- 期刊
胸主動脈剝離患者死亡率及相關因素探討
Mortality rate and related factors of clients with thoracic aortic dissection
摘要
主動脈剝離是一種極易致命的疾病，因為好發部位在胸主動脈，需緊急手術治療，否則隨時造成死亡。造成胸主動脈剝離最常見的危險因子即是高血壓；近年來各國高血壓患者持續增加，導致罹患胸主動脈剝離的民眾增加，死亡率也隨之上升，此健康議題各國醫療體系不可忽視。本文依循實証步驟，搜尋相關文獻，使用Cochrane Library、CINAHL、PubMed、Science Direct、OVID、資料庫，搜尋130筆文章，經謹慎文獻評讀，分析出與主題相符的文章共29篇以探討胸主動脈剝離患者死亡率及相關影響因子。研究結果顯示，西方國家對於胸主動脈剝離甚為重視，於1996年開始進行整合性的大規模研究；然而，東方國家相關研究卻甚為稀少。以外科手術置換人工血管可降低胸主動脈剝離患者的死亡率；其中，血管腔內主動脈瘤修復手術比傳統開刀手術可降低更多死亡率和合併症，但前者有使用條件限制；抗高血壓藥物治療，也是防止胸主動脈剝離的必然方針。年紀和性別也發現會影響胸主動脈剝離病人的手術成功率和死亡率。時間、季節、情緒及壓力皆會誘發胸主動脈剝離，因此患者需注意天氣變化、做好情緒及壓力管理。在術後，病人覺得生活品質偏低，因為在工作、日常及休閒活動上受到限制。結論為由於缺乏中長期的研究追蹤及質性、護理相關的實證研究，我們建議相關研究是必須，以利護理人員照護胸主動脈剝離患者之實證支持。
並列摘要
Aortic dissection is a life-threatening disease which often occurs in the thoracic aorta. Emergency surgery is necessary for clients with thoracic aortic dissection; otherwise they will die at any time. Hypertension is the most common risk factor of aortic dissection. In the recent years, the population of hypertension clients gradually and globally grows; it could increase the prevalence of aortic dissection and mortality rate. This has become a public health issue that all countries and people cannot ignore. The aim of this article was to explore the mortality of clients with thoracic aortic dissection and related risk factors according to the evidence-based research. The evidenced data of mortality rate and related factors of thoracic aortic dissection were found and analyzed by searching the data bases of Cochrane Library、CINAHL、PubMed、Science Direct and OVID. Results of studies indicated that the Western countries have focused on aortic dissection studies since 1996; however the Eastern countries have not. Studies revealed that TEVAR caused less complication than traditional surgery, but with more restrictive condition in using it. Anti-hypertension medication is an inevitable method of preventing aortic dissection. Age and gender were found to influence aortic dissection clients´ successful rate of surgery and mortality. Timing, reason, emotion, and stress could also induce aortic dissection, thus clients should be careful of weather change, and emotional and stress control. After aortic dissection surgery, clients perceived that their quality of life became not well than before because they have to work and live with more limitations. To conclude, due to the lack of long-term retrospective, qualitative, and nursing studies, we strongly suggest that evidence-based research is necessary to help clinical nurses in caring of aortic dissection patients.