糖尿病病人因低血糖至急診就醫，就醫頻次與住院風險及外傷之關聯探討

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題名:	糖尿病病人因低血糖至急診就醫，就醫頻次與住院風險及外傷之關聯探討 The Association Between The Frequency of ED Visits And Hospitalization & Trauma Event In DM Patients With Hypoglycemic Episode.
作者:	郭俊麟 Kuo, Chun-Lin
貢獻者:	陳品玲
關鍵詞:	低血糖;住院;急診就醫頻次;外傷 Hypoglycemia;ED visits;Hospitalization;trauma event
日期:	2016-06-20
上傳時間:	2019-08-27 12:28:17 (UTC+8)
摘要:	低血糖則可能會意識不清、抽筋、昏迷等，進一步造成身體的外傷或腦部永久傷害。糖尿病病人若因多次低血糖至急診就醫的次數增加，有可能增加重度低血糖的機會，後續造成身體的外傷或是腦部傷害，提高需要住院的風險，導致醫療支出及社會成本的增加。就我們所知，台灣過去沒有任何文獻針對糖尿病低血糖的急診就醫頻次與後續住院及外傷風險的相關性做探討，也沒有文獻研究探討急診低血糖併發外傷的情況。本研究期望以病歷回顧方式，收集一段時間內因低血糖至急診就醫之個案，比較單一次低血糖急診就醫族群與多次(二次以上)低血糖急診就醫族群之間的差異，探討兩族群是否在住院風險上有所不同，及兩族群之間因低血糖造成身體傷害有無差異，並且藉此研究了解急診室因低血糖併發外傷的普遍情況。主要研究目的如下：一、探討因低血糖來急診就醫的族群中，單一次低血糖就醫族群及多次低血糖就醫族群之基本屬性差異。二、分析單一次低血糖急診就醫族群及多次低血糖急診就醫族群的急診血液常規及生化差異。三、分析因低血糖來急診就醫頻次與住院風險之相關性。四、分析因低血糖來急診就醫頻次與後續外傷之相關性。本研究利用病歷回顧方式收集相關資料，收案條件為年齡在20歲以上的糖尿病患者，在二年期間 (2011/06/01~2013/05/31)因為低血糖而至台北市立萬芳醫院急診室就醫。最後共計有479人次符合收案條件，其中299人因低血糖至急診就醫一次共計299人次，另76人因低血糖至急診就醫兩次以上共計180人次。研究發現，兩族群的基本屬性無顯著差異。多次低血糖急診就醫族群，可能因為較多的感染、食慾不佳、以及肝功能不全等問題，所以才造成反覆多次的低血糖來急診就醫。另外，因為低血糖至急診就醫的糖尿病族群，低血糖就醫的頻次並不會影響後續住院及外傷的風險，22.1%的低血糖急診就醫病人後續會住院，感染佔一半以上的住院原因。在急診，糖尿病低血糖病人併發外傷比例達2.7%，併發嚴重外傷住院比例達0.8%, 外傷機轉全部都是跌倒，低血糖病人衛教預防跌倒更顯重要。然而因外傷的個案不多，仍需要後續更大型的研究證實。 The Association Between The Freqeuncy of ED Visits And Hospitalization & Trauma Event In DM Patients With Hypoglycemic Episode. Abstract Background: Hypoglycemia is a common episode in ED daily clinical practice. Severe hypoglycemia can result in altered mental status, seizure or coma, increasing the risk of further hospitalization and trauma event. Objective: Among all DM patients who visit ED due to hypoglycemia episodes, comparing the single visit group with multiple visits group (visits equal or more than 2 times), to find out the difference of hypoglycemia-related hospitalization and trauma events between the two groups. Methods: Design and Settings: This is a two-year retrospective study of 1 medical center with annual ED around 70000 visits. We review medical records of all adult (older than 20 years) DM patients who visit ED from 2011/06/01~2013/05/31 in Wan Fang Hospital due to hypoglycemic events, and collect data to compare multiple visits group with single visit group. Descriptive statistical analysis, Pearson’s chi-squared test, Fisher’s exact test and student’s t-test are used. Statistical analysis is carried out with SPSS, version 22. Results: Infection, loss of appetite and abnormal liver function are the possible causes why multiple visits goup visit ED repeatedly. Among 479 hypoglycemic visits in ED during the study period, 106 (22.1%) subjects are admitted. The risk of hospitalization and trauma event between multiple visits group and single visit group are the same. 10 of 375 patients (2.7%) have hypoglycemia with trauma event, and all of their trauma mechanisms are fall. Conclusion: In DM patients who visit ED due to hypoglycemia, the frequency of ED visits does not increased the risk of further hospitalization and trauma event. Hypoglycemia-related hospitalization rate is about 22.1% of all ED visits. Hypoglycemia associated trauma event account for about 2.7% of all patients. Fall is the major mechanism of trauma. To prevent falls is an important issue in DM patients who suffer from hypoglycemia
描述:	碩士指導教授-陳品玲委員-蔡行瀚委員-白志偉
資料類型:	thesis
顯示於類別:	[傷害防治學研究所] 博碩士論文

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