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研究生:游雅茹
研究生(外文):YU,YA-JU
論文名稱:門診高血脂伴隨心房顫動病患,使用不同降血脂和新型口服抗凝血藥物組合,預防中風成效之住院追蹤世代研究
論文名稱(外文):Assessment on effectiveness and safety of different combinations of hypolipidemic and novel oral anti-coagulant drugs to prevent stroke in outpatients with hyperlipidemia and atrial fibrillation – A Retrospective Cohort Study in Taiwan
指導教授:朱基銘朱基銘引用關係
指導教授(外文):Chu, Chi-Ming
口試委員:簡戊鑑高立庭彭家勛謝士明朱基銘
口試委員(外文):Chien, Wu-ChienKao, Li-TingPeng, Giia-SheunShieh, Shyh-MingChu, Chi-Ming
口試日期:2021-04-07
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2021
畢業學年度:109
語文別:中文
論文頁數:137
中文關鍵詞:健保資料庫高血脂心房顫動中風statin藥物口服抗凝血藥物新型口服抗凝血藥物
外文關鍵詞:Health insurance databaseHyperlipidemiaAtrial fibrillationStrokeStatinsOral anticoagulantNovel oral anticoagulant
相關次數:
  • 被引用被引用:0
  • 點閱點閱:21
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一、正文目錄
圖表目錄 I
表目錄 II
附錄目錄 III
中文摘要 IV
Abstract VI
第壹章 緒論
第一節、 研究背景 1
第二節、 研究動機與重要性 4
第三節、 研究目的 7
第貳章 文獻探討
第一節、 腦血管疾病及腦中風疾病 8
第二節、 高血脂及臨床藥物治療指引 12
第三節、 心房顫動及臨床藥物治療指引 24
第參章 研究方法
第一節、 研究架構 44
第二節、 研究假設 46
第三節、 研究材料與方法 50
第四節、 變項操作型定義 55
第五節、 資料處理及統計方法 57
第肆章 研究結果 59
第伍章 討論
第一節、 研究假設驗證-單變項分析模式 96
第二節、 研究假設驗證-多變項分析模式 98
第三節、 綜合討論與結論 103
第陸章 優劣勢與建議 109
第柒章 參考文獻 112
附錄
二、圖表目錄
圖1、世界衛生組織年報統計2 0 1 6 之十大死因 2
圖2、1 0 8國人死因統計十大死因死亡人數及死亡率 2
圖3、TO A S T c l a s s i f i c a t i o n 11
圖4、A F與非A F 患者心血管死亡率及中風累積事件發生 12
圖5、高膽固醇患者在區域及高低收入國家間差異 13
圖6、2 0 1 8 A H A / A C C 血脂治療指引流程圖 18
圖7、血中膽固醇的合成及分解路徑 19
圖8、S t a t i ns類藥物作用機轉 20
圖9、各s t a t i n 藥物動力學相關資料 21
圖10、S t a t i n s 藥物強度 21
圖11、S t a t i n s 與L D L 對特定病因死亡率的影響 24
圖12、F r a m i n g h a m H e a r t S t u d y 26
圖13、凝血級聯機制 32
圖14、各N O A C s 標準常用日劑量 35
圖15、大型國際相關臨床試驗統整 36
圖16、研究架構圖 45
圖17、串檔流程圖 52
圖18、研究流程圖 54
三、表目錄
表1、2 0 1 7 年台灣高風險病人血脂異常臨床治療指引 17
表2、各statin 劑量與強度表 22
表3、心房顫動類型 27
表4、C H A D S 2 s c o r e 細項及分數 30
表5、C H A 2 D S 2 - VA S c s c o r e 細項及分數 31
表6、據CHADS2 score 使用抗血栓劑之建議 37
表7、據CHA2DS2-VASc score 使用抗血栓劑之建議 37
表8、用於非瓣膜性心房纖維顫動病患健保規範 38
表9、全民健康保險資料承保檔 51
表一、 有無使用口服抗凝血藥物-兩組患者基本特性 60
表二、 Wa r f a r i n 與N O A C s 兩組患者基本特性 63
表三、 N O A C s合併rosuvastatin 或atorvastatin-4 組患者基本特性 66
表四、 依患者有無使用口服抗凝血藥物之2 組-追蹤成效 71
表五、 使用傳統口服抗凝血藥物或N O A C s之追蹤成 73
表六、 不同N O A C s合併rosuvastatin 或atorvastatin- 共4 組 74
表七、 比較不同藥物分組後續缺血性腦中風 78
表八、 比較不同藥物分組後續短暫性腦缺血 80
表九、 比較不同藥物分組後續靜脈栓塞 82
表十、 比較不同藥物分組後續出血性事件 85
表十一、 比較不同藥物分組後續輸血 87
表十二、 比較不同藥物分組後續服藥後一年內死亡 88
表十三、 比較不同藥物分組後續服藥後死亡 89
表十四、 比較不同藥物分組後續是否使用加護病房 91
表十五、 比較不同藥物分組後續住院天數 93
表十六、 比較不同藥物分組後續醫療費用 94
四、附錄目錄
附表一、 降血脂藥物健保代碼 126
附表二、 口服抗凝血藥物健保代碼 127
附表三、 抗血小板藥物健保代碼 128
附表四、 有無使用口服抗凝血藥-事件發生率 130
附表五、 傳統與新型口服抗凝血藥物-事件發生率 130
附表六、 不同種新型口服抗凝血併用statins 藥物-共四組 132
附表七、 比較不同藥物分組後續用藥天數 133



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