臺灣博碩士論文加值系統

中文摘要
背景
中風造成了世界性的醫療負擔。目前還沒有單一的復健方法可以很嚴謹的證明其對中風後遺症的效果。這個結果促使人們去尋找其他的治療方式，企圖進一步提高中風後復健的效果，如針灸和中藥。
研究目的
評估傳統中醫治療在中風後遺症門診患者的療效。
研究方法
在南台灣的一家中醫教學醫院採病歷回顧及縱貫性研究。以巴氏量表和美國國家衛生研究院中風評估表為評估方法，進行統計分析。
研究結果
在傳統中醫治療後，中風患者的日常生活活動和神經功能缺損有顯著的進展。相對於針灸次數8次以下，在相鄰的兩次評估間，針灸次數25次以上在美國國家衛生研究院評估表中右下肢進步的分數是較多的，且在統計學上達到顯著。
結論
建議25次以上的針灸治療，有助於中風後遺症復健。但仍需更進一步的研究傳統中醫治療對於中風後遺症的效果。

Abstract
Background
As one of the leading causes of death, strokes contribute to a worldwide health care burden. There is still no single rehabilitation intervention demonstrated unequivocally to aid recovery. This reality drives people to search for other modalities of treatment in an attempt to further improve the outcome of stroke rehabilitation, such as acupuncture and Chinese herb medicine.
Objective
Assess the efficacy of traditional Chinese medicine treatment on stroke outpatients.
Methods
We reviewed the charts of stroke patients from Kaohsiung Municipal Chinese Medicine Hospital between January 1, 2010 and December 31, 2012. We used Barthel Index and the U.S. National Institutes of Health Stroke Scale for outcome measures and statistical analysis. This is a chart review, retrospective, and longitudinal study.
Results
After intervention with traditional Chinese medicine, the activities of daily living and neurological deficits of stroke patients improved significantly. Between two adjacent assessments, Right Leg, the subscale of NIHSS progressed significantly by increasing acupuncture sessions in stroke outpatients. The improvements of Right Leg scores in NIHSS were significantly in patients received more than 25 acpuncture sessions, compared to those with less than 8 sessions.
Conclusion
Further research to explore the efficacy of traditional Chinese medicine treatment in post-stroke rehabilitation is needed.

目錄
第一章 緒論…………………………………………………………………………1
第一節 研究背景………………………………………………………………1
第二節 研究動機………………………………………………………………3
第三節 研究目的………………………………………………………………5
第二章 文獻回顧……………………………………………………………………6
第一節 針灸在中風的治療……………………………………………………7
第二節 中藥在中風的治療 …………………………………………………12
第三章 研究方法 …………………………………………………………………13
第一節 研究設計……………………………………………………………13
第二節 研究對象……………………………………………………………14
第三節 治療方案……………………………………………………………16
第四節 結果測量……………………………………………………………18
第五節 統計分析……………………………………………………………20
第四章 研究結果…………………………………………………………………21
第一節 人口統計特質………………………………………………………21
第二節 巴氏量表……………………………………………………………25
第三節 美國國衛院腦中風評估表…………………………………………31
第四節 成對樣本t檢定……………………………………………………37
第五節 混合模式……………………………………………………………42
第五章 討論與結論………………………………………………………………49
第一節 描述性統計結果討論………………………………………………49
第二節 混合模式……………………………………………………………53
第三節 結論…………………………………………………………………54
參考文獻…………………………………………………………………………55

參考文獻

Chen, C.C., Lee, H.C., Chang, J.H., Chen, S.S., Li, T.C., Tsai, C.H., et al. (2012). Chinese Herb Astragalus membranaceus Enhances Recovery of Hemorrhagic Stroke: Double-Blind, Placebo-Controlled, Randomized Study. Evidence-Based Complementary and Alternative Medicine. Volume 2012, Article ID 708452, 11 pages.

Gosman-Hedstrom, G., Claesson, L., Klingenstiema, U., Carlsson, J., Olausson, B., Frizell, M., et al. (1998). Effects of acupuncture treatment on daily life activities and quality of life: a controlled, prospectie, and randomized study of acute stroke patients. Stroke. 29(10), 2100-2108.

Granger, C.V., Hamilton, B.B.,& Gresham, G.E. (1988). The stroke rehabilitation outcome study–Part I:general description. Arch Phys Med Rehabi. 69, 506–509.

Hsieh, F.I., Lien, L.M., Chen, S.T., Bai, C.H., Sun, M.C., Tseng, H.P., et al. (2010). Get With The Guidelines-Stroke Performance Indicators: Surveillance of Stroke Care in the Taiwan Stroke Registry Get With The Guidelines-Stroke in Taiwan. Circulation. 122(11), 1116-1123.

Hu, H.H., Chung, C., Liu, T.J., Chen RC., Chen CH., Chou P. ,et al.(1993). A randomized controlled trial on the treatment for acute partial ischemic stroke with acupuncture. Neuroepidemiology. 12(2), 106-113.

Johansson, B.B., Haker, E., Arbin, M.V., Brittion, M., Langstrom, G., Terent,A., et al. (2001). Acupuncture and transcutaneous nerve stimulation in stroke rehabilitation: a randomized, controlled trial. Stroke. 32(3), 707-713.

Johansson, K., Lindgren, I., Widner, H., Wiklund, I., & Johansson, B.B. (1993).Can sensory stimulation improve the functional outcome in stroke patients? Neurology. 43(11), 2189-2192.

Kjendahl, A., Sallstrom, S., Osten P.E., Stanghelle, J.K., & Borchgrevink, C.F. (1998). Acupuncture in stroke. Tidsskr Nor Laegeforen. 118(9), 1362-1366.



Liao, C.C., Lin, J.G., Tsai, C.C., Lane, H.L., Su, T.C., Wang, H.H., et al. (2012). An Investigation of the Use of Traditional Chinese Medicine in Stroke Patients in Taiwan. Evidence-Based Complementary and Alternative Medicine. Volume 2012, Article ID 387164, 8 pages.

Lyden P.D., Lu M.,& Levine S.R. (2001). A modified National Institutes of Health Stroke Scale for use in stroke clinical trials: preliminary reliability and validity. Stroke. 32, 1310–1317.

Park, J., White, A.R., James, M.A., Hemsley, A.G., Johnson, P., Chambers, J., et al. (2005). Acupuncture for subacute stroke rehabilitation: a Sham-controlled, subject- and assessor-blind, randomized trial. Complementary Medicine. 165(17), 2026-2031.

Pei, J., Sun, L., Chen, R., Zhu, T., Qian, Y., & Yuan, D. (2001). The effect of electro-acupuncture on motor function recovery in patients with acute cerebral infarction: a randomly controlled trial. J Tradit Chin Med. 21(4), 270-272.

Pierce, L., Rodrigues, Fisher, L., & Buettuer, M. (1995). Frequently selected nursing diagnoses for the rehabilitation client with Stroke. Rehabilitation Nursing. 20(3), 138-143.

Rabinstein A.A., & Shulman L.M. (2003). Acupuncture in clinical neurology. Neurologist. 9(3), 137-148.

Sallstrom, S., Kjendahl, A., Osten, P.E., Stanghelle, J.K., & Borchgrevink, C.F.(1995). Acupuncture therapy in stroke during the subacute phase. A randomized controlled trial. Tidsskr Nor Laegeforen. 115(23), 2884-2887.

Sze, F.K., Wong, E., Or, K.K., Lau, J., & Woo, J. (2002). Does acupuncture improve motor recovery after stroke? A menta-analysis of randomized controlled trials. Stroke. 33(11), 2604-2619.

Wei, Y.C., Sun, M.F., Chang , K.C., Chang C.J., Hung, Y.C., Lin, Y.J., et al. (2011) Pilot Scheme of Health Policy in Stroke Adjuvant Acupuncture Therapy for Acute and Subacute Ischemic Stroke in Taiwan. Evidence-Based Complementary and Alternative Medicine. Volume 2011, Article ID 689813, 9 pages.


World Health Organization. (2002). Acupuncture: Review and Analysis Reports on Controlled Clinical Trials. Geneva, Switzerland: WHO.

World Health Organization. (2004). Global Burden of Disease: Statistics. Geneva, Switzerland: WHO.

Wu, H.M., Tang, J.L., Lin, X.P., Lau, J. T., Leung, P.C., Woo, J., &Li Y.(2009) .Acupuncture for stroke rehabilitation. The cochrane collaboration Library, Issue 1, 1-24.

Wu, P., Mills, E., Moher,D., and Seely,D. (2010). Acupuncture in poststroke rehabilitation: a systematic review and meta-analysis of randomized trials. Stroke. 41(4), e171-e179.

史麗珠、彭佩宜、高鳳聲、蘇靖鈞、鄭蕙君、李幸禧（2000）。北部某大學學生的求醫行為：中西醫之選擇。秀傳醫學雜誌，2（4），151-159。

胡漢華 (主編)（2008）。台灣腦中風防治指引。台北市：台灣腦中風學會。

陳昭星（2005）。民眾求醫行為之研究-以彰化醫療次區域為例。國立中山大學高階經營碩士論文，未出版，高雄市。

楊蕙雯（2009）。腦中風之障礙與失能評估量表簡介。台北市醫師公會會刊，2009年第53卷第10期，20-23。