因周邊血管病變導致下肢截肢患者的長期存活及其義肢使用狀況之調查研究

Abstract

周邊血管病變是導致下肢截肢的主要 原因，而周邊血管病變的形成主要有糖尿 病及非糖尿病等兩大類因素。當一些患者 因周邊血管病變而導致截肢之後，並非從 此高枕無憂，反而他們要常常面臨需接受 再度截肢的命運，同時其存活率比起同年 齡的人們也來得低。而上述這些惡運與糖 尿病、高血壓、高脂血症、冠狀動脈疾病 及腦中風等相關疾病的控制良好與否，有 著密切的關係；此外，也與不同時代、地 域、人種、文化及生活習慣有關。而我國 這些流行病學資料極少且不夠完整，因 此，在我國也應積極進行調查，以建立永 續性的資料庫，並加以分析各種相關因 子，找出預防的對策，以便降低因周邊血 管病變而導致的致病率及死亡率。 本研究收集臺大醫院1993 年1 月1 日到1999 年12 月31 日期間，所有因周邊 血管病變而接受下肢截肢的個案，登錄其 截肢部位、截肢日期及相關疾病的實驗室 檢查資料。然後利用電話追蹤並對照衛生 署之死亡資料庫以確認個案之存活狀態。 結果共有347 位下肢截肢的住院個案進入 本研究，其中174 人在2001 年追蹤時已死 亡，67 人失去聯絡（佔19.3%），而有106 人在其截肢日期49±20 個月之後完成電話 訪問。在存活因素的分析方面，發現年齡 愈大，截肢部位愈高及合併有尿毒症者其 存活率較低。而曾接受復健治療的患者存 活率較高。此外，在義肢使用狀況的調查 方面發現，曾接受住院復健治療的截肢患 者，其目前仍使用義肢的比率較高，也具 有較佳的行走能力及日常生活功能。

The most common cause of the lower limb amputation is peripheral vascular disease (PVD), which includes the diabetic and non-diabetic group. Those amputees have been suffered from the higher rate of reamputation and the lower rate of long-term survival. The incidence of subsequent contra-lateral amputation and the length of patient survival were found to be related to different race, country and period, meanwhile, to the control of diabetes mellitus, hypertension, coronary artery disease. The main aim of this research is to investigate the - 2 - long-term survival rates and its predicting factors in these amputees. The goal of prosthetic rehabilitation is to compensate for the loss of limb by amputation by, in the case of a lower limb, encouraging walking, however, the amputees may use their prosthesis to a greater or lesser degree or simply stop using it under some reasons. The other objective of this research is to study factors such as physical and mental health, rehabilitation, physical independence and satisfaction with the prosthesis to understand why amputees use their prosthesis or not. The sample was collected from the medical records of amputees, who were amputated due to PVD from January 1st, 1993 to December 31st 1999 in National Taiwan University Hospital. More information will be collected by telephone interview with a questionnaire. There were 347 lower limb amputees during the above periods, but 174 amputees had been died, the other 67 amputees couldn’t be contacted (19.3%). Only 106 amputees complete the questionnaire by phone. The duration of amputation was 49±20 months. The higher in age, amputation level and uremia, the lower survival rate was found among those amputees. The higher survival rate and higher functional level (walking ability and/or ADL ability) were noted among those amputees who had received rehabilitation programs.