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系統識別號 U0026-0302201815593200
論文名稱(中文) 住院高齡患者接受心肺復甦術後存活之流行病學及相關因子:以台灣健保資料庫為例
論文名稱(英文) Epidemiology and Associated Factors of Survival after Cardiopulmonary Resuscitation in Hospitalized Old Patients: Results of Taiwan's National Health Insurance Database
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 105
學期 2
出版年 106
研究生(中文) 黃基彰
研究生(英文) Chi-Chang Huang
學號 TC6034050
學位類別 碩士
語文別 中文
論文頁數 63頁
口試委員 指導教授-盧豐華
共同指導教授-張家銘
召集委員-邱靜如
中文關鍵字 高齡者  心肺復甦術  存活出院  一年存活 
英文關鍵字 Elderly  Cardiopulmonary resuscitation  survival to discharge  one year survival 
學科別分類
中文摘要 心肺復甦術(Cardiopulmonary Resuscitation , CPR)雖是標準治療心跳驟停的標準處置,過去國外大型流行病學資料顯示高齡長者經歷CPR急救存活出院的機會只有10~20%左右,而一年存活資料的探討資料則相對較少。然而臨床經驗中,有不少家屬決策者會表達,若是經急救可以存活出院甚至有機會一年存活,他們會願意施行心肺復甦術;但是若施行心肺復甦術只是延長死亡時間、痛苦或失能,多數的家屬會選擇放棄急救措施。由於亞洲過去這類流行病學資料較少,因此本研究利用健保資料庫設計回溯性世代研究(Retrospective cohort study)來了解台灣住院高齡患者經心肺復甦術急救後存活分析。在研究中可以發現高齡患者經歷CPR後存活出院的比率為10.93%,一年存活率下降到5.71%。存活出院的多變項邏輯式迴歸分析中,年齡、男性、較長急救時間、急救時心律非心室頻脈或心室纖維顫動、住院主診斷是惡性腫瘤、和急救前身上有灌食管路或氣切管路等因子都是降低存活出院的因子。其中又以急救超過10分鐘(OR:9.590, p=0.002)和癌症為住院主診斷(OR4.549,p=0.014)等原因對無法存活出院影響最大。降低一年存活的影響因子包括年紀≧90歲(OR:4.882, p=0.003),急救後需要氣切管路(OR:3.167, p=0.014)或是急救後新增管路數目(一種管路OR4.929, p=0.011、兩種管路OR為4.070, P=0.002, 三種OR 9.914, p<0.001),其中新增管路數目是關鍵因子。若感染症為住院主診斷則有較好的長期預後。藉由本研究可以提醒醫療人員對老年病患執行心肺復甦術時,多考慮急救的成效與相關因素。
英文摘要 SUMMARY
CPR is management for cardiac arrest. In the past, rate of survival to discharge after in-hospital cardiopulmonary resuscitation among the elderly was approximately 10%~20% in literature review. However, the long term outcome after CPR is rarely discussed. In clinical experience, most family wouldn’t choose implementation of CPR if the post-CPR results show increasing suffering or disability. We designed a retrospective cohort study to investigate the epidemiology and survival factors among hospitalized elderly adult after undergoing CPR. Our data showed the rate of survival to discharge after CPR was around 10.93% and one-year survival rate was 5.71%. Multiple logistic regressions revealed older age, male, longer duration of cardiac massage, main diagnosis of malignancy at admission, fatal ventricular arrhythmia, and nasogastric feeding tube associated with lower rate of survival to discharge after CPR. Among these factors, the time of cardiac massage over ten minutes (OR:9.590, p=0.002) and main diagnosis of malignancy at admission(OR4.549,p=0.014) were most important. The one-year survival after discharge decreased if elderly aged ≧ 90 years old, newly created tracheostomy after CPR, or increased numbers of new added medical tubes after CPR. Infection as main diagnosis of admission was associated better prognosis of long term survival. This study reminds health care professionals to consider the effectiveness and associated factors before implementation of CPR among hospitalized elderly patients.
Key words: Elderly, Cardiopulmonary resuscitation, survival to discharge, one year survival

論文目次 目錄
中文摘要 Ⅰ
Abstract Ⅱ
目錄 Ⅵ
圖目錄 Ⅶ
表目錄 Ⅶ
第一章 前言 1
第一節 研究背景 1
第二節 研究目的 2
第三節 名詞解釋 3
第二章 文獻回顧 5
第一節 健保資料庫的介紹及應用之優缺點 5
第二節 高齡住院患者經歷心肺復甦術急救後存活的流行病學概況 6
第三節 高齡住院患者急救後的長期存活、功能狀況及醫療利用 10
第四節 影響高齡住院病患心肺復甦術成效之相關因子 14
第五節 文獻總結 17
第三章 研究方法 19
第一節 研究架構與研究假設 19
第二節 資料來源、研究樣本與變項說明 20
第三節 分析方法 29
第四節 研究倫理 29
第四章 研究結果 30
第一節 研究對象流行病學概述 30
第二節 存活出院 34
第三節 長期存活 42
第五章 研究討論 48
第一節 流行病學差異探討 48
第二節 存活出院影響因子 49
第三節 長期存活影響因子 51
第六章 結論 54
第一節 總結 54
第二節 研究限制與未來方向 55
第七章 參考文獻 56
第八章 附錄 63
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