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研究生:游秉勳
研究生(外文):Ping-Hsun Yu
論文名稱:Statin使用及到院前心跳停止病患預後之關聯性分析
論文名稱(外文):Statin and Outcomes in Patients Presenting with Cardiac Arrest: A Nationwide Cohort Study
指導教授:湯澡薰湯澡薰引用關係
指導教授(外文):Chao-Hsiun Tang
口試委員:陳文鍾陳怡樺
口試委員(外文):Wen-Jone ChenYi-Hua Chen
口試日期:2017-06-23
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:醫務管理學研究所
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:2017
畢業學年度:105
語文別:中文
論文頁數:82
中文關鍵詞:心跳停止statin一年存活
外文關鍵詞:statincardiac arrestone year survival
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研究目的:在冠心症、敗血症與缺血性中風發生前服用statin,對於疾病的預後有改善的效果。而突發性心跳停止的病患會有類似敗血症的的生理學反應。本文研究至急診時以心跳停止來表現的病患,是否在心跳停止前服用statin能改善其預後。

研究方法:本研究資料來源為『全民健康保險資料庫』全人口檔。以2004年至2011年資料庫篩選出在急診接受心肺復甦術的患者為分析對象,將病患分為在接受心肺復甦前30天連續使用statin與完全沒有使用statin兩群進行分析 。

研究結果:在使用傾向分數配對後的族群中,接受statin治療的患者,其一年存活率是沒有接受治療者的1.41倍(風險比=1.41,95%信賴區間=1.16-1.71,P≤0.01)。在次族群分析中,發現有糖尿病、慢性腎臟病與較高Charlson Comorbidity Index者,對於statin的治療特別的有反應。若在住院後停用statin,則其保護作用可能會變得不明顯。

結論:在心跳停止發先前30日使用statin,對於發生心跳停止的病患其預後有幫助,而此效果可以延續至一年,但若在住院後停用,則此保護作用可能會消失。

關鍵字:心跳停止、statin、一年存活
Background: Pretreatment with statins is associated with improved outcomes in severe sepsis, acute coronary syndrome, and stroke. Patients with cardiac arrest experience sepsis-like syndrome and ischemia reperfusion injuries in the heart and brain. The aim of this study was to investigate the effects of statin use before cardiac arrest on outcomes in patients presenting to emergency departments with cardiac arrest.

Methods: Medical records of 142,131 adult patients who experienced non-traumatic cardiac arrest and were resuscitated between 2004 and 2011 were retrieved from the Taiwan National Health Insurance Research Database (NHIRD). Patients were grouped into 2 groups: the “statin group” comprised patients who had received statin treatment for at least 30 days prior to the cardiac arrest event; the “non-statin group” comprised patients who had no statin use within 30 days before the event.

Results: Patients with prior statin treatment had better 1-year survival (4.8% vs. 3.2%; adjusted odds ratio 1.41, 95% confidence interval 1.16-1.71; p = 0.001) than patients in the propensity score-matched non-statin group. A favorable outcome effect of statin on one-year survival was observed in the presence of diabetes mellitus, chronic kidney disease, and Charlson Comorbidity Index score greater than 5 in the subgroup analysis. The beneficial effects of statins may become insignificant if statin use is discontinued after hospital admission.

Conclusion: Statin use before cardiac arrest is associated with one-year survival in cardiac arrest patients except for those with statin discontinuation after admission in a propensity score-matched nationwide cohort study.
致謝 i
中文摘要 ii
Abstract iii
目錄 v
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 8
第三節 研究之重要性 9
第二章 文獻探討 10
第一節 到院前心跳停止病患之流行病學 10
第二節 敗血症及到院前心跳停止病患之生理狀態及statin可能之作用 15
第三節 急性冠心症及突發性心跳停止之關聯性及statin可能在兩者之作用 22
第四節 statin對於神經之保護作用 31
第三章 研究方法 37
第一節 研究設計 38
第二節 研究架構 40
第三節 研究假說 41
第四節 研究對象 42
第五節 研究方式工具及操作型定義 43
第六節 資料蒐集 47
第七節 資料處理與統計方法 48
第四章 研究結果 49
第一節 病患篩選描述性統計分析 50
第二節 Statin的使用對於心跳停止病患預後影響之推論性統計分析 58
第三節 次分組分析 (subgroup analysis) 62
第四節心跳停止前後使用分析 65
第五章 討論 66
第一節 研究結果分析 66
第二節 假說驗證 71
第三節 研究限制 72
第六章 結論與建議 74
第一節 結論 74
第二節 建議 76
參考文獻 77
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