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系統識別號 U0026-0102201911425100
論文名稱(中文) 急性心肌梗塞病人之急性及前驅症狀與病人有關的院前延遲時間之相關性
論文名稱(英文) Relationship between acute, prodromal symptoms and patient-related delay time in patients with acute myocardial infarction
校院名稱 成功大學
系所名稱(中) 護理學系
系所名稱(英) Department of Nursing
學年度 107
學期 1
出版年 108
研究生(中文) 吳柏勳
研究生(英文) Bo-Hsun Wu
學號 T26041055
學位類別 碩士
語文別 中文
論文頁數 91頁
口試委員 指導教授-陳幸眉
口試委員-邱艷芬
口試委員-詹世鴻
中文關鍵字 前驅症狀  病人有關的院前延遲時間  急性心肌梗塞 
英文關鍵字 prodromal symptoms  patient-related delay time  acute myocardial infarction 
學科別分類
中文摘要 本研究旨在探討急性心肌梗塞病人急性及前驅症狀與病人有關的院前延遲時間之相關,採橫斷式、結構性問卷於2018年02月至2018年09月於南部某醫學中心,針對由急診入院的急性心肌梗塞病人進行資料收集,共收案121位。研究工具係以「Mcsweeney Acute and Prodromal Myocardial Infarction Symptom Survey」及「症狀、決策就醫的時間點」進行前驅症狀、急性症狀及病人有關的院前延遲時間之測量。所得資料以SPSS 22.0統計軟體進行分析,統計方法為描述性分析、卡方檢定、獨立性t檢定、單因子變異數分析、皮爾森相關與逐步迴歸等推論性統計,p < .05為統計判斷標準。
研究結果顯示:前驅症狀發生率83.5%,男性多以左胸痛、女性多以小腿及頭痛強度增加、及小於65歲者多以胸部中間疼痛及異常疲倦表現;前驅症狀有胸痛、呼吸困難或上肢不適症狀者,在急性症狀也多出現相同症狀。前驅症狀與年齡呈正相關,在無高血脂者得分較高。病人有關的院前延遲時間之中位數0.5小時,佔院前總延遲時間的40.1%,高血脂者有較短的院前延遲;前驅症狀與病人有關的院前延遲時間呈顯著正相關 (r = .20, p < .05),經逐步迴歸分析發現其可解釋3.3%的與病人有關的院前延遲時間。
本研究結果建議,前驅症狀有預測急性心肌梗塞之價值,建議未來針對心肌梗塞高風險族群或有病史者之衛教,應包含急性及前驅症狀的認識及處理;在研究部分,可朝其他可能影響病人有關院前延遲之因子,及決策就醫後的過程進行調查,以期改善病人有關的院前延遲時間。
英文摘要 SUMMURY
The study aimed to investigate the relationship between acute and prodromal symptoms and patient-related delay time in patients with acute myocardial infarction. A cross-sectional research design and a structural questionnaire were used and data were collected from February to September 2018 in a medical center located in Southern Taiwan. Instrucments included Mcsweeney Acute and Prodromal Myocardial Infarction Symptom Survey, and time points of acute symptoms onset and treatment seeking to mesure prodromal symptoms and patient-related delay time. Descriptive data included frequency, percentage, mean, median, and standard deviation, and inferential analysis were determined by p < .05 including independent t-tests, one-way ANOVA, Pearson correlation analysis, chi-square tests, and stepwise liner regression analysis. A total of 121 cases were recruited. The results showed that the incidence of prodromal symptoms was 83.5%. Furthermore three prodromal symptoms, chest pain, short of breath and upper limb pain had same presentation on acute symptoms. Prodromal symptoms was positively correlated with age, and participants without hyperlipidemia had higher prodromal symptoms and longer delay time. The median patient-related delay time in our study was 0.5 hours, and counted 40.1% of the total pre-hospital delay time. Patient-related delay time was significantly positively correlated with prodromal symptoms (r = .20, p < .05). According to the results of this study, the prodromal symptoms may have the value of predicting acute myocardial infarction. It is recommend that the future education for myocardial infarction patient, especially high-risk group should include the understanding of and how to deal with acute and prodromal symptoms.
Key word: prodromal symptoms, patient-related delay time, acute myocardial infarction


INTRODUCTION
Acute myocardial infarction (AMI) is one of the leading causes of death and disability in the world. Myocardial infarction is caused by a complete obstruction of the coronary arteries, leading to myocardial necrosis. The sooner revascularization, the patient can have a better prognosis and also reduce the cost of medical care. Under the door-to-balloon guidelines, it is effective to shorten the time to complete primary PCI in the hospital. But Menees et al. (2013) indicated that the mortality is unchanged even door-to-balloon time is declined. Thus the suggestion form Taiwan Society of Emergency Medicine is to shorten the prehospital ischemia time is more important and it may be helpful to improve clinical outcomes.The prehospital ischemia time is also called prehospital delay time, it devides to patient-related and system delay. The crucial part for prehospital delay is patient-related delay. Previous studies had shown patient-related delay may influence by symptoms. Haung et al. (2011) indicated that prodromal symptoms could predict the attack of acute myocardial infarction and may prolong the patient-related delay time. Until now, little is known about the relationship between prodromal symptom and patient-related delay time in Taiwan. Therefore, the purpose of this study was to investigate the relationship between prodromal symptoms and patient-related delay time.

MATERIALS AND METHODS
he study was conducted in a coronary vascular ward in the southern medical hospital. The researcher approached patients by emergency triage system who diagnosed ST-segment elevation myocardial infarction and non ST-segment elevation myocardial infarction by the emergency physician. All participants were with clear consciousness, more than 20 years olds and they could communicate in Chinese and Taiwanese. The only exclusion criteria was patients diagnosed by a physician with a mental disorder or cognitive dysfunction. The researcher met the participants to complete questionnaires when their conditions were stable and transfered to cardiovascular ward, and all interviews were conducted in 10 to15 minutes. The questionnaire included demographic data, acute symptoms, prodromal symptoms, times for acute symptom onset and treatment-seeking, and clinical outcomes. Prodromal symptoms were collected by McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS), it has good test-retest reliability on original scale development. The KR-20 and Cronbach's α for internal consistency reliabilities in this study were .59 and .74, respeactively. The time for acute symptom onset and treatment-seeking time were calculated based on self-reported data. All data were analyzed by SPSS 22.0 software. Descriptive data included frequency, percentage, mean, median, and standard deviation. Inferential analysis included independent t-tests, one-way ANOVA, Pearson correlation analysis, chi-square tests, and stepwise liner regression analysis.

RESULTS AND DISCUSSION
This study found that the patient related delay time was significantly positively correlated with the prodromal symptom score, suggesting the greater the prodromal symptoms, the longer the delay time is. Women had higher prodromal symptoms than men. Men had more left chest pain, while women often showed pain or discomfort in the leg and increased headache intensity. Likewise, participants with hyperlipidemia had a shorter delay time than those without. Higher age had fewer prodromal symptoms. For those non-elderly patients, they often presented with pain or discomfort in the chest and unusual fatigue. It appears that the prodromal symptoms are mostly clustered and may affect each other. For example, unusual fatigue may be accompanied by sleep disorders and lack of appetite. Likewise, participants had more prodromal symptoms experienced, they also experienced greater numbers of acute symptoms, such as chest pain, shortness of breath, and upper limb discomfort.
The median patient-related delay time was 0.5 hours and accounted for 40.1% of total pre-hospital delay time. A stepwise liner regression analysis found that prodromal symptoms could explain 3.3% of variance in patient-related delay time. The result suggested the need to investigate other important influence factors of patient-related delay time.
Overall, findings from this study recommend that public's awareness should be strengthened on prodromal and acute symptoms. Future research on how patients dealing with the symptoms is needed.
論文目次 中文摘要 II
英文摘要 IV
SUMMURY IV
INTRODUCTION V
MATERIALS AND METHODS V
RESULTS AND DISCUSSION VI
致謝 VII
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機與重要性 3
第三節 研究目的 6
第四節 研究架構 7
第五節 名詞定義 8
一、前驅症狀 (Prodromal symptoms) 8
二、急性症狀 (Acute symptoms) 8
三、病人有關的院前延遲時間 (patient related delay, PRD) 9
四、臨床結果 10
第二章 文獻查證 11
第一節 急性心肌梗塞概論 11
第二節 急性心肌梗塞之前驅症狀 16
第三節 病人有關的院前延遲時間 20
第四節 急性心肌梗塞前驅症狀與急性症狀之相關 23
第五節 急性心肌梗塞前驅症狀與病人有關的院前延遲時間之相關 24
第六節 病人有關的院前延遲時間與臨床結果之相關 26
第三章 研究方法 27
第一節 研究設計 27
第二節 研究場域及對象 27
第三節 研究工具 28
第四節 研究步驟與資料收集 32
第五節 資料處理與分析 33
第六節 研究倫理 34
第四章 研究結果 35
第一節 急性心肌梗塞病人之人口學特性及疾病變項描述分析 35
第二節 急性心肌梗塞病人前驅症狀、急性症狀之經歷 37
第三節 病人有關的院前延遲時間 41
第四節 臨床結果 42
第五節 前驅症狀及病人有關的院前延遲時間於人口學變項之差異 44
第六節 前驅症狀及病人有關的院前延遲時間於疾病變項之差異 47
第七節 前驅症狀及病人有關的院前延遲時間於有無急性症狀之差異 48
第八節 前驅症狀及病人有關的院前延遲時間於臨床結果之差異 50
第九節 前驅症狀及病人有關的院前延遲時間在連續性人口學、疾病變項、急性症狀及臨床結果之相關 51
第十節 影響病人有關的院前延遲時間之重要預測因素 55
第五章 討論 56
第一節 急性心肌梗塞病人的前驅症狀 56
第二節 前驅症狀在急性症狀之表現 59
第三節 急性心肌梗塞病人有關的院前延遲時間 59
第四節 病人有關的院前延遲時間之重要預測因素 62
結論 64
參考文獻 67
附錄 85
附錄一 急性心肌梗塞前驅症狀MAPMISS使用同意書 85
附錄二 正式收案問卷 86
附錄三 人體試驗委員回臨床研究核准函 91
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