目的：留置型導尿管已被證實和腦中風常發生的併發症-泌尿道感染具有相關性，本研究旨在分析急性腦中風患者施用留置型導尿管的發生率、危險因子，以及預後情況。
方法：前瞻性研究某醫學中心於2006年8月至2008年12月登錄罹患腦中風並於發病十日內住院的病人。以Kaplan-Meier法估算施用留置型導尿管的發生率，以Cox模型分析影響施用留置型導尿管的危險因子，並以logistic迴歸分析急性腦中風不良預後（三個月內死亡或modified Rankin Scale >2）的危險因子。
結果：本研究共分析2789位急性腦中風住院病患，其中761位（27%）於住院中施用留置型導尿管。接受留置型導尿管的累積發生率於住院第二日為23% (95%信賴區間22%~25%)、於第七日為27% (25%~29%)。施用留置型導尿管的危險因子包含年紀大 (HR 1.01; 95%信賴區間1.00~1.01)、較高的腦中風嚴重度 (HR 1.08; 1.07~1.09)、及出血型腦中風 (HR 2.03; 1.69~2.44)，而性別、糖尿病、曾罹患腦中風則沒有影響。施用留置型導尿管的病患亦有較高機會於發病三個月產生不良預後 (OR 2.43; 95%信賴區間1.65~3.58)。
結論：施用留置型導尿管對照護急性腦中風住院病患似是常見的醫療處置，並且有較高比例產生不良預後。謹慎使用留置型導尿管預期將能提升腦中風住院病患的照護品質。

Objective: Urinary catheterization is associated with urinary tract infection, a common complication of stroke. We aimed to investigate the incidence and risk factors associated with urinary catheterization following acute stroke, and its impact on stroke outcome.
Method: We prospectively studied a cohort of stroke patients hospitalized within 10 days after onset from August 2006 to December 2008. Kaplan-Meier method was used to estimate the cumulative incidence of Foley catheter insertion over time, and Cox proportional hazards regression analysis to evaluate the independent predictors. The impact of urinary catheterization on poor stroke outcome (modified Rankin Scale >2 or dead) at 3 months was analyzed by logistic regression.
Results: Of 2789 study patients, 761 (27%) received Foley catheter insertion. Most urinary catheterization was carried out within two days of admission, with estimated cumulative incidence of 23% (95% CI, 22% to 25%) at 2 days, and 27% (25% to 29%) at 7 days. Predictors of urinary catheterization were advanced age (HR 1.01 per year; 95% CI, 1.00-1.01), increased National Institutes of Health Stroke Scale score (HR 1.08 per point; 1.07-1.09), and hemorrhagic (versus ischemic) stroke (HR 2.03; 1.69-2.44), after adjustment for gender, diabetes mellitus and previous stroke/transient ischemic attack. The influence of urinary catheterization on poor outcome at 3 months remained significant (OR 2.43; 1.65-3.58) after adjustment for relevant covariates.
Conclusion: Urinary catheterization was common among hospitalized acute stroke patients, and associated with poor outcome at 3 months. Judicious use of urinary catheter in acute stroke patients is crucial to improve quality of care.

論文審定書 i
誌謝 ii
中文摘要 iii
英文摘要 iv
Introduction 1
Methods 2
Results 5
Discussion 7
References 13
Table 1 16
Table 2 17
Table 3 18
Table 4 19
Figure 20

1. Poisson SN, Johnston SC, Josephson SA. Urinary tract infections complicating stroke: mechanisms, consequences, and possible solutions. Stroke 2010;41:e180-184.
2. Rocco A, Pasquini M, Cecconi E, et al. Monitoring after the acute stage of stroke: a prospective study. Stroke 2007;38:1225-1228.
3. Stott DJ, Falconer A, Miller H, Tilston JC, Langhorne P. Urinary tract infection after stroke. QJM 2009;102:243-249.
4. Kong KH, Young S. Incidence and outcome of poststroke urinary retention: a prospective study. Arch Phys Med Rehabil 2000;81:1464-1467.
5. Burney TL, Senapati M, Desai S, Choudhary ST, Badlani GH. Acute cerebrovascular accident and lower urinary tract dysfunction: a prospective correlation of the site of brain injury with urodynamic findings. J Urol 1996;156:1748-1750.
6. Meng NH, Lo SF, Chou LW, Yang PY, Chang CH, Chou EC. Incomplete bladder emptying in patients with stroke: is detrusor external sphincter dyssynergia a potential cause? Arch Phys Med Rehabil 2010;91:1105-1109.
7. Marinkovic SP, Badlani G. Voiding and sexual dysfunction after cerebrovascular accidents. J Urol 2001;165:359-370.
8. Jordan LA, Mackey E, Coughlan K, Wyer M, Allnutt N, Middleton S. Continence management in acute stroke: a survey of current practices in Australia. J Adv Nurs 2011;67:94-104.
9. Henssge U, Hoffman A, Kavanagh S, et al. The National Sentinel Stroke Audit 2010. 2011. [online] Available at: https://audit.rcplondon.ac.uk/SentinelStroke/page/page.aspx?pc=welcome. Accessed August 19, 2011.
10. Hsieh FI, Lien LM, Chen ST, et al. Get With the Guidelines-Stroke performance indicators: surveillance of stroke care in the Taiwan Stroke Registry: Get With the Guidelines-Stroke in Taiwan. Circulation 2010;122:1116-1123.
11. Lin HJ, Chang WL, Tseng MC. Readmission after stroke in a hospital-based registry: risk, etiologies, and risk factors. Neurology 2011;76:438-443.
12. Stroke Foundation of New Zealand. National Acute Stroke Service Audit 2009. 2010. [online] Available at: www.stroke.org.nz. Accessed August 19, 2011.
13. Selius BA, Subedi R. Urinary retention in adults: diagnosis and initial management. Am Fam Physician 2008;77:643-650.
14. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010;31:319-326.
15. Dromerick AW, Edwards DF. Relation of postvoid residual to urinary tract infection during stroke rehabilitation. Arch Phys Med Rehabil 2003;84:1369-1372.
16. Tenke P, Kovacs B, Bjerklund Johansen TE, Matsumoto T, Tambyah PA, Naber KG. European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Int J Antimicrob Agents 2008;31 Suppl 1:S68-78.