https://scholars.lib.ntu.edu.tw/handle/123456789/188174
標題: | 急性心肌梗塞病人健康相關生活品質及調整品質後存活分析(2/2) | 作者: | 廖朝崧 | 關鍵字: | 健康相關生活品質;急性心 肌梗塞;調整品質後存活人年;Survival analysis;Acute myocardial infarction;Quality adjusted life expectancy | 公開日期: | 2002 | 出版社: | 臺北市:國立臺灣大學醫學院內科 | 摘要: | 台灣老化的人口結構,勢必使動脈硬 化性疾病成為未來疾病與公共衛生工作的 主流。目前動脈硬化性疾病的研究,著重 在早期動脈硬化的偵測及其相關危險因子 的介入治療,以預防心臟血管疾病的發生。 我們由台大病歷室回溯性篩選出 75-88 年間符合收案標準之急性心肌梗塞 病人,於九十年底,我們完成了台大醫院 急性心肌梗塞病人調查問卷,完成建檔者 有1600 人納入研究族群。我們準備用世界 衛生組織之生活品質問卷(WHOQOL),以 台大醫院急性心肌梗塞病人之追蹤世代, 做健康相關生活品質(HRQL)的調查。我們 本來要以台大醫院急性心肌梗塞病人之追 蹤世代,發展急性心肌梗塞病人特殊疾病 (Disease-specific)生活品質問卷。後來在 2001 年4 月赴日本參加生活品質研討會時 才得知,要發展世界衛生組織之心肌梗塞 之疾病特殊生活品質問卷,必須至少三個 以上WHO 的會員國參與,所以本研究此部份暫緩。我們用多變項Cox proportional 存活 分析來看各種心血管危險因子對預測死亡 的相對危險時,發現女性、腦中風及糖尿 病病史、較高的Killip 程度、較低的左心室輸出量、會有較差的存活時間。而有接 受血栓溶解治療及冠狀動脈整形手術者, 則有較長的存活時間。本計劃本擬對病人 作長期的預後及HRQL 的影響評估。並計 算急性心肌梗塞病人其接受不同治療策略 之調整生活品質後預期壽命(Quality adjusted life expectancy, QALE)是否不 同。我們會將其放在下一年度的研究中。 總之,本計畫用醫院急性心肌梗塞患 者之長期追蹤世代,已經找出一些有意義 的預測指標,若能做健康相關生活品質的 調查,以進一步釐清心肌梗塞的各種治 療,對長期存活之影響,並計算其調整生 活品質後存活人年(Quality adjusted life year, QALY )來推估心臟血管疾病預防的 成本效益分析,並以之作為醫藥衛生政策 決定之參考。 The prevalence rate of atherosclerotic disease increased rapidly with the trend of aging population in Taiwan. Choice of proper intervention therapy or modification of risk factors in high-risk population should be paid much attention to. We reviewed medical records and retrospectively recruited a cohort of 1,600 patients with acute myocardial infarction in the National Taiwan University Hospital (NTUH) during 1986-1999. We tried to develop the disease-specific quality of life (QOL) questionnaire through focus groups in patients with acute myocardial infarction (AMI) in NTUH. However, the plan should be delayed due to the basic requirement of multi-national nature for the development of disease-specific questionnaires for WHOQOL. And, the Taiwan version of WHOQOL BREF plus AMI-specific QOL questionnaire will be used to evaluate the quality of life (HRQL) in the patients cohort of AMI who has survived in the next year. The quality adjusted survival time (QAST) will be calculated from the survival analysis combined with HRQL score from patients with AMI. The efficacy and quality adjusted life expectancy (QALE) for different treatment modalities of intervention (invasive and noninvasive) will be analyzed and compared. So far, we have accomplished the analysis for prognostic factors on survival. Cox proportional hazard model analysis revealed that female, medical treatment only, higher Killip classification, history of CVA (cerebrovascular apoplexy) and DM (diabetes mellitus), lower cardiac output, atrial fibrillation had poor survival time. Further analysis for intervention strategies, we identified elective PTCA had better prognosis, and treatments with coronary bypass graft surgery and thrombolytic therapy could not provide better survival outcome. In conclusion, this study was designed to evaluate the patients of AMI in a hospital-based cohort in NTUH with the Taiwan version of WHOQOL BREF questionnaire of AMI. The multiple Cox proportional hazard metal analysis identified some interesting risk factors, which may provide an important reference for choice of treatment for patients with AMI in Taiwan. Regarding the QALE and cost-effectiveness of different treatment strategies for AMI will be scheduled in the next year. |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/23568 | 其他識別: | 902314B002295 | Rights: | 國立臺灣大學醫學院內科 |
顯示於: | 醫學系 |
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902314B002295.pdf | 53.4 kB | Adobe PDF | 檢視/開啟 |
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