周明智Ming-Chih Chou劉森永Sen-Yung Liu醫學研究所博士班2026-03-132025-07-0320252025-06-26https://handle.ncl.edu.tw/11296/26ke4thttps://scholars.csmu.edu.tw/handle/123456789/5490研究目的：本研究旨在探討缺血性中風患者於急性後期照護期間，其基本資料與功能性恢復結果之間的相關性，進一步分析可能的預測因子。本研究亦評估頸動脈超音波常規檢查是否具備預測功能恢復潛力，以期建立早期預測模式。研究方法及資料：本研究回顧性收集142名患有心房顫動/撲動的缺血性腦中風患者。收集患者的神經學影像、頸動脈超音波和基本生化數據。記錄了入院前後的Barthel量表、mRS和NIHSS評分。所有統計分析均使用R for Windows(版本3.6.3)進行。P< 0.05代表顯著意義。比較住院前後的Barthel量表、NIHSS 和 mRS評分以確定患者的預後，並分為改善或未改善組。應用多變數logistic分析危險因素的顯著性，並獲得勝算比(ORs)。利用受試者工作特徵(ROC)曲線和約登指數來尋找重要的閥值，並計算曲線下面積(AUC)以提供準確性。研究結果：142名缺血性中風患者的平均年齡約為66歲，其中男性88名女性54名。大量慢性病當中，最常見的是:混合性高脂血症86例(60.56%)，高血壓115例(80.99%)，糖尿病49(34.51%)。在進行EuroQol-5(EQ-5D)評估時，焦慮/抑鬱是最突出的領域，有44名患者(30.99%)改善。另一方面，自我照顧領域有36名患者(25.35%)改善。NIHSS和Barthel量表的多變項logistic分析顯示，對側斑塊指數統計顯著性(P<0.05)的改善，而NIHSS在焦慮/抑鬱呈現顯著相關和Barthel量表的日常活動也呈現顯著相關(P<0.05)。ROC曲線和約登指數分析顯示NIHSS和Barthel量表與對側斑塊指數的結果相同，對側斑塊指數的閥值是4.5。結論與建議：急性後期照護的結果與NIHSS和Barthel量表評分相關。EQ-5D的焦慮/抑鬱和日常活動領域與患者接受PAC急性後期照護顯著相關。此外，頸動脈超音波斑塊指數能預測患者的功能預後。Objective：This study aims to investigate the relationship between baseline characteristics and functional recovery outcomes in patients with ischemic stroke during the PAC period, and to further analyze potential predictive factors. Additionally, this study evaluates whether routine carotid ultrasound examinations have the potential to predict functional recovery, with the ultimate goal of establishing an early prediction model to support clinical decision-making and the development of individualized treatment plans.Methods and Materials：This retrospective study included 142 patients with ischemic stroke associated with atrial fibrillation/flutter. Neurological imaging, carotid ultrasound results, and baseline biochemical data were collected. Barthel Index, modified Rankin Scale (mRS), and National Institutes of Health Stroke Scale (NIHSS) scores were recorded both before and after hospitalization. All statistical analyses were performed using R for Windows (version 3.6.3), with a significance level set at P < 0.05. Changes in Barthel Index, NIHSS, and mRS scores before and after hospitalization were compared to determine patient outcomes, categorizing them into improved or non-improved groups. Multivariate logistic regression was used to analyze the significance of risk factors and to calculate odds ratios (ORs). Receiver operating characteristic (ROC) curves and the Youden index were employed to identify optimal cut-off values, and the area under the curve (AUC) was calculated to assess predictive accuracy.Results：The 142 patients with ischemic stroke had a mean age of approximately 66 years, comprising 88 males and 54 females. Among various chronic conditions, the most common were: mixed hyperlipidemia in 86 patients (60.56%), hypertension in 115 patients (80.99%), and diabetes mellitus in 49 patients (34.51%). When assessed using the EuroQol-5D (EQ-5D), the most affected domain was anxiety/depression, impacting 44 patients (30.99%). On the other hand, improvement in the self-care domain was observed in 36 patients (25.35%). Multivariate logistic regression analysis of NIHSS and Barthel Index revealed that contralateral plaque index was significantly associated with improvement (P < 0.05). Additionally, NIHSS improvement showed a significant correlation with anxiety/depression, while Barthel Index improvement was significantly associated with activities of daily living (P < 0.05). ROC curve and Youden index analyses confirmed these findings, with the optimal cut-off value for the contralateral plaque index determined to be 4.5.Conclusion and Suggestion：The outcomes of post-acute care (PAC) were found to be associated with NIHSS and Barthel Index scores. The anxiety/depression and activities of daily living domains of the EQ-5D were also significantly related to patients receiving PAC. Furthermore, the carotid ultrasound plaque index demonstrated predictive value for patients' functional outcomes.缺血性中風心房顫動/撲動巴氏量表急性後期照護頸動脈超音波Ischemic strokeatrial fibrillation/flutterBarthel IndexNIHSSmRSpost-acute careplaque indexEQ-5Dthesis