中文摘要

本研究想探討外科手術介入治療雙極性情感疾病症患者合併中風的發生率與預後，是否較一般大眾的差異以及預後的危險因子。
本研究根據國家健康保險研究資料庫(NHIRD) 從1999至2005包括25481雙極性疾病病人，和性別年齡相當101924 的沒有雙極性情感疾病的對照病人， 在1999至2005 曾有中風診斷的病人被排除，Cox proportional-hazards model比較兩個族群在2006至2010年因中風而執行手術的差別以及追蹤預後。
本研究定義中風接受外科手術的個案，是資料庫中出現ICD-9診斷碼中風(430-438)，合併治療下列中風手術的(ICD-9 procedure code)，包括 Craniotectomy or craniotomy: ( 01.xx ) ，Clipping( 39.51 ) ，Coiling ( 39.52,39.72,39.79 )，Embolization of carotid-cavernous fistula: ( 38.82,38.81 )，EC-IC bypass( 39.28 )，Carotid Endarterectomy ( 38.12 ) ，Carotid Angioplasty and Stenting ( 39.90 )… 等。
結果發現，683（2.7％）雙極性疾病病人和2100（2.1％ ）對照組得到中風。131（0.5％）雙極性情感疾病症患者和410（0.4％）非雙極性情感疾病症對照組因中風動手術。雙極性疾病病人有較高的比例中風與動手術。
五年之預後在雙極性情感疾病症患者和非雙極性情感疾病症對照組未見明顯差異(Log Rank = 0.287)。在校正相關因子後，雙極性情感疾病症並未影響手術預後。
雙極性疾病病人較對照組容易發生中風，以及接受中風外科手術治療，五年內死亡率兩者未見明顯差異，故若病人符合開刀的條件，應建議病人接受積極治療。

Abstract

Stroke is a severe illness and it causes loss of life, medical burden, and lost of productivity. Bipolar disorder is one kind of mental disorder and induces clinically occupational, social, interpersonal dysfunction.
The study aimed to evaluate the prognosis about bipolar patients had received surgical interventions for stroke. And also offer strategies for physicians to treat bipolar patients with stroke.
In the study, 25,481 bipolar patients from National Health Insurance Research Database (NHIRD) between 1999 and 2005. 101,924 age- and sex- matched control participants not have diagnosis of bipolar disorder. Both groups excluded participants had stroke from 1999 to 2005. Surgical procedures for stroke included Craniectomy or Craniotomy, Clipping, Coiling, Embolization of carotid-cavernous fistula, EC-IC bypass, Carotid Endarterectomy, Carotid Angioplasty and Stenting. Patient survival after surgical procedure was evaluated from 2006 to 2010.
The five-year stroke-free survival rate and mortality rate were estimated by Cox proportional-hazards model after adjusting for confounding risk factor.
683(2.7 %) bipolar patients and 2100(2.1%) controls had stroke. 131(0.5%) bipolar patients and 410(0.4%) controls had received surgical procedure for stroke. Bipolar patients had higher rate of stroke and surgical treatment before adjusted confounding factors.
But five year survival rate was not significantly different between two groups (Log Rank = 0.287). After adjusted for variables, the mortality for bipolar patient had received surgical procedure was not significantly different from those did not have bipolar disorder.
We found bipolar patient had higher risk for stroke. The result of the study suggested that patients should receive surgical procedure if indicated.

論文審定書 i
誌謝 ii
中文摘要 iii
英文摘要 iv
目錄 vi
第一章 緒論 1
第一節 研究動機與背景 1
第二節 研究目的 3
第二章 文獻查證 4
第一節 雙極性情感疾病症( Bipolar Disorder) 4
一 盛行率與症狀 4
二 治療與預後 4
三 情感疾患與中風的相關性 5
第二節 中風 ( Stroke ) 6
一 症狀 6
二 到院前評估 6
三 缺血性中風 7
四 出血性中風 8
第三節 中風的外科治療 10
第四節 中風的危險因子 14
第三章 研究方法 16
第一節 研究架構 16
第二節 研究變項 17
第三節 資料處理與分析方法 19
第四章 研究分析與結果: 20
第一節 雙極性情感疾病症患者與非雙極性情感疾病症對照組的分析 20
第二節 雙極性情感疾病症中風患者與非雙極性情感疾病症中風患者對照組的分析 25
第三節 雙極性情感疾病症中風動手術患者與非雙極性情感疾病症中風動手術患者對照組的分析 28
第四節 雙極性情感疾病症中風動手術患者與非雙極性情感疾病症中風動手術患者對照組的存活分析 32
第五章 綜合討論 35
第一節 討論 35
第二節 限制 37
第三節 結論 38
參考文獻 39

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