Statin使用及到院前心跳停止病患預後之關聯性分析

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題名:	Statin使用及到院前心跳停止病患預後之關聯性分析 Statin and Outcomes in Patients Presenting with Cardiac Arrest: A Nationwide Cohort Study
作者:	游秉勳 Yu, Ping-Hsun
關鍵詞:	心跳停止;statin;一年存活;statin;cardiac arrest;one year survival
日期:	2017-06-23
上傳時間:	2019-05-29 10:27:15 (UTC+8)
摘要:	研究目的：在冠心症、敗血症與缺血性中風發生前服用statin，對於疾病的預後有改善的效果。而突發性心跳停止的病患會有類似敗血症的的生理學反應。本文研究至急診時以心跳停止來表現的病患，是否在心跳停止前服用statin能改善其預後。研究方法：本研究資料來源為『全民健康保險資料庫』全人口檔。以2004年至2011年資料庫篩選出在急診接受心肺復甦術的患者為分析對象，將病患分為在接受心肺復甦前30天連續使用statin與完全沒有使用statin兩群進行分析。研究結果：在使用傾向分數配對後的族群中，接受statin治療的患者，其一年存活率是沒有接受治療者的1.41倍（風險比=1.41，95%信賴區間=1.16-1.71，P≤0.01）。在次族群分析中，發現有糖尿病、慢性腎臟病與較高Charlson Comorbidity Index者，對於statin的治療特別的有反應。若在住院後停用statin，則其保護作用可能會變得不明顯。結論：在心跳停止發先前30日使用statin，對於發生心跳停止的病患其預後有幫助，而此效果可以延續至一年，但若在住院後停用，則此保護作用可能會消失。關鍵字：心跳停止、statin、一年存活 Background: Pretreatment with statins is associated with improved outcomes in severe sepsis, acute coronary syndrome, and stroke. Patients with cardiac arrest experience sepsis-like syndrome and ischemia reperfusion injuries in the heart and brain. The aim of this study was to investigate the effects of statin use before cardiac arrest on outcomes in patients presenting to emergency departments with cardiac arrest. Methods: Medical records of 142,131 adult patients who experienced non-traumatic cardiac arrest and were resuscitated between 2004 and 2011 were retrieved from the Taiwan National Health Insurance Research Database (NHIRD). Patients were grouped into 2 groups: the “statin group” comprised patients who had received statin treatment for at least 30 days prior to the cardiac arrest event; the “non-statin group” comprised patients who had no statin use within 30 days before the event. Results: Patients with prior statin treatment had better 1-year survival (4.8% vs. 3.2%; adjusted odds ratio 1.41, 95% confidence interval 1.16-1.71; p = 0.001) than patients in the propensity score-matched non-statin group. A favorable outcome effect of statin on one-year survival was observed in the presence of diabetes mellitus, chronic kidney disease, and Charlson Comorbidity Index score greater than 5 in the subgroup analysis. The beneficial effects of statins may become insignificant if statin use is discontinued after hospital admission. Conclusion: Statin use before cardiac arrest is associated with one-year survival in cardiac arrest patients except for those with statin discontinuation after admission in a propensity score-matched nationwide cohort study.
描述:	碩士論文指導教授-湯澡薰委員-陳文鍾委員-陳怡樺
資料類型:	thesis
顯示於類別:	[醫務管理學系暨研究所] 博碩士論文

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