目的:
慢性阻塞性肺疾病為常見且嚴重之疾病，一旦慢性阻塞性肺疾病急性惡化致呼吸衰竭而導致長期依賴呼吸器，造成國家醫療費用高額負擔，許多文獻指出施打流行性感冒疫苗可有效減少嚴重併發症及醫療資源之使用，但未提及慢性阻塞性肺疾病之各級嚴重度對於疫苗相關之成效，利用此次研究，探討各慢性阻塞性肺疾病各嚴重度對於施打流行性感冒疫苗，各級間之醫療效益，提供防治公共政策能精確推行於適用之對象上，達到醫療資源最佳化，保障國人健康及醫療資源之使用。
方法:
本研究以回溯性病歷收集研究，收集慢性阻塞性肺疾病之病人依據其肺活量測定採用國際實證指引建議等級評估組織(GRADE)方法進行嚴重度分級，分為四級嚴重度為輕度、中度、重度和極重度，並分析各嚴重度對於接種流行性感冒疫苗後一年內因呼吸道疾病之醫療資源使用。利用t檢定、卡方檢定和迴歸分析探討其醫療資源的使用於各嚴重度間之差異。
結果:
研究分析結果顯示在中度、重度和極重度之嚴重度病人，於接種流行性感冒疫苗因呼吸道疾病而就醫其住院次數、住院天數，住院之醫療花費、急診次數和呼吸衰竭之發生有顯著下降，具有顯著差異。
討論:
流行性感冒疫苗在慢性阻塞性肺疾病各嚴重分級中呈現安全有效的保護力，然而在重度和極重度族群疫苗保護效果受到其共病症影響。輕度族群在醫療效益中無顯著差異，發現其生活習慣中抽菸對於輕度和中度之急診就醫次數高於其它級嚴重度，顯示此族群戒菸重要性大於接種流行性感冒疫苗。
關鍵字:慢性阻塞性肺疾病、流行性感冒疫苗、醫療資源、查爾森共病指數

Abstract
Objective:
Chronic obstructive pulmonary disease (COPD) is prevalent in the elderly population, with high impact on quality of life, morbidity, and mortality. Patients with exacerbation of COPD are at especially high risk for developing ventilator dependence. It causes a high burden of national medical expenses. According to past research studies shows that influenza vaccine can effectively reduce the severity of illness, however, there was no consistent research mention about severity of COPD association between effectiveness of influenza vaccine. In this study would contribute to understanding the severity of COPD on the response to influenza vaccination. Providing an important value of public policies and of vaccination policies among severity of COPD.
Method:
This is a retrospective study analysis influenza vaccine exposure in different severity of COPD. Classification of airflow limitation severity in COPD by perform spirometry, mild, moderate, severe and very severe of four classification. Using T-test, chi-square test and regression to analysis influenza vaccine exposure in different severity of COPD.
Result:
After analysis, the effectiveness of influenza vaccine in reducing severe exacerbations of hospital admissions, length of stay, medical expenses of hospitalization, emergency admission and respiratory failure occurs in moderate, severe and very severe groups, with statistical significance. Overall, the result evident a positive benefit ration for influenza vaccination in moderate, severe and very severe classification.
Conclusion:
Influenza vaccine is safe and effective among each classification. Effectiveness of influenza vaccine exist in severe and very severe classification of COPD patients associated with comorbidities. Another interesting finding of this study is that the increased number of emergency department admissions for smoking-related in mild and moderate classification of COPD. Quitting smoking may more effective than influenza vaccine effectiveness for mild and moderate classification of COPD.
Keyword: influenza vaccine, influenza vaccine effectiveness, charlson comorbidity index, Chronic obstructive pulmonary disease.

目錄
論文審定書 i
中文摘要 ii
Abstract iii
圖次 vi
表次 vii
第一章 緒論………………………………….……………………………………... 1
第一節 研究背景與動機…………………………………………………………. 1
第二節 研究目的…………………………………………………………………. 3
第二章 文獻查證 ...4
第一節 慢性阻塞性肺疾病流行病學、致病機轉、診斷、分類及治療方式……….4
一、慢性阻塞性肺疾病流行病學 4
二、慢性阻塞性肺疾病致病機轉 5
三、慢性阻塞性肺疾病診斷 6
四、慢性阻塞性肺疾病嚴重度分類 7
五、慢性阻塞性肺疾病治療方式 8
第二節 成人之疫苗種類………………………………………………………... 10
一、成人之流行性感冒疫苗 10
第三節 慢性阻塞性肺疾病與疫苗之相關性…………………………………... 12
第四節 小結……………………………………………………………………... 13
第三章 研究方法 16
第一節 研究假說………………………………………………………………... 16
第二節 研究設計………………………………………………………………... 17
第三節 研究架構………………………………………………………………... 18
第四節 資料來源與研究對象…………………………………………………... 19
第五節 研究測量變項…………………………………………………………... 23
第六節 資料處理與統計分析…………………………………………………... 24
第四章 研究分析與結果 25
第一節 研究樣本之描述性統計分析…………………………………………... 25
第二節 接種疫苗族群基本資料分析…………………………………………... 26
第三節 慢性阻塞性肺疾病分級之基本資料分析……………………………... 28
第四節 不同嚴重度之慢性阻塞性肺疾病於疫苗接種自變項分析…………... 31
第五節 接種流行性感冒疫苗在醫療資源之差異分析………………………... 46
第六節 研究假設………………………………………………………………... 54
第五章 討論 55
第一節 本研究樣本慢性阻塞性肺疾病對象特性……………………………... 55
第二節 接種流行性感冒疫苗接種率…………………………………………... 56
第三節 接種流行性感冒疫苗對於其慢性阻塞性肺疾病嚴重之影響 57
第六章 研究結論與建議 59
第一節 研究結論………………………………………………………………... 59
第二節 研究限制……………………………………………………………….. 60
第三節 研究建議………………………………………………………………... 61
參考文獻 62
附錄 66

圖次
圖3-3-1 研究架構 18
圖3-4-1 研究對象篩選流程 2
表次
表2-1-1肺功能檢查診斷慢性阻塞性肺疾病之嚴重度 6
表2-1-2 mMRC呼吸困難量表 7
表2-1-3 CAT量表 7
表2-1-4 慢性阻塞性肺疾病加入自覺症狀之分級 8
表2-1-5 慢性阻塞性肺疾病之藥物治療 9
表2-4-1 慢性阻塞性肺疾病接種流感疫苗之研究整理 14
表3-4-1 本研究所使用之資料庫資料及欄位 22
表3-5-1 研究測量變相與定義:共變項、依變項及自變項 23
表4-1-1 研究樣本之分布情形 25
表4-2-1 慢性阻塞性肺疾病有未接種疫苗在不同之共變項分布情形 27
表4-3-1 慢性阻塞性肺疾病分組之共變項分布情形 30
表4-4-1 慢性阻塞性肺疾病接種疫苗有文在不同之依變項分布情形 33
表4-4-2輕度慢性阻塞性肺疾病之接種流行性感冒疫苗在不同依變項分布情形 35
表4-4-3 中度慢性阻塞性肺疾病之接種流行性感冒疫苗在不同依變項分布情形 37
表4-4-4重度慢性阻塞性肺疾病之接種流行性感冒疫苗在不同依變項分布情形 39
表4-4-5 極重度慢性阻塞性肺疾病之接種流行性感冒疫苗在不同自變項分布情 41
表4-5-1 研究樣本接種狀態與住院次數之負二項迴歸分析 44
表4-5-2 研究樣本接種狀態與住院天數之複線性迴歸分析 45
表4-5-3 研究樣本接種狀態與與住院費用之複線性迴歸分析 46
表4-5-4 研究樣本接種狀態與急診次數之負二項回歸分析 48
表4-5-5 研究樣本接種狀態與呼吸衰竭之複邏輯斯迴歸分析 49
表4-6-1 研究假設驗證 50
表6-1-1 慢性阻塞性肺疾病各嚴重度之接種流性性感冒疫苗於各個依變項比較 56

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