臺灣博碩士論文加值系統

先前有些研究指出，主動脈直徑(Aortic diameter)的擴大會增加主動脈剝離(Aortic dissection, AD)及主動脈破裂(Aortic rupture, AR)的風險。然而有些研究指出，主動脈直徑的大小在急性(Acute) AD的發生所扮演的角色是有限的，而這方面的研究卻非常少見，因此本研究將探討主動脈直徑與急性A型AD的關聯性。
在本研究中，共調查了110位高雄醫學大學附設醫院心臟血管外科的急性A型AD接受手術的患者。在年齡方面，將這110位患者分成[<50歲]及[ >=50歲]兩個族群。本研究分別以Classic dissection與IMH為觀點及以年齡為觀點，探討IMH 患者與Classic aortic dissection患者的Body surface area (BSA), Aortic size index (ASI) 及主動脈的四個部位Middle ascending aorta (Mid AscA) ，Aortic root，Distal ascending aorta (Distal AscA) 和 Maximal diameter (Max Dm) 的直徑之間的差異。
收集資料包含110位患者的臨床症狀、人口統計學資料、病史及用CT測量3個部位的主動脈直徑。本研究使用統計分析套裝軟體SPSS for Windows 19.0中文視窗版進行描述性統計分析，計算百分比、平均值及標準差，並以獨立樣本t檢定來檢定組間的差異。

以年齡為觀點，本研究發現Age>= 50的患者和Age<50的患者
在主動脈直徑的最大差異值發生於Mid AscA 位置, 相差達4.19
mm，且達統計上的顯著差異(p=0.034)，但其他部位的直徑卻沒有統
計上的差異。
以Classic dissection或者IMH為觀點，發現IMH Group的Mid
AscA及Distal AscA的主動脈直徑較Classic group來的大，分別
相差達 2.82 mm和3.00 mm ，且達統計上的差異(p<0.05) ，此研究
結果是先前的文獻所未曾提出的。
許多文獻提出, 主動脈直徑大小並非是AD的唯一危險因子。高血壓、長期吸煙、有糖尿病病史者及結締組織疾病等也是AD的危險因子，有些患者甚至在更小的主動脈直徑發生A型AD，與本研究的研究結果頗相似。所以主動脈直徑與急性A型AD的關聯性值得進一步探討。

Some previous studies indicated that aortic enlargement can
increase the risk of aortic dissection (AD) and aortic rupture (AR). However, some studies reported that the role of aortic size plays in the incidence of acute AD is limited, and the related research is very rare. In this research, the relevance between aortic diameter and acute type A AD was investigated。
In this research, 110 acute type A AD patients who had undergone surgery in Kaohsiung Medical University were investigated. On the respect of age, those 110 patients were divided into two groups, i.e. [<50 years] and [> = 50 years old]. In viewpoint of the classic dissection and IMH as well as the age, the differences on aortic diameter at four positions, i.e. aorta middle ascending aorta (Mid AscA), aortic root diameter, distal ascending aorta (Distal AscA) and maximal diameter (Max Dm) between the classic dissection and IMH patients were investigated.
In viewpoint of age, this research found that the largest difference in aortic diameter between Age> = 50 patients and Age <50 patients occur at the Mid AscA position, the difference is 4.19 mm and is statistically significant (p = 0.034). No statistical significance was found for the other three positions, i.e. Aortic root, Dis AscA and Max Dm.
In viewpoint of classic dissection or IMH, it was found that the Mid AscA and Distal AscA diameters of IMH group are 2.82 mm and 3.00 mm respectively larger than those of classic group. In addition, the statistical results are significant (p <0.05). Similar results were not reported in the literature before.
Many studies suggested that aortic diameter size is not the only risk factor for AD. Hypertension, long-term smoking, diabetes and connectivity tissue disease are also risk factors for AD. Some patients with even smaller aortic diameter may still suffer Type A AD. Similar observations were found in this research. Therefore the relevance of aortic diameter with Acute Type A AD needs further exploration.

目錄
頁次
中文摘要………………………………………………………….. . I
英文摘要……………………………………………………………III
第一章 緒論
第一節 研究動機…………………………………………………………………1
第二節 研究目的…………………………………………………………………2
第三節 名詞註釋…………………………………………………………………2
第二章 文獻探討
第一節 主動脈解剖生理學.......................................................4
第二節 急性主動脈剝離概論...................................................6
第三節 急性主動脈剝離流行病學...........................................8
第四節 主動脈剝離的病理生理學.........................................10
第五節 主動脈剝離症的分類.................................................18
第六節 臨床表徵與診斷方法.................................................20
第七節 治療方法…………………………………………….28
第八節 治療結果…………………………………………….32
第九節 主動脈直徑與主動脈剝離………………………….33
第三章 研究方法
第一節 研究對象…………………………………………….38
第二節 資料處理和分析…………………………………….38
第四章 結果
第一節 研究對象基本資料.....................................................41
第二節 AD患者主動脈發生剝離時的主動脈直徑…..........43
第三節 Classic dissection與IMH患者的Aortic
diameter之差異性..…………………………………44
第四節 急性Type A AD患者於50歲(含) 以上及
50歲以下的Aortic diameter之差異……………….45
第五章 討論
第一節 主動脈直徑與主動脈剝離……………………. ….47
第二節 不同型態的AD及年齡與主動脈直徑的關係…...48
第三節 ASI與主動脈剝離/破裂的關聯性………………..49
第四節 主動脈剝離的致病因子…………………………...50
第六章 結論……………………………………………………….52
參考文獻…………………………………………………………….55




表目錄

表1受試者基本資料………………………………………………………………………………..41
表2 110位有效AD樣本的Clinical data……………………....................42
表3 AD患者主動脈不同部位之尺寸……………………………………………43
表4 AD患者Aortic diameter大於5.5公分及小於5公分
的比例 (n=110)……………………………………………………………………..44
表5典型與非典型AD患者主動脈不同部位Aortic diameter
的t檢定………………………………………………………………………………..44
表6 Classic dissection與IMH患者ASI 的 t檢定……………………….45
表7年齡50歲上下之AD患者的Aortic diameter
之t檢定結果………………………………………………………………………..46

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二、教科書部份:
1.Braunwald Textbook of Cardiovascular Medicine- 8th Edition, 2010出版社：Philadelphia: Saunders/Elsevier。
2.Sabiston Textbook of Surgery- 18th Edition, 2008出版社：Philadelphia: Saunders/Elsevier。
3.Clinically Oriented Anatomy- 15th Edition, 2010出版社：藝軒圖書出版社。