臺灣博碩士論文加值系統

研究動機研究重要性:
昏厥十分常見，有百分之二十到百分之五十的成人一生中曾經歷過至少一次的昏厥，昏厥必須與眩暈、昏迷、癲癇、頭暈、心因性猝死作鑑別診斷; 而眩暈與頭暈是耳鼻喉科門診常見症狀。血管迷走神經性昏厥是昏厥最常見的原因，雖然危險程度較低且有較好的預後，但發生年齡愈高卻有不好的預後，目前最常用來診斷血管迷走神經反應的方式是頭抬高傾斜試驗(head-up tilt test); 測試被用來評估無法解釋原因的昏厥病人。本研究亦可提供頭抬高傾斜試驗與臨床症狀相關性預測，及頭抬高傾斜試驗與身體質量相關，以為診斷參考。
研究方法與對象:
本研究採方便取樣，選定之研究受試者均來自醫院中區一醫學中心，心臟專科醫師安排此項檢查之患者，自93年7月至98年，共計有93名病患參與本研究，執行傾斜床試驗。描述性資料含研究對象基本資料，含:性別、年齡、疾病特性、血壓、心跳、身體質量，以百分比、平均值及標準差描述研究其分佈情形; 分為頭抬高傾斜試驗陽性組、頭抬高傾斜試驗陰性兩組，比較頭抬高傾斜試驗陽性反應及陰性反應兩組基準心跳、血壓有無差異，以t-test檢定; 頭抬高傾斜試驗陽性反應及陰性反應臨床症狀以卡方檢定; 頭抬高傾斜試驗陽性反應及陰性反應與臨床症狀多寡以卡方檢定。

結果: 共計有93名病患參與:男性41名女性52名平均年齡(53.29±18.85) 身高(161.7±8.74)體重(62.99±11.62) 患者全部進行BHUT檢查，陽性率為1%(1/93)。陰性患者中對92例進行SNHUT檢查，陽性率為67%(62/92) 兩組在性別、年齡、疾病特性、心跳並無顯著差異，臨床症狀中與噁心、嘔吐、心悸單一症狀並無顯著相關，而與眩暈有關(p=0.022) ，但頭抬高傾斜試驗陽性與臨床症狀多者有相關(p=0.001) 兩組在第六分鐘血壓、體重及身體質量確有差異(p<0.05) 身體質量並不影響檢查結果。

結論: 本研究發現頭抬高傾斜試驗陽性組身體質量國人(23.27±3.08)遠低於國外(36.9±3.9) ; 臨床症狀 以眩暈表現確實可預測頭抬高傾斜試驗陽性，與國外研究相符。頭抬高傾斜試驗除了對迷走神經性暈厥有重要診斷價值外，臨床症狀多者至少一項以上的患者中的診斷價值也值得重視。

Syncope is very common, and 20% to 50% of adults have experienced at least one times of syncope, syncope with dizziness, coma, seizures, dizziness. Cardiogenic cause is considered as a result of the differential diagnosis of sudden death. Vertigo and dizziness are common symptoms of ear-nose-throat clinic. Vasovagal syncope is the most common causes of syncope, although lower degree of risk and better prognosis, but the higher age has not occurred in the prognosis. The current test used to diagnose vasovagal reaction is the first elevation tilt test (head-up tilt test); the test was used to assess the causes of unexplained syncope. This study will also provide the tilt table test in their first time and predict the relevance of clinical symptoms, and head up tilt test, body mass associated with that diagnosis reference.
Research Methods and Objects:
In this study, convenience sampling, the study subjects were selected from the hospital in a medical center district, the heart specialist arrangements for the inspection of the patients, from July, 2004 to March, 2009, a total of 93 patients participated in this study tilt test implementation. Descriptive information on subjects including of gender, age, disease characteristics, blood pressure, heart rate, body mass, percentage, average and standard deviation to describe the distribution of study. Head up tilt table test is divided into positive, head up tilt table test negative for the two groups to compare up tilt test, the first positive and negative response to two sets of baseline heart rate, blood pressure difference between whether or not to test t-test; head up tilt test, positive and negative symptoms in chi-square test; head up tilt test, positive and negative reactions and clinical symptoms in the amount of chi-square test.

Results: A total of 93 patients to participate: 41 males 52 females mean age (53.29 ± 18.85) Height (161.7 ± 8.74) body weight (62.99 ± 11.62) for patients with all BHUT examination, the positive rate of 1% (1 / 93 ). Negative patients to 92 cases of SNHUT examination, the positive rate was 67% (62/92) the two groups in terms of gender, age, disease characteristics, no significant differences in heart rate, clinical symptoms with nausea, vomiting, heart palpitations do not have a single symptom significantly correlated with the vertigo-related (p = 0.022), but head up tilt table test positive with clinical symptoms are related to more (p = 0.001) groups in the sixth minute of blood pressure, weight and body mass do have differences (p <0.05) body mass does not affect the test results.

Conclusion: This study found that head up tilt testing positive people body mass (23.27 ± 3.08) much lower than abroad (36.9 ± 3.9); clinical symptoms to the performance of true vertigo predictable positive head up tilt table test, and study abroad line. Head up tilt test, in addition to vagal syncope has important diagnostic value, clinical symptoms were at least one more than the diagnosis of patients also deserved attention.

目 錄
頁次
英文縮寫 III
中文摘要 IV
英文摘要 VI
壹、導論 1
一、緒論 1
1. 研究動機 3
2. 研究重要性 4
3. 研究目的 5
二、文獻查證 6
1. 定義昏厥 6
2. 造成昏厥的主要機轉 6
3. 心源性昏厥 7
4. 血液流失 8
5. 頸動脈竇高度敏感 9
6. 姿勢性昏厥 9
7. 藥物引起的昏厥 10
8. 神經性昏厥 10
9. 精神性的昏厥 11
10.代謝性的昏厥,罕見的原因 13
11.診斷 13
12. 迷走神經性昏厥 20
13. 迷走神經性昏厥治療 21
14. 頭抬高傾斜試驗(head-up tilt test) 24
15. 自主神經系統與身體質量指數 27
貳、研究構想 31
參、研究材料與方法 32
一、研究設計 32
二、研究場所與對象 33
三、研究工具 34
四、研究步驟 34
肆、結果 36
ㄧ、試驗結果 36
二、相關因素分析 37
1. 藥物因素 37
2. 操作因素 38
3. 情緒緊張 38
4. 臨床護理 38
三、防範措施 38
伍、討論 40
陸、結論 46
柒、參考文獻 49
捌、表一 57
玖、圖 62
拾、附圖 63

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