- 學位論文
影響接受心導管支架放置病患住院天數的關係探討:回溯性研究
Factors Associated with Length of Stay in Patients Receiving Percutaneous Coronary intervention: A Retrospective Study
摘要
心臟病是國人十大死因第二位，且發生率有年輕化趨勢，心導管治療與支架放置是最常見的治療方式之一。研究顯示與冠狀動脈疾病相關危險因子有性別、抽菸、喝酒、代謝症候群等。鮮少研究探討鮮少探討接受心導管治療的冠狀動脈疾病病患其危險因子對住院天數的影響之議題，因此本研究在探討接受心導管治療的冠狀動脈疾病病患基本屬性(性別、年齡、身體質量指數、婚姻狀態、教育程度、吸菸、喝酒)、心臟功能(收縮壓、舒張壓、左心室射出功能)、營養與代謝指標(營養評估分數、尿酸、三酸甘油脂、膽固醇、高密度膽固醇、低密度膽固醇、糖化血色素)與住院天數之關係，找出影響超過三天住院天數的預測因子。採病歷回溯性研究，於南部某醫學中心電子病歷資訊系統，在入院診斷中有登錄冠狀動脈疾病的國際疾病分類代碼ICD-9:410-414.9(排除心臟腫瘤)及當次住院中有計價心導管治療(PTCA+STENT)之病患進行資料收集，內容包括於基本屬性、當次住院前有監測左心室射出功能(LVEF)、生理參數與實驗室檢驗報告、營養代謝指標和住院天數。以SPSS 22.0軟體進行研究資料之統計分析，研究對象之基本屬性與其他變項資料採描述性分析，以t檢定、單因子變異數分析、皮爾森積差相關係數分析各變項的相關性，另以邏輯斯迴歸分析影響心導管支架放置病患三天住院天數的預測因子。 研究結果呈現個案以男性居多，平均住院天數為2.39±1.44天。女性在平均壽命較長，收縮壓與膽固醇較高。單身者的HbA1C指數比已婚者高。無抽菸者在收縮壓與Cholesterol高於有抽菸者。最後757人進入邏輯斯迴歸分析後，發現抽菸與HbA1C可以用來預測三天住院天數，二個變項可解釋接受心導管治療的冠狀動脈疾病病患三天住院天數之5.1%的變異量，其中HbA1C的ROC curve發現HbA1C超過6.55，則病患住院天數會超過三天。 建議護理衛教指導上可加強對血糖控制與戒菸的相關衛教，在入院護理評估上深入評估抽菸項目，有助於心導管支架放置病患住院治療之控制。
並列摘要
Heart disease is the second leading cause of death among Taiwan people, and the incidence is younger than before. Percutaneous coronary intervention is the one of the common treatments for coronary heart diseases. Studies have shown that risk factors associated with coronary artery disease include the factors of gender, smoking, alcohol, and metabolic syndrome. Few studies have focused on the risk factors of length of stay in patients with coronary artery diseases receiving percutaneous coronary interventions. Therefore, this study was to investigate the factors associated with length of stay among the basic characteristics (gender, age, BMI, marital status, education level, smoking, drinking), cardiac function (systolic blood pressure, diastolic blood pressure, left ventricular ejection function (LVEF), and nutrition and metabolic factors (the Malnutrition Universal Screening Tool, urine acid, triglyceride, cholesterol, HDL-C, LDL-C, HbA1C) of coronary heart disease patients receiving percutaneous coronary interventions. Further analysis of predictors that affected length of stay over three days. We retrospectively reviewed the medical records in the central computer databank of a medical center in the south Taiwan. Data were collected according to patients with international disease classification code ICD-9: 410-414.9 for coronary artery disease (exclude cardiac tumor) while admission, and receiving percutaneous coronary intervention with PTCA+ STENT coding, the data including basic characteristics, pre-hospitalized monitoring of LVEF, physiological parameters, laboratory test reports, nutritional and metabolic factors, and length of stay. The basic characteristics and other variables of the subjects and the predictive factors affecting the three-day hospitalization of patients with cardiac catheter stent placement were analyzed by the descriptive analysis, inference ststistics and logistic regression analysis by SPSS 22.0 software. The result showed that the subjects were mostly males and the mean length of stay were 2.39 1.44 days. Females had a higher mean age, higher systolic blood pressure and cholesterol level. Singles have higher HbA1C indexs than married ones. Non-smokers were higher in systolic blood pressures and cholesterol level than smokers. Finally, a total of 757 subjects found that smoking and HbA1C index can be used to predict the length of hospital stay more than three days. These two variables can explain 5.1% of the total variances. The ROC curve of HbA1C index found that the cut-off value of the length of hospital stay for three days is 6.55. The results of this study will provide directions of education guidances of nursing programs on blood sugar control and smoking cessation, and in-depth evaluation of smoking items in the nursing admission assessment, which is helpful to control the legth of stay in the hospitalization of patients with cardiac catheter stent placement.