透過您的圖書館登入
IP:54.147.102.111
  • 學位論文

季節月份對台灣某醫學中心植入體內去顫器病人發生心室心律不整的 研究調查

Seasonal Variations of Ventricular Arrhythmias in Patients with Implantable Cardioverter-Defibrillation – A Single Medical Center Study in Taiwan–

指導教授 : 陳佳慧
若您是本文的作者,可授權文章由華藝線上圖書館中協助推廣。

摘要


植入體內去顫器被公認為致命性心室心律不整標準治療,經由電擊傳導即時矯正心律,減少心因性猝死的風險。但研究顯示季節月份伴隨不同的心室心律不整發生率(以體內去顫器電擊為指標)。本研究目的,在描述518位體內去顫器病人,在各季節月份適當電擊的發生率;次系統分析不同病人基本屬性【包括年齡、性別、居住地、適應症初級預防及二級預防、結構性心臟病及非結構性心臟病、有無冠狀動脈疾病、有無糖尿病、左心室射出率、有無發生電風暴】,是否呈現不同的季節月份適當電擊的發生率。以民國84年2月16日開始的第一例體內去顫器病人至103年12月31日止所有在本院裝體內去顫器為收案個案,總共收案518人,經兩位心臟科專家仔細審查,登錄體內去顫器發生電擊時間,篩選出適當電擊次數。另外,扣除死亡、接受心臟移植及流失個案的追蹤年月截止月,算出真正在本院的追蹤月份數。所有資料以SPSS統計軟體進行分析。 結果發現:(1)台灣某醫學中心裝置體內去顫器518人,追蹤平均月數為50±44月,平均年齡55.7±18.6歲;男性占70.8%,追蹤期間有發生VT/VF的171人(33%)無發生過VT/VF有347人(67%);發生VT/VF的171人與無發生過VT/VF有347人,在追蹤平均月份數,兩者有明顯差異(P<.001)。整體而言,VT/VF平均月發生率為5.6%,季節月份的VT/VF發生率以秋季與初冬(9-12月)最低,平均發生率落在2.2-3.6%;最高為晚春(5月)及早夏(6月)其VT/VF發生率為8.4%-8.5%。(2)次系統顯示有電風暴的病人,平均VT/VF的月發生率(44.7%)顯著高於其他樣本,季節差異也類似;呈現秋季及初冬VT/VF發生率(13.7-19.1%)最低,晚春(5月)及早夏(6月)其VT/VF發生率(87.4%-98.7%)仍為高峰。 總結,觀察到體內去顫器病人VT/VF發生率在季節有明顯變化,次系統中不同病人基本屬性其VT/VF發生率在季節也有明顯變化,秋季和初冬的VT/VF發生率多為最低。未來研究應針對體內去顫器病人,進一步釐清台灣季節變化伴隨不同VT/VF發生率的機轉。

並列摘要


The implantable cardioverter-defibrillator (ICD) has become a standard treatment for individual at risk for life-threatening ventricular arrhythmia. Electrical shock is delivered to restore the heart rhythm but recent studies have demonstrated that the incidence of ventricular arrhythmia (i.e. appropriate shock) was related to seasonal factors. The aim of this study was to describe seasonal variation of appropriate shock incidences over 12 months in 518 ICD recipients. As a subgroup analysis, shock incidences over 12-month were stratified by 9 patient characteristics of old age, gender, residential area, indication for ICD (primary/secondary, structure/non-structure heart disease), diabetic or coronary heart disease comorbidities, lower ejection fraction (<50%), and electric storm (yes/no) for the shock group. The incidences and dates of ICD shock were independently coded from carefully reviewing all stored ICD device-generated electrocardiography by two cardiologists. Consecutive 518 patients (55.7±18.6 years; 70.8% males) receiving ICD between 1995 and 2014 at a 2000-bed, tertiary, academic medical center in Taiwan were included in the study with an average follow-ups of 50.3±44.0 months. During the follow-ups, 171(33%) recipients experienced appropriate shocks with a mean shock incidence of 5.6% per month for the whole sample. There is no significant differences in patient characteristics between shock (n=171) and non-shock groups (n=347) except for duration of follow-up (68.2±43.8 vs. 41.0±41.4 for non-shock group; P<0.001). Seasonal variation was evident with autumn/early winter (September to December) had lower shock incidences (2.2-3.6%) and late spring/early summer (May and June) had slightly higher incidences (8.4-8.5%). Subgroup analysis showed that ICD recipients with electric storms had significant higher mean shock incidences of 44.7% per month with a similar seasonal variation of autumn/early winter (November to January) having lower incidences (13.7 to 19.1%) but peak in May and June (87.4 to 98.7%). In conclusion, seasonal variation is observed in ICD recipients with some subgroups having more dramatic patterns than others. Autumn and early winter typically have lower shock incidences regardless of patient characteristics. Future studies are indicated to explore the mechanism of this seasonal variation of ICD shocks in Taiwan and beyond.

並列關鍵字

Ventricular Arrhythmia Seasonal Month

參考文獻


Willich, S. N., Maclure, M., Mittleman, M., Arntz, H. R., & Muller, J. E. (1993). Sudden cardiac death. Support for a role of triggering in causation. Circulation, 87(5), 1442-1450. doi: 10.1161/01.CIR.87.5.1442
林亮宇、陳文鍾(2014)•心室心律不整•於內科主治醫師合著,內科學(第七版第一冊,357-365頁)•台北市:力大圖書。
林于凱、俞菘維、林沛練、王玉純(2015)•台灣不同地區之氣溫與全死因及心血管疾病死亡風險之相關分析•臺灣公共衛生雜誌,34(1),103-114•doi:10.6288/TJPH201534103039
林于凱,吳祐誠,黃鈴雅,林嘉明,吳聰能,周昌弘,...&王玉純.(2011).極端氣溫對台灣都會區65歲以上族群心肺疾病死亡之風險趨勢分析.臺灣公共衛生雜誌,30(3),277-289•DOI:10.6288/TJPH2011-30-03-08
交通部中央氣象局•(2015)•台灣氣候特徵簡介-台灣的溫度•RetrievedMay2,2015,http://www.cwb.gov.tw/V7/climate/climate_info/statistics/statistics_1_3.html

延伸閱讀