Cerqueira, M.D. , Henzlova, M.
J., Radiation Dose to Patients From Cardiac Diagnostic Imaging. Circulation.
2007; 116: 1290-1305.
5.Gibbons, R.J., Chatterjee, K., Daley, J., Douglas, J.S., Fihn, S.D., Gardin,
J.M., & Schafer, W. P. ACC/AHA/ACP-ASIM guidelines for the management of
patients with chronic stable angina: a report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines
(Committee on Management of Patients With Chronic Stable Angina). Journal of
the American College of Cardiology, 1999:33(7), 2092-2197.
6.Graves EJ: Vital and Health Statistics:National Hospital Discharge
Survey:Annual summary 1991, Hyattsville, Md.,National center for Health
Statistics1993: 67-68.
7.Gruentzig, A.R., Percutaneous Transluminal Coronary Angioplasty. Seminars in
Roentgenology. 1981; 16: 152-153.
8.Jensen, L.O., Thayssen, P., Mintz, G.S., et al., Comparison of Intravascular
Ultrasound and Angiographic Assessment of Coronary Reference Segment Size in
Patients with Type 2 Diabetes mellitus. Am J Cardiol 2008; 101: 590-595.
9.Kim, D. H., Park, S.J., Jung, J.W., Kim, N.K., and Choi, J.Y., The comparison
between the echocardiographic data to the cardiac catheterization data on the
diagnosis, treatment, and follow-up in patients diagnosed as pulmonary valve
stenosis. J Cardiovasc Ultrasound 2013;21:18-22.
10.Korte, C.L., Hansen, H. G., Steen, F.W. Vascular ultrasound for
atherosclerosis imaging. Interface Focus 2011, 1, 565–575.
11.Leber, A.W., Knez, A., von Ziegler, F., Becker, A., Nikolaou, K., Paul, S.,
Wintersperger, B., Reiser, M., Becker, C.R., Steinbeck, G., Boekstegers, P.,
Quantification of obstructive and nonobstructive coronary lesions by 64-slice
computed tomography: a comparative study with quantitative coronary
angiography and intravascular ultrasound. J Am Coll Cardiol, 2005, 46(1): p.
147-154.
12.Lembcke, A., Durmus, T., Westermann, Y., Geigenmueller, A., Claus, B.,
Butler, C., and Thiele, H., Assessment of mitral valve stenosis by helical
MDCT: comparison with transthoracic Doppler echocardiography and cardiac
catheterization cardiopulmonary Imaging. AJR 2011;197:614-622.
13.Leschka, S., Alkadhi, H., Plass, A., Desbiolles, L., Grünenfelder, J.,
Marincek, B., Wildermuth, S., Accuracy of MSCT coronary angiography with 64-
slice technology: first experience. Eur Heart J, 2005. 26(15): p. 1482-1487.
14.Reiser M, Becker CR, Steinbeck G, Boekstegers P.Quantification of obstructive
and nonobstructive coronary lesions by 64-slice computed tomography: a
comparative study with quantitative coronary angiography and intravascular
ultrasound. J Am Coll Cardiol, 2005. 46(1): p. 147-154.

二、中文部分
1.行政院衛生福利部統計處，103年度主要死因分析，2014，台北。
2.劉秉彥，陳志鴻，冠狀動脈疾病，科學發展，2002: 352; 48-53.
http://ejournal.stpi.narl.org.tw/NSC_INDEX/Journal/EJ0001/9104/9104-08.pdf
3.周愛卿，先天性心臟病心導管術，上海科學技術出版社，2009年，2月出版。
4.楊勝利，劉惠亮，心導管及冠心病介入診療手冊，人民軍醫出版社，2013年，3月出版。
4.行政院衛生福利部國民健康局，高血脂防治手冊，台北。
5.林幸榮醫師網路資料，http://wd.vghtpe.gov.tw/mre/ Fpage.action?muid=3012&fid=2104