臺灣博碩士論文加值系統

在臨床上，肌少症與心臟術後三十天內的死亡率顯著相關，以及肌少症病患在心臟術後的住院天數顯著較長，然而，肌少症病患在心臟術後長期的身體功能恢復情形是否與非肌少症病患有所差異，尚待證實。故本研究目的為（一）探討心臟手術病人術前存有肌少症之現況；（二）探討肌少症組、非肌少症組的加護病房及總住院天數、一年內死亡率是否有所差異；（三）探討肌少症組與非肌少症組在一年內身體功能變化量，是否有所差異。
本研究為國科會贊助「老年心臟手術病患術後功能恢復和其影響因子的長期追蹤研究」之子計畫，收案期間自民國102年2月自106年4月，資料庫共312位，其中5位取消手術，65位未完成肌少症評估（握力、行走速度、肌肉質量），故符合收案者共242位，在術前(T0)蒐集研究對象之基本資料表、疾病特性、握力、五公尺內行走速度，以及術前身體功能─基礎日常功能、身體活動量、握力、六分鐘行走距離，並在術後一個月(T1)、術後三個月(T2)、術後六個月(T3)、術後十二個月(T4)再次測量基礎日常功能、身體活動量、握力、六分鐘行走距離。使用Mann Whitney U test比較肌少症、非肌少症組間術後四個時間點之基礎日常功能、身體活動量、握力、六分鐘行走距離之變化量是否有顯著差異，其顯著水準設為0.05。
結果顯示（一）術前存有肌少症的病患共54位(22%)，肌少症病患年齡顯著較高、身體質量顯著較低、EuroSCORE分數顯著較高、女性比率顯著較高、無抽菸者比率較高、罹患腎臟疾病比率顯著較高，在術前的身體功能上，肌少症的基礎日常功能、身體活動量、握力、六分鐘行走距離皆低於非肌少症。（二）肌少症組的加護病房住院天數(5 vs 3天)、總住院天數(20 vs 15天)顯著高於非肌少症組，肌少症組的一年內死亡率與非肌少症組相比，無顯著差異。（三）身體變化量：肌少症組的術後十二個月的身體活動變化量顯著低於非肌少症組(584 vs 1808 MET·min/week, p=0.004)，反之，肌少症組在術後一、三、六、十二個月的基礎日常功能變化量、握力變化量、六分鐘行走距離變化量與非肌少症組相比，均無顯著差異。
這些結果顯示固然肌少症病人在術後住院期間需要較長的時間以恢復至可穩定出院的狀態，但是，肌少症病患在一年內的死亡率及身體功能變化量上，與非肌少症病患是相當的，因此在臨床上，不應該將肌少症當作執行心臟手術的排除條件。

Background: Sarcopenia is identified as a predictor of length of hospital stay (LOS) and 30-day mortality after cardiac surgery. The impact of sarcopenia on functional changes in one-year after cardiac surgery remained unknown.
Methods: We conducted a prospective cohort study to evaluate physical functions, preoperatively and 1, 3, 6, 12 months postoperatively, in 242 adult patients (≥ 20 years) who undergoing cardiac surgery. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria - lean mass index (LMI), grip strength (GS), and 5-meter walking speed was assessed before surgery. Primary outcomes were changes from presurgical baseline to postoperative follow-ups in activity of daily living (ADL) measured by Barthel index, physical activity (PA) measured by international physical activity questionnaire-short form in MET·min/week, grip strength (GS) in kg, walking distance measured by 6-minute walking test. Secondary outcomes included length of ICU stay, LOS and one-year mortality. All outcomes were compared between sarcopenia and non-sarcopenia groups.
Results: Among 242 participants enrolled between Feburary 2013 and April 2017, sarcopenia presented in 22.3% (n=54) of our sample. The patients with sarcopenia were significantly older, having lower BMI, having higher EuroSCORE, and more dominated in women, patients with renal disease and non-smokers. Pre-surgically, all functional measures scored lower in sarcopenia group compared to non-sarcopenia group. Surprisingly, changes in functional status at 1, 3, 6, and 12 months postoperatively were not significantly differed between sarcopenia and non-sarcopenia groups in changes of ADL scores, grip strength, and walking distance from the presurgical baseline. On the other hand, PA changes of sarcopenia group weren’t significantly less until at 12 months [583.7 vs 1808.0 MET·min/week, p=0.004]. Nevertheless, the mean lengths of ICU and hospital stay were significantly longer for sarcopenia group [4.8 days vs 2.9 for non-sarcopenia group, p=0.03; 20.2 days vs 15.4, p=0.02]. But 1-year morality rate was not differed between sarcopenia and non-sarcopenia group [3.7% versus 3.2%, p=0.85].
Conclusions: Although the hospital duration was significantly longer for sarcopenia, the long-term surgical benefit of sarcopenia patients was comparable to non-sarcopenia. Sarcopenia is not a restriction for cardiac surgery.

中文摘要 i
Abstract iii
圖目錄 vi
表目錄 vii
第一章 緒論 1
第一節 研究動機及重要性 1
第二節 研究目的 2
第三節 名詞界定 3
第二章 文獻查證 4
第一節 肌少症的定義與成因 4
第二節 肌少症與心血管疾病之關聯 7
第三節 肌少症的量測 9
第四節 肌少症的預後 12
第三章 研究方法 13
第一節 研究設計 13
第二節 研究假設 15
第三節 研究架構 16
第四節 研究對象與場所 17
第五節 研究工具 18
第六節 資料處理及分析 22
第七節 研究倫理考量 23
第四章 研究結果 24
第一節 研究對象之基本屬性、手術相關資料 26
第二節 肌少症的盛行率與其基本屬性、手術相關特性分析 27
第三節 肌少症組與非肌少症組之住院天數、一年內累積死亡率 31
第四節 肌少症組與非肌少症組的術後十二個月內身體功能分析 32
第五章 討論 40
第一節 心臟手術病人術前存有肌少症現況、基本屬性、疾病屬性探討
40
第二節 肌少症與非肌少症之加護病房住院天數、總住院天數、 術後一年內累積死亡率探討 43
第六章 結論與建議 48
第一節 結論與建議 48
第二節 研究限制 49
第三節 參考資料 50

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