臺灣博碩士論文加值系統

目的：中風是世界各國造成死亡以及失能的主要原因，即使中風死亡率已經降低，但治療的負擔卻呈上升趨勢。中風後容易伴隨許多併發症，感染為其中一個不可忽視的議題，中風後因臨床狀況的影響與免疫力下降，使感染機率大增，一旦感染可能造成預後變差或是增加死亡率。因此，預防中風患者發生感染情況就顯得極為重要。比起給予預防性抗生素來預防感染疾病發生，目前傾向於以控制發炎反應、增強免疫力作為預防與治療中風後感染的手段，而針灸在調節身體免疫能力上有其特殊優勢，以針灸作為中風後功能障礙的輔助治療手段亦行之已久，但對於針灸作為預防中風後發生感染疾病的保護作用，相關研究極少，且研究樣本數不多。因此，本研究比較在中風患者中，有接受針灸治療與沒有接受針灸治療的患者群中，感染發生率是否有差異。藉此能更了解針灸治療對於中風患者是否有保護的效果。
方法：以2000年到2010年健保資料庫百萬歸人檔，找出初次中風患者，其中接受6次以上針灸治療為治療組，以頻率配對方式，配對出接受少於6次針灸治療的初次中風患者為對照組，比較追蹤兩組患者在中風後發生感染疾病的比例。
結果：接受針灸治療的中風患者感染的比例，相較對照組具有顯著較低風險(adjusted HR: 0.34, 95% CI: 0.25-0.45)，接受針灸治療組比對照組有較低的感染疾病累積發生率(p<0.001)。
結論：根據本研究結果，推測針灸治療可降低中風患者感染機率，但今後還需進一步研究。

Background：Stroke is a major cause of disability and death worldwide. Although the mortality rates of stroke have declined, the burden of stroke care has shown an upward trend. Complications are known to be common in stroke patients, especially infections, which can hinder functional recovery and are associated with higher mortality rates. When it mentions to the prevention of infection after stroke, it is much preferred to control the inflammation reaction and strengthen the immunity compared with using preventive antibiotics. Acupuncture has been used as the assistant treatment for functional impairment after stroke for a long time. Some studies have showed acupuncture could prevent or treat infection by regulating immune system. However, the sample size is usually small. Therefore, this research aims to study the correlation between acupuncture and the protection effect of post-stroke infection.
Methods：Using the Longitudinal Health Insurance Database 2000, we selected the newly stroke patients with who received at least 6 sessions of acupuncture treatment as our treatment group. Frequency match method was applied to select those who never or received less than 6 sessions of acupuncture as the control group. We compared the infection rate after stroke of two cohorts.
Results：The result indicates that the treatment group has a significant lower risk of getting infected after stroke (adjusted HR: 0.34, 95% CI: 0.25-0.45). There is a significant lower cumulative incidence of infection disease of acupuncture cohort compared with the control cohort (p<0.001).
Conclusions：Based on the results of the present study, suggesting acupuncture treatment can reduce the infection rate in post-stroke patients. However, further study is need in the future.

目錄 IV
圖目錄 V
表目錄 VI
中文摘要 1
第一章 前言 2
第二章 文獻探討 4
第一節 中風的治療 4
第二節 感染疾病 4
第三節 感染發生率 4
第四節 影響感染因素 5
第五節 中風後的免疫狀態 5
第六節 對抗中風後感染 6
第七節 中風的針灸治療 6
第八節 針灸與感染發生率 7
第三章 材料與方法 8
第一節 資據來源 8
第二節 醫療倫理 9
第三節 研究事件 9
第四節 統計分析 9
第四章 結果 10
第五章 討論 20
第六章 結論 23
參考文獻 24
ABSTRACT 32

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