tag:blogger.com,1999:blog-55518593629056995922024-03-16T11:49:42.705-07:00控糖筆記:專業圖解糖尿病及甲狀腺衛教網站內分泌科專業醫師親自撰文書寫文章,提供民眾所需的健康及醫療知識。
莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comBlogger199125tag:blogger.com,1999:blog-5551859362905699592.post-7811661390609473552024-03-14T23:45:00.000-07:002024-03-16T02:52:11.262-07:00基礎代謝率及每日消耗熱量計算機<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr3SypvDAKIANo9edKHYh61hbtXx91QRqL14WskWwOfktMw8xkS8jS9c0CtLMoHJSjdB_j7uyc6lsyq2ZM76u23QgXK-crEC3eO4KqIYSI770Cz6obPhz2KzedQ1ZK8E8puUNLVizPqk0p-oN_kr8bde2207n9cmLiDtNXmx-v44UvzdiPbeelRKpD_UQU/s1200/TDEE%E8%A8%88%E7%AE%97%E6%A9%9F.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr3SypvDAKIANo9edKHYh61hbtXx91QRqL14WskWwOfktMw8xkS8jS9c0CtLMoHJSjdB_j7uyc6lsyq2ZM76u23QgXK-crEC3eO4KqIYSI770Cz6obPhz2KzedQ1ZK8E8puUNLVizPqk0p-oN_kr8bde2207n9cmLiDtNXmx-v44UvzdiPbeelRKpD_UQU/s16000/TDEE%E8%A8%88%E7%AE%97%E6%A9%9F.png" /></a></div><br /><p></p>
<span style="color: #3d85c6; font-size: x-large;">每日消耗熱量(TDEE)及基礎代謝率(BMR)計算機
</span></div>
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<legend><span class="number">1</span> 性別:</legend>
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<input checked="checked" id="GenderSectiobBox_0" name="GenderSectionBox" type="radio" value="1" />
男生</label>
<br />
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女生</label>
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<legend><span class="number">2</span> 目前年紀:</legend>
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<legend><span class="number">3</span> 目前身高(cm):</legend>
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<legend><span class="number">4</span> 目前體重(kg):</legend>
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<legend><span class="number">5</span> 日常活動量?</legend>
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久坐族/無運動習慣者</label>
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<input id="ExerciseSelectionBox_1" name="ExerciseSelectionBox" type="radio" value="1.375" />
輕度運動/每週運動1-3天</label>
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中度運動/每週運動3-5天</label>
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高度運動/每週運動6-7天</label>
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超高度運動/體力活的工作/每天運動兩次</label>
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<br />
<br />
<br />
<div class="ResultClass" id="FinalScores" style="display: none;">
<legend>檢測結果:</legend>
<legend>Harris–Benedict公式</legend>
<legend>基礎代謝率BMR為<span id="FinalScoresSpan"></span>大卡</legend>
<legend>每日消耗熱量TDEE為<span id="FinalScoresSpan2"></span>大卡</legend>
<legend>-------------------------------------------------</legend>
<legend>Mifflin-St.Jeor公式</legend>
<legend>基礎代謝率BMR為<span id="FinalScoresSpanMS"></span>大卡</legend>
<legend>每日消耗熱量TDEE為<span id="FinalScoresSpanMS2"></span>大卡</legend>
</div>
<br />
<br />
<legend>每日消耗熱量(TDEE)及基礎代謝率(BMR)計算機撰寫:</legend>
<legend><span style="color: #0b04d8;">莊武龍醫師</span></legend>
<legend>若有任何問題,歡迎來信指教。</legend>
<legend>臉書粉絲專頁:<a href="https://www.facebook.com/dmnote/">莊武龍醫師的控糖筆記</a></legend>
<br />
<br />
<legend>參考公式</legend>
<legend>Harris–Benedict公式</legend>
<legend>男性基礎代謝率BMR=[5.0×身高(cm)+13.7×體重(kg)]-[6.8×年齡]+66</legend>
<legend>女性基礎代謝率BMR=[1.8×身高(cm)+9.6×體重(kg)]-[4.7×年齡]+655</legend>
<br />
<legend>Mifflin-St.Jeor公式</legend>
<legend>男性基礎代謝率BMR=[6.25×身高(cm)+10×體重(kg)]-[5×年齡]+5</legend>
<legend>女性基礎代謝率BMR=[6.25×身高(cm)+10×體重(kg)]-[5×年齡]-161</legend>
<h2>TDEE計算方式</h2>
<table>
<tr>
<th>活動水平</th>
<th>描述</th>
<th>計算公式</th>
</tr>
<tr>
<td>久坐(沒運動)</td>
<td>日常生活中幾乎沒有或完全不運動的人</td>
<td>BMR x 1.2</td>
</tr>
<tr>
<td>輕強度活動</td>
<td>每週運動1~3天</td>
<td>BMR x 1.4</td>
</tr>
<tr>
<td>中強度活動</td>
<td>每週運動3~5天</td>
<td>BMR x 1.6</td>
</tr>
<tr>
<td>高強度活動</td>
<td>每週運動6~7天</td>
<td>BMR x 1.8</td>
</tr>
<tr>
<td>超高強度活動</td>
<td>每天運動2次以上</td>
<td>BMR x 2</td>
</tr>
</table>
<h1>TDEE(每日能量消耗)計算方式</h1>
<p>TDEE(Total Daily Energy Expenditure,每日能量消耗)計算方式主要考慮基礎代謝率(BMR)和日常活動強度。基礎代謝率(BMR)是指你在安靜狀態下(比如睡眠中)不進行任何活動時身體維持基本生命活動(如呼吸、心跳等)所需的最低能量消耗。根據你的活動水平,將BMR乘以特定的係數,就可以估算出TDEE,這代表了你一天消耗的總能量,包括基本生命活動和各種活動所需的能量。</p>
<h2>活動水平及其對應的TDEE係數</h2>
<ul>
<li><strong>久坐(沒運動):</strong> BMR乘以1.2</li>
<li><strong>輕強度活動(每週運動1~3天):</strong> BMR乘以1.4</li>
<li><strong>中強度活動(每週運動3~5天):</strong> BMR乘以1.6</li>
<li><strong>高強度活動(每週運動6~7天):</strong> BMR乘以1.8</li>
<li><strong>超高強度活動(每天運動2次以上):</strong> BMR乘以2</li>
</ul>
<p>要準確計算TDEE,首先需要知道你的BMR,這可以通過多種公式計算得出,如哈里斯-班尼迪克特公式、閔克斯公式等。計算BMR需要考慮性別、年齡、體重和身高等因素。得到BMR後,再根據上述活動水平乘以相應的係數,就可以估算出大概的TDEE了。</p>
<p>記住,這些都只是估算值,實際的能量消耗會因人而異,受到多種因素的影響。</p>
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</div>
莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-7517871699190431542024-03-06T01:14:00.000-08:002024-03-06T01:14:48.211-08:00糖尿病患者發生腕隧道症候群的原因與治療方式<p> 糖尿病患者發生腕隧道症候群的原因</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioD-ba5uuXYjJrioBLIspJ1DruuADbRL56asBw774c5cGqXwW2a-a9ZMQHj9o4RmoniVOGBkOkkbj9JjisCv7D951P8ZmeKT8otz6uTX7Mux0YR3AJDbjUu83_5v3x0_MV3gI2QqhQc0ZbH8ezpJG5jKMGQxkcYuGMWsVLjrFCUgHRrMafllbMJakkKNLu/s1200/OA-%E8%85%95%E9%9A%A7%E9%81%93%E7%97%87%E5%80%99%E7%BE%A4-2024-0306.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioD-ba5uuXYjJrioBLIspJ1DruuADbRL56asBw774c5cGqXwW2a-a9ZMQHj9o4RmoniVOGBkOkkbj9JjisCv7D951P8ZmeKT8otz6uTX7Mux0YR3AJDbjUu83_5v3x0_MV3gI2QqhQc0ZbH8ezpJG5jKMGQxkcYuGMWsVLjrFCUgHRrMafllbMJakkKNLu/s16000/OA-%E8%85%95%E9%9A%A7%E9%81%93%E7%97%87%E5%80%99%E7%BE%A4-2024-0306.png" /></a></div><br /><h2 style="text-align: left;"><span style="font-size: x-large;"><span style="color: #2b00fe;">腕隧道症候群發生的原因</span></span></h2><p><span style="font-size: large;">懷孕、停經、肥胖、腎功能衰竭、甲狀腺功能低下會增加發生腕隧道症候群的風險。即使不是做重覆握持動作的工作,也可能發生腕隧道症候群。</span></p><p><span style="font-size: large;">腕隧道症候群是當今全球最常見的周邊神經受困症狀。</span></p><p><span style="font-size: large;">它被定義為在腕關節水平上對正中神經的壓迫,伴隨著該神經功能下降。</span></p><p><span style="font-size: large;">腕隧道症候群主要是一種特發性疾病,影響7-16%的成年人口。</span></p><p><span style="font-size: large;">它佔所有神經受壓綜合症約90%。</span></p><p><span style="font-size: large;">一般報告指出腕隧道症候群在女性中更為常見,</span></p><p><span style="font-size: large;">並隨著年齡增長而增加,在45至64歲之間的高發生率。</span></p><p><span style="font-size: large;">職業風險因素包括強力握持、腕部重複彎曲和伸展以及振動暴露。</span></p><p><span style="font-size: large;">還有許多外在和內在因素引起次發性CTS。</span></p><p><span style="font-size: large;">其中,懷孕、停經、肥胖、腎功能衰竭、甲狀腺功能低下、口服避孕藥使用和</span></p><p><span style="font-size: large;">充血性心力衰竭等因素可能通過增加隧道內滑膜(synovial sheath)的體積來促成腕隧道症候群。</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">腕隧道症候群也是黏多醣代謝異常症中最常見的肌肉骨骼臨床表現之一,</span></p><p><span style="font-size: large;">會在報告在黏多醣代謝異常症I型、II型、IV型和VI型中出現。</span></p><p><span style="font-size: large;">橈骨遠端直接骨折、創傷後關節炎和腫瘤、神經節囊腫或持續性橈骨神經均可改變隧道的輪廓。</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">神經病變的因素,如糖尿病、酗酒、維生素缺乏以及暴露於毒素,都可能引起腕隧道症候群的症狀。</span></p><p><span style="font-size: large;">因為這些因素會直接損傷神經,而不一定會是因導致腕管內壓力的急劇增加而引起腕隧道症候群。</span></p><p><span style="font-size: large;">其他致病因素包括橫腕韌帶(transverse carpal ligament)的形態和機械變化(即肥大和僵硬),這可能導致腕隧道空間和彈性明顯減少。</span></p><p><span style="font-size: large;"><br /></span></p><h2 style="text-align: left;"><span style="color: #2b00fe; font-size: large;">治療方式</span></h2><p><span style="font-size: large;">輕度和中度腕隧道症候群的初始治療可以從非手術性的治療做起。</span></p><p><span style="font-size: large;">包括戴腕部固定器、類固醇注射和口服藥物。</span></p><p><span style="font-size: large;">有些患者使用腕部固定器後,可以觀察到腕隧道症候群症狀在休息手部活動後會改善。</span></p><p><span style="font-size: large;">局部類固醇注射入腕隧道可減少通過其的滑膜的炎症和水腫來降低腕隧道內壓力。</span></p><p><span style="font-size: large;">嚴重CTS的這種管理在1個月內相比安慰劑提供了症狀上的優勢;然而,在輕度和中度病例中,1個月後的優勢仍不確定。局部皮質類固醇注射的主要不良反應是抑制腱細胞中膠原蛋白和蛋白聚糖的合成,引起腱的機械強度下降和進一步退化。口服類固醇,即泼尼松,僅在CTS的短期治療中顯示出一些好處。非甾體抗炎藥(NSAIDs)和利尿劑未能證明有明顯好處,不建議用於CTS的治療。</span></p><p><span style="font-size: large;">保守治療方法可能在疾病的初期階段有效,延遲手術介入。</span></p><p><br /></p><h2 style="text-align: left;"><span style="font-size: x-large;"><span style="color: #2b00fe;">神經解套注射治療</span></span></h2><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMvWmLknMNkj6aCDLSQkeMN57rInHhHqP4GX3kV19F-48uptoVgAIcoSjcxV2h5RJgS_hjfLzeix57gOQllom_AOIsUvUQcg4WRrkx4DWJPCY0k4922ZrYRy3BPLqD-DrUCubUsHRWJELHOYwN8obS2bFDu3KfD_3a3e27Ax3ZUPpqTjqZXSKD5lDcv4jx/s1200/OA-%E8%85%95%E9%9A%A7%E9%81%93%E7%97%87%E5%80%99%E7%BE%A42-2024-0306.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMvWmLknMNkj6aCDLSQkeMN57rInHhHqP4GX3kV19F-48uptoVgAIcoSjcxV2h5RJgS_hjfLzeix57gOQllom_AOIsUvUQcg4WRrkx4DWJPCY0k4922ZrYRy3BPLqD-DrUCubUsHRWJELHOYwN8obS2bFDu3KfD_3a3e27Ax3ZUPpqTjqZXSKD5lDcv4jx/s16000/OA-%E8%85%95%E9%9A%A7%E9%81%93%E7%97%87%E5%80%99%E7%BE%A42-2024-0306.png" /></a></div><br /><span style="font-size: x-large;"><br /></span><p></p><p><span style="font-size: large;">保守治療,如消除致病活動、固定、治療潛在疾病、非類固醇抗炎藥(NSAIDs)、物理治療和職業治療,是治療的第一步。</span></p><p><span style="font-size: large;">當保守措施失敗時,介入性注射技術被視為下一步。</span></p><p><span style="font-size: large;">神經解套注射(Nerve Hydrodissection)是肌肉骨骼超音波的新興技術之一。</span></p><p><span style="font-size: large;">神經解套注射(Nerve Hydrodissection)是一種將神經與周圍組織分離的注射技術。</span></p><p><span style="font-size: large;">治療過程中會用超音波導引注射葡萄糖水做神經解套,讓通過皮下的正中神經從上下夾擠的軟組織表面滑開。患者在接受注射後,神經壓迫的症狀減輕,進而改善手麻或手痛。</span></p><p><br /></p><p><br /></p>莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-34747502938636043682024-02-01T00:46:00.000-08:002024-02-01T00:48:01.061-08:00長新冠(Long COVID)新冠肺炎後遺症症狀及治療<p class="p1" style="font-family: Arial; font-size: 64px; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px 0px 12px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEh5_EFc6au5xPwEwDyIPckSDuKJFFMICluSD16RRz4OMQlWx1GjpSTPB3q8fpgqHmpWCObdvzw3Z7ZGE4BbrQ-0YKF2kmc4YJGBEZEAFTHbtT7owTLeEAMzgsZS1vM011ZaBnZFsejXD9uyAEJfs2bzILVw0y-62BLIiBOmE0GwPrhYcobWjOYZKBSx4g=s1200" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" src="https://blogger.googleusercontent.com/img/a/AVvXsEh5_EFc6au5xPwEwDyIPckSDuKJFFMICluSD16RRz4OMQlWx1GjpSTPB3q8fpgqHmpWCObdvzw3Z7ZGE4BbrQ-0YKF2kmc4YJGBEZEAFTHbtT7owTLeEAMzgsZS1vM011ZaBnZFsejXD9uyAEJfs2bzILVw0y-62BLIiBOmE0GwPrhYcobWjOYZKBSx4g=s16000" /></a></div><br /><span style="color: #0b5394;"><br /></span><p></p><p class="p1" style="font-family: Arial; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px 0px 12px;"><span style="font-size: large;"><span face="Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"" style="color: #374151; white-space-collapse: preserve;">長新冠(Long COVID)</span><span face="Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"" style="color: #374151; white-space-collapse: preserve;">,也被稱為新冠後遺症綜合症(PASC),指的是個體在COVID-19急性期過後仍然經歷持續症狀的狀態。</span><span face="Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"" style="color: #374151; white-space-collapse: preserve;">長新冠(Long COVID)</span><span face="Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"" style="color: #374151; white-space-collapse: preserve;">的症狀可能多樣,並可能影響不同的器官系統。治療</span><span face="Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"" style="color: #374151; white-space-collapse: preserve;">長新冠(Long COVID)</span><span face="Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"" style="color: #374151; white-space-collapse: preserve;">的方法通常著重於管理特定症狀並改善整體健康。以下是對常見長期COVID症狀的摘要以及可能的治療策略:</span></span></p><h2 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; line-height: 1.33333; margin: 2rem 0px 1rem; white-space-collapse: preserve;">常見長新冠(Long COVID)症狀:</h2><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">1. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">疲勞:</span></h3><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; margin: 0px 0px 1.25em; white-space-collapse: preserve;">持續而令人難以忍受的疲勞是長新冠(Long COVID)的一個標誌性症狀,影響日常功能。</p><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">2. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">呼吸急促:</span></h3><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; margin: 0px 0px 1.25em; white-space-collapse: preserve;">一些人在長新冠(Long COVID)期間可能會持續出現呼吸方面的症狀,包括呼吸急促或呼吸困難。</p><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">3. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">認知功能障礙(腦霧):</span></h3><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; margin: 0px 0px 1.25em; white-space-collapse: preserve;">認知障礙,通常被稱為"腦霧",包括集中注意力、記憶和思維清晰度方面的困難。</p><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">4. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">肌肉和關節疼痛:</span></h3><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; margin: 0px 0px 1.25em; white-space-collapse: preserve;">持續的肌肉和關節疼痛,類似於急性感染期的症狀,可能在長新冠(Long COVID)中持續存在。</p><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">5. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">胸痛和緊迫感:</span></h3><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; margin: 0px 0px 1.25em; white-space-collapse: preserve;">胸部不適、疼痛或緊迫感可能持續存在,即使急性病期已經解決。</p><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">6. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">頭痛:</span></h3><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; margin: 0px 0px 1.25em; white-space-collapse: preserve;">一些人在長新冠(Long COVID)中可能持續出現慢性頭痛或偏頭痛。</p><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">7. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">嗅覺和味覺喪失:</span></h3><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; margin: 0px 0px 1.25em; white-space-collapse: preserve;">一些人在急性期後仍可能繼續出現嗅覺損失或味覺異常。</p><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">8. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">睡眠障礙:</span></h3><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; margin: 0px 0px 1.25em; white-space-collapse: preserve;">失眠或睡眠模式的混亂可能持續存在,加重整體疲勞。</p><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">9. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">心悸:</span></h3><p style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; margin: 0px 0px 1.25em; white-space-collapse: preserve;">心跳不規則或心悸可能發生,應密切監控心臟症狀。</p><p class="p1" style="font-family: Arial; font-size: 64px; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px 0px 12px;"><span style="color: #0b5394;"></span></p><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">10. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">情緒障礙:</span></h3><h2 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; line-height: 1.33333; margin: 2rem 0px 1rem; white-space-collapse: preserve;">長新冠(Long COVID)的治療策略:</h2><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">1. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">症狀管理:</span></h3><ul style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; display: flex; flex-direction: column; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.25em; padding: 0px; white-space-collapse: preserve;"><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: block; margin: 0px; min-height: 28px; padding-left: 0.375em;">使用藥物或針對每個人需求定制的介入來處理特定症狀。</li><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: block; margin: 0px; min-height: 28px; padding-left: 0.375em;">對於肌肉和關節疼痛,可以使用止痛藥和抗炎藥物。</li></ul><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">2. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">物理治療:</span></h3><ul style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; display: flex; flex-direction: column; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.25em; padding: 0px; white-space-collapse: preserve;"><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: block; margin: 0px; min-height: 28px; padding-left: 0.375em;">運用物理治療來處理肌骨症狀並改善活動能力。</li></ul><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">3. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">肺部康復:</span></h3><ul style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; display: flex; flex-direction: column; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.25em; padding: 0px; white-space-collapse: preserve;"><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: block; margin: 0px; min-height: 28px; padding-left: 0.375em;">對於呼吸方面的持續症狀,可實施肺部康復。</li></ul><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">4. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">認知康復:</span></h3><ul style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; display: flex; flex-direction: column; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.25em; padding: 0px; white-space-collapse: preserve;"><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: block; margin: 0px; min-height: 28px; padding-left: 0.375em;">參與認知康復計劃,以應對認知功能障礙。</li></ul><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">5. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">心理支持:</span></h3><ul style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; display: flex; flex-direction: column; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.25em; padding: 0px; white-space-collapse: preserve;"><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: block; margin: 0px; min-height: 28px; padding-left: 0.375em;">提供心理支持,包括心理諮詢或治療,以應對情緒障礙和焦慮。</li></ul><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">6. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">逐漸運動計劃:</span></h3><ul style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; display: flex; flex-direction: column; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.25em; padding: 0px; white-space-collapse: preserve;"><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: block; margin: 0px; min-height: 28px; padding-left: 0.375em;">實施謹慎監測的逐漸運動計劃,以改善耐力並減輕疲勞。</li></ul><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">7. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">營養支持:</span></h3><ul style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; display: flex; flex-direction: column; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.25em; padding: 0px; white-space-collapse: preserve;"><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: block; margin: 0px; min-height: 28px; padding-left: 0.375em;">確保均衡的飲食和足夠的水分,以支持整體健康和康復。</li></ul><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">8. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">藥物調整:</span></h3><ul style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; display: flex; flex-direction: column; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.25em; padding: 0px; white-space-collapse: preserve;"><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: block; margin: 0px; min-height: 28px; padding-left: 0.375em;">根據需要調整藥物,特別是對於心血管症狀的患者。</li></ul><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">9. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">多學科綜合治療:</span></h3><ul style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: #374151; display: flex; flex-direction: column; font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 16px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.25em; padding: 0px; white-space-collapse: preserve;"><li style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; display: block; margin: 0px; min-height: 28px; padding-left: 0.375em;">與多學科醫療團隊合作,處理不同的症狀並提供整體照護。</li></ul><p class="p1" style="font-family: Arial; font-size: 64px; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px 0px 12px;"><span style="color: #0b5394;"></span></p><h3 style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box; color: var(--tw-prose-headings); font-family: Söhne, ui-sans-serif, system-ui, -apple-system, "Segoe UI", Roboto, Ubuntu, Cantarell, "Noto Sans", sans-serif, "Helvetica Neue", Arial, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"; font-size: 1.25em; line-height: 1.6; margin: 1rem 0px 0.5rem; white-space-collapse: preserve;">10. <span color="inherit" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;">監測和追蹤:</span></h3><div><span style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(69,89,164,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 transparent; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 transparent; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 transparent; --tw-shadow: 0 0 transparent; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(217, 217, 227); box-sizing: border-box;"><span face="Söhne, ui-sans-serif, system-ui, -apple-system, Segoe UI, Roboto, Ubuntu, Cantarell, Noto Sans, sans-serif, Helvetica Neue, Arial, Apple Color Emoji, Segoe UI Emoji, Segoe UI Symbol, Noto Color Emoji" style="color: #374151;"><span style="white-space-collapse: preserve;">對於患有長新冠(Long COVID)的個體,與醫療專業人員合作至關重要,他們可以為其特定需求制定治療計劃。</span></span></span></div><div><br /></div><p class="p1" style="font-family: Arial; font-size: 64px; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px 0px 12px;"><span style="color: white;"><br /></span></p><p class="p1" style="font-family: Arial; font-size: 64px; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px 0px 12px;"><span style="color: white;">狀及治療</span></p>莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-47046750173563337932024-01-30T23:13:00.000-08:002024-01-31T00:22:16.057-08:00胰島素阻抗的種類與機轉<h1 style="text-align: left;"><span style="font-size: large;">胰島素阻抗的種類與機轉</span></h1><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a alt="胰島素阻抗的種類與機轉" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1yBxFBhdmNZ9CyOZlIBAPD-w7wRrm6fCMdI6AsY0c3ma_m_ry3OppdSIX-2Edrf03xlo7aJejtWdV4U5uj_5Y_1tyDzJ1XQvyXT9JjbBCDWz7zPx5PX1wuFS9lh_KKzAIXXkeQD2JnGgfjc2LaP6ayUbr2yRfgIkrKRndUNpLklQQZj90xza59zkAwc6Y/s1200/OA-%E8%83%B0%E5%B3%B6%E7%B4%A0%E9%98%BB%E6%8A%97%E7%A0%94%E7%A9%B6-2024-0131.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1yBxFBhdmNZ9CyOZlIBAPD-w7wRrm6fCMdI6AsY0c3ma_m_ry3OppdSIX-2Edrf03xlo7aJejtWdV4U5uj_5Y_1tyDzJ1XQvyXT9JjbBCDWz7zPx5PX1wuFS9lh_KKzAIXXkeQD2JnGgfjc2LaP6ayUbr2yRfgIkrKRndUNpLklQQZj90xza59zkAwc6Y/s16000/OA-%E8%83%B0%E5%B3%B6%E7%B4%A0%E9%98%BB%E6%8A%97%E7%A0%94%E7%A9%B6-2024-0131.png" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p><br /></p><p><br /></p><p></p><div class="separator" style="clear: both; text-align: center;"><a alt="血胰島素阻抗的種類" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8xqw6ViVnoEwypZJwsinYvAdWe5KblvGewKniZ6cEPiftRnRKPSlC3lyLDsqZYPcLdKKM4FIzjU6qaILfx8W-spRaocgJh-_b0Nv-ckOwstJSn-DGWZr_jm_ZXql1884l3mdl6oosggXRN6GtBvaRasBKzK1XyAiX1OXtHZ3vlMpHMKYZeAdmkcVsY4w3/s1200/OA-%E8%83%B0%E5%B3%B6%E7%B4%A0%E9%98%BB%E6%8A%97%E7%A8%AE%E9%A1%9E-2024-0131.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8xqw6ViVnoEwypZJwsinYvAdWe5KblvGewKniZ6cEPiftRnRKPSlC3lyLDsqZYPcLdKKM4FIzjU6qaILfx8W-spRaocgJh-_b0Nv-ckOwstJSn-DGWZr_jm_ZXql1884l3mdl6oosggXRN6GtBvaRasBKzK1XyAiX1OXtHZ3vlMpHMKYZeAdmkcVsY4w3/w640-h334/OA-%E8%83%B0%E5%B3%B6%E7%B4%A0%E9%98%BB%E6%8A%97%E7%A8%AE%E9%A1%9E-2024-0131.png" width="640" /></a></div><br /><p></p><p><span style="font-size: large;">胰島素阻抗的種類傳統上被分類為A型和B型。</span></p><p><span style="font-size: large;">亦即A型胰島素阻抗症狀(Type B insulin resistance syndrome)及B型胰島素阻抗症狀(Type B insulin resistance syndrome)。</span></p><p><span style="font-size: large;">不過科學研究也漸漸發現了與胰島素受體下游信號相關基因突變引起的胰島素阻抗症狀,所以有研究會把分類歸類為遺傳性胰島素阻抗症狀及B型胰島素阻抗症狀。把A型胰島素阻抗症狀歸類在遺傳性胰島素阻抗症狀裏面。比較常聽到的基因疾病Rabson-Mendenhall 症候群,矮妖精貌症候群(Leprechaunism=Donohue Syndrome)亦即Donohue氏症候群(Donohue Syndrome)也是列在遺傳性胰島素阻抗症狀的分類。</span></p><p><span style="font-size: x-large;"><br /></span></p><p><span style="font-size: large;">胰島素阻抗的種類與機轉的理論推論可以簡略參考最上面第一張圖。</span></p><p><span style="font-size: large;">在健康的個體中,血清胰島素主要通過胰島素受體活化細胞內部的胰島素信號傳導路徑,進而抑制細胞內部類胰島素生長因子1(IGF-1)的信號傳導。</span></p><p><span style="font-size: large;">在胰島素阻抗的糖尿病患者中,盡管血中存在高水平的胰島素,但細胞內部由於受到抑制而無法通過胰島素受體進行正常信號轉導,同時稍微激活了細胞內部IGF-1的信號轉導。</span></p><p><span style="font-size: large;">在B型胰島素阻抗症狀的患者,雖然存在明顯高血漿中的高胰島素濃度水平,但是由胰島素受體的抗體抑制了細胞內部的胰島素訊號。血液中高水平的胰島素濃度會使得IGF-1接收器啓動並引發強大釋出細胞內部類胰島素生長因子1(IGF-1)的信號。多囊卵巢徵侯群即可能是由於IGF-1信號啓動和胰島素信號抑制所引起的。</span></p><p><span style="font-size: x-large;"><br /></span></p><p><span style="font-size: x-large;"><span style="color: red;">B型胰島素阻抗症狀,簡單來說就是跟免疫系統錯亂有關。</span></span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeFxLkZrL6a6c0QKEAbHI4_Y_v63S34NdRLSXedG1CWrsaX4_VhGSzme5zL33ONO6xLFv9ysiicRLgRq_Rexula2PPbamurMA5-E3zQ-bSX1GHdSDr0pWu1QVVJaym9K4pPWdmjEfYZB_1tC5dbDrVo2qImBo4dxcEcrqvdFLvyJWPCxr4spB-SSBkFm3H/s1200/OA-%E8%83%B0%E5%B3%B6%E7%B4%A0%E9%98%BB%E6%8A%97-PCOS-2024-0131.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeFxLkZrL6a6c0QKEAbHI4_Y_v63S34NdRLSXedG1CWrsaX4_VhGSzme5zL33ONO6xLFv9ysiicRLgRq_Rexula2PPbamurMA5-E3zQ-bSX1GHdSDr0pWu1QVVJaym9K4pPWdmjEfYZB_1tC5dbDrVo2qImBo4dxcEcrqvdFLvyJWPCxr4spB-SSBkFm3H/w640-h334/OA-%E8%83%B0%E5%B3%B6%E7%B4%A0%E9%98%BB%E6%8A%97-PCOS-2024-0131.png" width="640" /></a></div><br /><span style="font-size: large;"><br /></span><p></p><p><span style="font-size: large;">B型胰島素阻抗症狀的方式,可能會需要用到類固醇或免疫調節藥物。有的個案經過類固醇或免疫調節藥物治療後,血糖大幅波動跟胰島素阻抗皆有改善。同時也改善了黑色棘皮症。</span></p><p><span style="font-size: large;">就像上圖B型胰島素阻抗症狀的個案的治療過程一樣,一開始治療時,血糖會很難控制,需要口服藥或甚至胰島素治療,治療到後面的時候,即使沒有口服藥或胰島素,血糖也改善變正常了,甚至血經不規則的症狀也改善了。</span></p><p><span style="font-size: large;">所以千萬別因為有胰島素阻抗就排斥類固醇或免疫調節藥物的治療,如果是B型胰島素阻抗症狀的患者,這樣的治療,反而會幫助改善病情。</span></p><p><span style="font-size: x-large;"><br /></span></p><p><span style="font-size: x-large;">另外B型胰島素阻抗症狀有幾個重點要注意:</span></p><p><span style="font-size: large;">1. 約76%的B型胰島素阻抗症狀的患者伴有低血糖症,這是重要的臨床特徵之一。</span></p><p><span style="font-size: large;">2. B型胰島素阻抗症狀有67%有其他自身免疫性疾病或免疫學測試值異常。</span></p><p><span style="font-size: large;">3. 最常見的相關自身免疫性疾病是系統性紅斑狼瘡(20%),還有其他像混合結締組織病、Sjogren氏症候群、自身免疫性甲狀腺疾病、自身免疫性血小板減少症、全身性硬皮病和類風濕關節炎。</span></p><p><span style="font-size: large;"></span></p><p><span style="font-size: large;">4. 鑑於治療伴隨的自身免疫性疾病可能會使B型胰島素抵抗症病情緩解或治癒,建議檢查患者是否伴有這些自身免疫性疾病。</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;"><br /></span></p><p><span style="color: #2b00fe; font-size: large;">參考文獻:</span></p><p><span style="font-size: large;">1.Watanabe T, Okabe S, Sakamoto S. Polycystic ovary syndrome in a patient with type B insulin resistance syndrome can improve with glucocorticoid treatment: a case report and literature review. Endocr J. 2023 Oct 30;70(10):1015-1021. </span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">2.Ogawa W, Araki E, Ishigaki Y, Hirota Y, Maegawa H, Yamauchi T, Yorifuji T, Katagiri H. New classification and diagnostic criteria for insulin resistance syndrome. Endocr J. 2022 </span></p><div><div style="background-color: white; border: 0px; color: #585858; font-family: "pingfang tc"; font-size: 14px; font-stretch: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; color: blue; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">作者</span></div><div style="background-color: white; border: 0px; font-stretch: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><div style="border: 0px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><div style="border: 0px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; 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font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">莊武龍醫師</span></span></span><br style="line-height: 23.4px; margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">專長於</span></span></span></span></span></span><span style="color: #222222; font-family: heiti tc;">甲狀腺射頻消融術、</span><span style="background-color: rgba(255, 255, 255, 0.498); color: #222222; font-family: inherit; font-style: inherit; font-variant-caps: inherit; font-variant-ligatures: inherit; font-weight: inherit;">週邊神經的超音波評估與營養評估</span></span></div><div style="border: 0px; color: #585858; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: large;"><span face=""carrois gothic" , sans-serif" style="background-color: rgba(255, 255, 255, 0.498); border: 0px; color: #222222; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; 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font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 22px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 22px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">文章僅供醫療衛教分享以及促進健康之用,請勿做為商業用途及其它不法的宣傳之用</span></span></span></span></span></span></div></div></div></div><div><br /></div>莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-10145942963222972452024-01-24T18:28:00.000-08:002024-01-24T18:33:53.160-08:00血液尿酸數值正常,仍然有可能是痛風<h1 style="text-align: left;"><span style="font-size: large;">血液尿酸數值正常,仍然有可能是痛風</span></h1>
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<a alt="血液尿酸數值正常,仍然有可能是痛風" href="https://1.bp.blogspot.com/-kKIHoYKHOxg/XmXvszIWS6I/AAAAAAAAGk4/RETEa2_w-ogbqfMc0EUhzhoyU9dPuxIFwCNcBGAsYHQ/s1600/%25E7%2597%259B%25E9%25A2%25A8-%25E6%258A%25BD%25E8%25A1%2580%25E6%25AA%25A2%25E9%25A9%2597-%25E5%25B0%25BF%25E9%2585%25B8.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" src="https://1.bp.blogspot.com/-kKIHoYKHOxg/XmXvszIWS6I/AAAAAAAAGk4/RETEa2_w-ogbqfMc0EUhzhoyU9dPuxIFwCNcBGAsYHQ/s16000/%25E7%2597%259B%25E9%25A2%25A8-%25E6%258A%25BD%25E8%25A1%2580%25E6%25AA%25A2%25E9%25A9%2597-%25E5%25B0%25BF%25E9%2585%25B8.png" /></a></div>
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<br /><span style="font-size: large;">2022英國的痛風治療指引建議的診斷方式:</span><div><div><span style="font-size: large;">1.測量有痛風症狀的人的血清尿酸水平,</span></div><div><span style="font-size: large;">以確認臨床診斷(血清尿酸水平≥360 μmol/L(6 mg/dL))。</span></div><div><span style="font-size: large;">如果在發作期間血清尿酸水平<360 μmol/L並且強烈懷疑是痛風,<span>可</span>在發作結束後至少兩週再次測量血清尿酸水平。</span></div><div><span style="font-size: large;">2.如果仍然無法確定或證實是否患有痛風,可以考慮做關節穿刺和關節液顯微觀察。</span></div><div><span style="font-size: large;">3.如果無法進行關節穿刺或者仍然無法確定是否患有痛風,請考慮使用X光、超音波掃描或雙能量電腦斷層掃描儀(Dual Energy Computed Tomography, DECT)來了解受影響的關節。</span></div><div><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;">以上為治療指引的診斷建議,所以換句話說,即使血液中的尿酸濃度正常,關節發炎的情形仍可能是痛風性關節炎。所以血液中的尿酸濃度還在安全或正常範圍是不能排除有痛風性關節炎的,如果臨床醫師仍懷疑痛風性關節炎,還得要搭配病史或其它檢查來確認。</span></div><div><br /></div><div><br /></div>
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<a alt="痛風結石或結晶,無法在X光上顯現出來,所以有時候可以到底是退化性關節炎還是痛風性關節炎不一定能夠單從X光判斷的出來,可以再搭配影像學檢查做為判斷的依據" href="https://1.bp.blogspot.com/-QYD1WCl9U04/XmXvzzSePKI/AAAAAAAAGk8/_Wv4I15g4mUX2qwLeWB99625sbd0jucUACNcBGAsYHQ/s1600/%25E7%2597%259B%25E9%25A2%25A8-%25E8%2586%259D%25E9%2597%259C%25E7%25AF%2580-X%25E5%2585%2589.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-QYD1WCl9U04/XmXvzzSePKI/AAAAAAAAGk8/_Wv4I15g4mUX2qwLeWB99625sbd0jucUACNcBGAsYHQ/s640/%25E7%2597%259B%25E9%25A2%25A8-%25E8%2586%259D%25E9%2597%259C%25E7%25AF%2580-X%25E5%2585%2589.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: large;">比較初期的痛風,在X光的表現上有時候不會出現明顯的骨頭破壞痕跡,而且痛風結石或結晶,無法在X光上顯現出來,所以有時候可以到底是退化性關節炎還是痛風性關節炎不一定能夠單從X光判斷的出來,可以再搭配影像學檢查做為判斷的依據。</span></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a alt="超音波下,可以看出膝蓋上出現雙重輪廓跡象(double contour sign),此為痛風的特徵,又或者可以在第一蹠趾關節(First MTP joints)看到出現痛風石(tophus)或結晶的變化" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4vD31pJWofdxGpDdOD-3S7jopLyplydtqamMbKv2sUqjZcf7X8ziYvIcRTcQY-XXZ5Mp0Ye103zhzsSpzeAFlHpVTbAg77UuGENS1xo0DFesQPOpj0ktXAzKoS3WGVWJ_Ca4kEL7siqyXj5W0W8uiXOcVZ1B8Iw840UyJn2CFFDC9cQo5592Yr_ARUi5F/s1200/OA-%E7%97%9B%E9%A2%A8%E5%B0%BF%E9%85%B8%E7%A0%94%E7%A9%B6-2024-0125.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4vD31pJWofdxGpDdOD-3S7jopLyplydtqamMbKv2sUqjZcf7X8ziYvIcRTcQY-XXZ5Mp0Ye103zhzsSpzeAFlHpVTbAg77UuGENS1xo0DFesQPOpj0ktXAzKoS3WGVWJ_Ca4kEL7siqyXj5W0W8uiXOcVZ1B8Iw840UyJn2CFFDC9cQo5592Yr_ARUi5F/s16000/OA-%E7%97%9B%E9%A2%A8%E5%B0%BF%E9%85%B8%E7%A0%94%E7%A9%B6-2024-0125.png" /></a></div><span style="font-size: large;">例如在超音波下,可以看出膝蓋上出現雙重輪廓跡象(double contour sign),此為痛風的特徵。又或者可以在第一蹠趾關節(First MTP joints)看到出現痛風石(tophus)或結晶的變化。在使用降尿酸治療後, 膝關節處的雙重輪廓跡象會慢慢消失。第一蹠趾關節(First MTP joints)看到出現痛風石(tophus)或結晶的體積也會變小。</span></div><div><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;">參考論文:</span></div><div><span style="font-size: large;">BMJ 2022;378:o1754 </span><br /><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><div style="background-color: white; border: 0px; color: #585858; font-family: "pingfang tc"; font-size: 14px; font-stretch: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; color: blue; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">作者</span></div><div style="background-color: white; border: 0px; font-stretch: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><div style="border: 0px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><div style="border: 0px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: large;"><span style="color: #585858; font-family: inherit; font-style: inherit; font-variant-caps: inherit; font-variant-ligatures: inherit; font-weight: inherit;"><span face=""carrois gothic" , sans-serif" style="background-color: rgba(255, 255, 255, 0.498); border: 0px; color: #222222; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">鹿港基督教醫院內分泌暨新陳代謝科</span></span></span><br style="line-height: 23.4px; margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">莊武龍醫師</span></span></span><br style="line-height: 23.4px; margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">專長於</span></span></span></span></span></span><span style="color: #222222; font-family: heiti tc;">甲狀腺射頻消融術、</span><span style="background-color: rgba(255, 255, 255, 0.498); color: #222222; font-family: inherit; font-style: inherit; font-variant-caps: inherit; font-variant-ligatures: inherit; font-weight: inherit;">週邊神經的超音波評估與營養評估</span></span></div><div style="border: 0px; color: #585858; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: large;"><span face=""carrois gothic" , sans-serif" style="background-color: rgba(255, 255, 255, 0.498); border: 0px; color: #222222; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">引用或是轉貼請注明出處,謝謝。</span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 22px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 22px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">文章僅供醫療衛教分享以及促進健康之用,請勿做為商業用途及其它不法的宣傳之用</span></span></span></span></span></span></div></div></div></div></div>莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-74758722612111400102024-01-24T00:33:00.000-08:002024-01-24T01:08:16.646-08:00[最新研究]射頻消融和微波消融在單發性甲狀腺乳突微小癌治療中的功效和安全性比較<p> [最新研究]射頻消融和微波消融在單發性甲狀腺乳突微小癌(PTMC)治療中的功效和安全性比較</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivk-8y7eyjWwiJnNEJqdyhujS5RN_AQbSbSkIZXmU5e-LEVd0D6Wpu47fBWraD1QgxGp1_YlesNQi8cIVw3cMyKsAeyGVULeICcIxGEpUeTV0UinaaxQYlH_NDlwzm_T6-5FtzByFnnv8eB2agGU0xz-Nsf95cV33Yxp6DThJ2L8CbFhG1xUId_XYdJOf9/s638/%E7%94%B2%E7%8B%80%E8%85%BA%E6%B6%88%E8%9E%8D%E6%B2%BB%E7%99%82%E7%9A%84%E6%9C%80%E6%96%B0%E7%A0%94%E7%A9%B6.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="334" data-original-width="638" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivk-8y7eyjWwiJnNEJqdyhujS5RN_AQbSbSkIZXmU5e-LEVd0D6Wpu47fBWraD1QgxGp1_YlesNQi8cIVw3cMyKsAeyGVULeICcIxGEpUeTV0UinaaxQYlH_NDlwzm_T6-5FtzByFnnv8eB2agGU0xz-Nsf95cV33Yxp6DThJ2L8CbFhG1xUId_XYdJOf9/s16000/%E7%94%B2%E7%8B%80%E8%85%BA%E6%B6%88%E8%9E%8D%E6%B2%BB%E7%99%82%E7%9A%84%E6%9C%80%E6%96%B0%E7%A0%94%E7%A9%B6.png" /></a></div><p>近年來,隨著超音波成像技術的快速發展,甲狀腺結節的檢測率和甲狀腺乳突微小癌(PTMC)的發生率顯著增加。由於甲狀腺乳突微小癌PTMC具有良好預後,在其治療方面出現了像超音波引導下的熱消融等微創技術不斷增長的趨勢。射頻消融(RFA)是最常見且廣泛使用的溫度消融技術。它通過電極引入高頻交流電流,生成高溫以使目標組織凝固壞死並摧毀腫瘤。另一種消融技術——微波消 融(MWA)利用微波能量產生高溫,導致細胞凝固壞死和腫瘤組織的破壞。RFA和MWA都具有微創性和恢復時間減少等優點,適用於小型低風險甲狀腺乳突微小癌PTMC患者。持續進行的研究和臨床試驗不斷改進乳頭癌微小癌的消融策略,重點是優化患者預後和生活質量。本研究旨在比較大量患者中RFA與MWA對單發性甲狀腺乳突微小癌PTMC的功效和安全性。</p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLEekJXkceR6iCGtsSD9p63lzZxU4TBMS0SiwQ2zd71u8moFnv_VlwtiYdJ7h2xAGjgww9Lxyxn_GApj8CA5TMhup-yE9dda8F7htof6I2G_fjHAvF7ntOLh-hpBzVOLAdR3kVRzZnF2Ab1byaS1V_w8Cx7GI7dYFOydao7W5rLCIDby-uRk9UJeTut-B7/s1200/%E7%94%B2%E7%8B%80%E8%85%BARFA%E7%A0%94%E7%A9%B6-2024-0124.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLEekJXkceR6iCGtsSD9p63lzZxU4TBMS0SiwQ2zd71u8moFnv_VlwtiYdJ7h2xAGjgww9Lxyxn_GApj8CA5TMhup-yE9dda8F7htof6I2G_fjHAvF7ntOLh-hpBzVOLAdR3kVRzZnF2Ab1byaS1V_w8Cx7GI7dYFOydao7W5rLCIDby-uRk9UJeTut-B7/w640-h334/%E7%94%B2%E7%8B%80%E8%85%BARFA%E7%A0%94%E7%A9%B6-2024-0124.png" width="640" /></a></div><p><br /></p><p>本研究比較了超音波導射頻消融(RFA)和微波消融(MWA)在治療單發甲狀腺乳突微小癌(PTMC)方面的效果和安全性。</p><p>該研究是一項回顧性研究,納入了512例甲狀腺乳突微小癌PTMC患者,其中346例接受了RFA治療,166例接受了MWA治療。</p><p>研究結果顯示,兩組患者的病灶都完全被消融,並且沒有出現局部或遠端復發。</p><p>RFA組使用的隔離液體的容積比MWA組更大。</p><p>在1周的隨訪中,RFA組患者被消融的區域的平均體積小於MWA組。</p><p>在3個月、9個月、12個月、15個月和18個月的隨訪中,RFA組被消融的區域的平均體積大於MWA組。</p><p>研究結果顯示,RFA和MWA都是治療單發PTMC的高效和安全方法,可作為不符合手術條件或不願接受手術的患者的替代治療方法。</p><p><br /></p><p>研究參考來源:</p><p>Int J Hyperthermia. 2024;41(1):2287964.</p>莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-44722639650317363582024-01-18T04:05:00.000-08:002024-01-24T01:09:28.720-08:00[最新研究]對於位於氣管附近與位於氣管遠處的甲狀腺乳突狀微小癌進行射頻消融治療的成效<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivk-8y7eyjWwiJnNEJqdyhujS5RN_AQbSbSkIZXmU5e-LEVd0D6Wpu47fBWraD1QgxGp1_YlesNQi8cIVw3cMyKsAeyGVULeICcIxGEpUeTV0UinaaxQYlH_NDlwzm_T6-5FtzByFnnv8eB2agGU0xz-Nsf95cV33Yxp6DThJ2L8CbFhG1xUId_XYdJOf9/s1200/%E7%94%B2%E7%8B%80%E8%85%BA%E6%B6%88%E8%9E%8D%E6%B2%BB%E7%99%82%E7%9A%84%E6%9C%80%E6%96%B0%E7%A0%94%E7%A9%B6.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivk-8y7eyjWwiJnNEJqdyhujS5RN_AQbSbSkIZXmU5e-LEVd0D6Wpu47fBWraD1QgxGp1_YlesNQi8cIVw3cMyKsAeyGVULeICcIxGEpUeTV0UinaaxQYlH_NDlwzm_T6-5FtzByFnnv8eB2agGU0xz-Nsf95cV33Yxp6DThJ2L8CbFhG1xUId_XYdJOf9/s16000/%E7%94%B2%E7%8B%80%E8%85%BA%E6%B6%88%E8%9E%8D%E6%B2%BB%E7%99%82%E7%9A%84%E6%9C%80%E6%96%B0%E7%A0%94%E7%A9%B6.png" /></a></div><br /><div><br /></div><div>[最新研究]對於位於氣管附近與位於氣管遠處的甲狀腺乳突狀微小癌進行射頻消融治療的成效</div><div><br /></div><div>研究納入了122名鄰近氣管的PTMC患者和470名遠離氣管的甲狀腺乳突狀微小癌(PTMC)患者。</div><div>平均隨訪時間為40.1個月,總體容積減少率為99.5%,累計腫瘤消失率為99.4%。</div><div>疾病進展的總體發病率為3.7%,併發症的發生率為1.0%。</div><div>在傾向評分匹配後,兩組在最新容積、容積減少率、累計腫瘤消失率、疾病進展和併發症的發生率方面沒有顯著差異。</div><div>多變量Cox回歸分析顯示,與氣管靠近無關聯。
研究結果顯示,無論PTMC是否靠近氣管,RFA都是一種安全有效的治療選擇。</div><div>高的容積減少率和腫瘤消失率表明RFA可以有效縮小和消除PTMC。</div><div>低的疾病進展和併發症發生率進一步支持RFA對PTMC的安全性和有效性。</div><div>無論PTMC是否靠近氣管,RFA的治療效果並無顯著差異。</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEGWlJsgJzGETiWR4Sb8DgO9Q9ZQ-xPpSqp0u2udYH638FnZ0i8cdchrxndliD2WkJDO8CZ8LpABbFMzNbR6Az12LjVFj2pxMYTrHmUpdn6iVQkJ6wI0XwQ8URuSqnAA1HNVQq2j96ff0gX4UNMEqZggvI-3rJfcpB4K2eFOdYKl084n6h1vgtIYGpqe0E/s1200/%E7%94%B2%E7%8B%80%E8%85%BARFA%E7%A0%94%E7%A9%B6.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEGWlJsgJzGETiWR4Sb8DgO9Q9ZQ-xPpSqp0u2udYH638FnZ0i8cdchrxndliD2WkJDO8CZ8LpABbFMzNbR6Az12LjVFj2pxMYTrHmUpdn6iVQkJ6wI0XwQ8URuSqnAA1HNVQq2j96ff0gX4UNMEqZggvI-3rJfcpB4K2eFOdYKl084n6h1vgtIYGpqe0E/s16000/%E7%94%B2%E7%8B%80%E8%85%BARFA%E7%A0%94%E7%A9%B6.png" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div>這一發現意味著RFA對於鄰近氣管和遠離氣管的PTMC都同樣有效。</div><div>此外,RFA作為一種低風險PTMC的非侵入性替代方法,具有潛在的應用價值。</div><div> 本研究中觀察到的低併發症發生率進一步證實了RFA對PTMC的安全性。</div><div>雖然少數患者在RFA過程中經歷了可逆的不適,但並未報告出現嚴重或持續的併發症。</div><div>低併發症率的整體結果令人放心,表明RFA可以作為PTMC的一種適應性良好的治療選擇。</div><div> 研究人員還評估了可能影響PTMC患者疾病進展的因素。</div><div>然而,在多變量Cox回歸分析中,並未發現氣管相鄰與疾病進展之間存在顯著關聯。</div><div>這表明,在確定PTMC疾病進展可能性方面,除了與氣管的接近程度外,其他因素更加重要。 </div><div> 研究人員還評估了可能影響PTMC患者疾病進展的因素。</div><div>然而,在多變量Cox回歸分析中,並未發現氣管相鄰與疾病進展之間存在顯著關聯。這表明,在確定PTMC疾病進展可能性方面,除了與氣管的接近程度外,其他因素更加重要。</div><div><br /></div><div>研究來源:</div><div><p class="p1" style="font-family: "Helvetica Neue"; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 13px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;">Int J Hyperthermia. 2024;41(1):2270671.</p></div>莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-41936377057985239922023-03-20T07:21:00.199-07:002023-03-21T05:40:05.403-07:00兒童腎功能腎絲球過濾率計算機<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpKoyWi3jTyI17L7vmg2lWTNk-ZVaI0lAjkHjusabJjMMGD1Vg3YVGFBus5q2a--VNCMN1bYkJoPVwUhSdkhaK2A7Du2pmCObBfc0feHwLCnYPnvwZSJFdLZWXPXU7jpeSf8WMb0Y_60HuapluT-0ka83awQhjJjZYTMrR6F2VSz-kkIDhlDznWgPqFg/s1200/%E5%85%92%E7%AB%A5%E8%85%8E%E5%8A%9F%E8%83%BD%E8%A8%88%E7%AE%97%E6%A9%9F.png" style="display: none; margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpKoyWi3jTyI17L7vmg2lWTNk-ZVaI0lAjkHjusabJjMMGD1Vg3YVGFBus5q2a--VNCMN1bYkJoPVwUhSdkhaK2A7Du2pmCObBfc0feHwLCnYPnvwZSJFdLZWXPXU7jpeSf8WMb0Y_60HuapluT-0ka83awQhjJjZYTMrR6F2VSz-kkIDhlDznWgPqFg/s1200/%E5%85%92%E7%AB%A5%E8%85%8E%E5%8A%9F%E8%83%BD%E8%A8%88%E7%AE%97%E6%A9%9F.png" /></a>
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<div class="form-style-5">
<form action="" id="form1" method="post" name="form1">
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<legend><span class="number">1</span>血清肌酸酐-Serum Creatinine(mg/dL): </legend>
請輸入血清肌酸酐-Serum Creatinine數值:
<input id="Crtext" name="showCrtext" type="text" />
<br />
</fieldset>
<fieldset>
<legend><span class="number">2</span>身高(cm):</legend>
請輸入身高(公分):
<br />
<input id="Heighttext" name="showHeighttext" type="text" /><br />
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<div id="calProcess" style="display: none;">
------------------------------------------
<br />
腎功能eGFR:<span class="number2" id="eGFRSpan1"></span> mL/min/1.73 m<sup>2</sup>
<br />
計算腎功能eGFR計算過程
<br />
eGFR=0.413x(<span class="number2" id="HeightResulttext"></span>)/(<span class="number2" id="CrResulttext"></span> )=<span class="number2" id="eGFRSpan2"></span> mL/min/1.73 m<sup>2</sup>
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<div style="font-size: medium;">
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span></div>
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<span style="font-size: large;"><br /></span>
<span style="font-size: large;">兒童腎功能腎絲球過濾率計算機-適用年齡:1-18歲</span>
</div>
<span style="font-size: large;">
eGFR計算公式-“Bedside Schwartz” equation (2009)
</span>
</div>
$$\text{eGFR} = 0.413 × 身高(cm)/血清肌酸酐濃度(mg/dL) $$
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<div style="font-size: 1.5em;">
計算程式撰寫:<span style="color: #0b04d8;">莊武龍醫師</span><br />
若有任何問題,歡迎來信指教。<br />
臉書粉絲專頁:<a href="https://www.facebook.com/dmnote/">莊武龍醫師的控糖筆記</a>
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莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-43964643172883650162022-03-11T00:05:00.009-08:002022-03-17T02:11:42.264-07:00星狀神經節阻斷術的應用與療效<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglO8tx2N1_bXpmwjSSfc1YDvV1Xwx82lOK0pgxUugoucBHcN8vv7RoUwEp_l8Hphrt_0iwPE8DcMK53djDItBbtnbO0r6RDil1DBNpK-M3ETaTYL_tyqbmk28TwCQq1ifh5FzwyQE3kqXzdkZiKD3u7zIoDl88wrbniSQWggLlMW9P7ZCV3lhf3Qa2CQ/s1200/星狀神經節阻斷術介紹400.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglO8tx2N1_bXpmwjSSfc1YDvV1Xwx82lOK0pgxUugoucBHcN8vv7RoUwEp_l8Hphrt_0iwPE8DcMK53djDItBbtnbO0r6RDil1DBNpK-M3ETaTYL_tyqbmk28TwCQq1ifh5FzwyQE3kqXzdkZiKD3u7zIoDl88wrbniSQWggLlMW9P7ZCV3lhf3Qa2CQ/s16000/星狀神經節阻斷術介紹400.png" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p></p><p><span style="font-size: large;"><span>難以治療的頭暈、暈眩、耳鳴、失眠甚至是顏面神經疼痛問題,有一部分的原因可能來自於自律神經失調。當藥物治療無效的時候,利用星狀神經節阻斷術來治療,就是一個很好的選項。除了可以拿來治療</span><span>頭暈、暈眩、耳鳴、失眠之外,也有人拿來治療更年期症狀,或是乳癌患者的熱潮紅症狀。</span></span></p><p><span style="font-size: large;"><span><br /></span></span></p><p><span style="font-size: large;">很多的新冠肺炎的人,在痊癒後,仍會有長新冠(Long COVID) 的症狀,例如:心悸、疲倦、暈眩以及注意力不集中。目前國外也有人發表研究(註1),使用星狀神經節阻斷術可能可以改善長新冠的症狀,甚至有的人還恢復了嗅覺。</span></p><p><br /></p><h2 style="text-align: left;"><span style="color: #2b00fe; font-size: x-large;">為什麼星狀神經節阻斷可以改善這些症狀</span></h2><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEg5B14x-qD_5m1kbxiosyCGs6Me5SvhIa8vdZRjsbv-cWlctyVdLBTyVTsAYmZKUVkgMKvZMbv5GIATd8QLW3cgJzr8QNgxYDJVymM8U7AAFf963-R1-jxjIm4Skrav1k44QEH-vStz57OJ3Ff7GAkGuaOoLSkJb9EOxmUbsC3BCQ8dgk1unrLuNPJxPg=s689" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="574" data-original-width="689" height="534" src="https://blogger.googleusercontent.com/img/a/AVvXsEg5B14x-qD_5m1kbxiosyCGs6Me5SvhIa8vdZRjsbv-cWlctyVdLBTyVTsAYmZKUVkgMKvZMbv5GIATd8QLW3cgJzr8QNgxYDJVymM8U7AAFf963-R1-jxjIm4Skrav1k44QEH-vStz57OJ3Ff7GAkGuaOoLSkJb9EOxmUbsC3BCQ8dgk1unrLuNPJxPg=w640-h534" width="640" /></a></div><br /><p><span style="font-size: large;">人體的神經主要分為中樞神經、週邊神經以及自律神經。自律神經支配著人體許多器官,控制人體的溫度、心跳、消化以及流汗。自律神經不受人自主的意識控制,會自行運行。但是情緒、壓力、荷爾蒙改變、停經或更年期會影響自律神經的調整,有些人可能就會有很難治癒的心悸或失眠問題。而糖尿病患者若是長期處於高血糖狀態,也是一種身體的壓力,也會比一般人容易有自律神經失調的症狀[註2,3]。</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">星狀神經節(stellate ganglion)屬於交感神經節,位置大略是在第7頸椎以及甲狀腺和頸動脈的附近,也就是上圖白色三的區域內。上圖所示的中頸神經節(middle cervical ganglion),約略是在第6頸椎的高度。</span></p><p><span style="font-size: large;">星狀神經節阻斷術並不是要做手術把神經切斷或燒壞。</span></p><p><span style="font-size: large;"><span>其實只是用麻醉藥讓</span><span>星狀神經節暫時不要放電,</span></span></p><p><span style="color: red; font-size: large;"><span>等麻醉藥的藥效退了之後,</span>星狀神經節的功能會『重新開機』。</span></p><p><span style="color: red; font-size: large;"><span>有的人的自律神經失調,經過了這樣的</span><span>『重新開機』調整,</span></span></p><p><span style="color: red; font-size: large;">自律神經失調的症狀就好了。</span></p><p><span style="font-size: large;">這就很像以前早期的電腦當機,</span></p><p><span style="font-size: large;">螢幕呈現藍畫面,任憑你鍵盤怎麼按,</span><span style="font-size: x-large;">電腦都不會有反應。</span></p><p><span style="font-size: large;">不過當你把電腦關掉重開機,電腦也可以重新運作的好好的。</span></p><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiSnfEpDea07BOVRS7vUsylrvpheJRFZeZPXG2ifxyCBhXawVvw_HaOUvxMvAlaS-mYNohsr66RGw2o8teTryaNFZc7V9aVRkG7YOQ-bmaiawT7SzJmPCTh_DYEFV6z1qfDhdavxZQgBwn02Bpk7Dha05XjoMfqlJUwQAOa7cmJdmBVxECVdOvilG3O3g=s1670" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="806" data-original-width="1670" height="308" src="https://blogger.googleusercontent.com/img/a/AVvXsEiSnfEpDea07BOVRS7vUsylrvpheJRFZeZPXG2ifxyCBhXawVvw_HaOUvxMvAlaS-mYNohsr66RGw2o8teTryaNFZc7V9aVRkG7YOQ-bmaiawT7SzJmPCTh_DYEFV6z1qfDhdavxZQgBwn02Bpk7Dha05XjoMfqlJUwQAOa7cmJdmBVxECVdOvilG3O3g=w640-h308" width="640" /></a></div><br /><p><span style="font-size: large;"> 星狀神經節(上圖紅色星星)的神經有支配到心臟,所以當自律神經失調時,可能常常會有心悸或是胸悶的症狀,但是心電圖卻不一定有異常表現。雖然心悸、心跳快速有一部分的人是因為甲狀腺亢進引起的,但是有自律神經失調的人,抽血檢查不一定看得到有甲狀腺亢進的現象。抽血檢查很容易檢查出是否有甲狀腺亢進,不過通常自律神經失調是無法靠抽血檢測得知的。因為</span><span style="font-size: large;"><span>星狀神經節的神經有支配到心臟,所以有些常心悸或是心跳較快的患者,做完</span><span>星狀神經節阻斷後,心悸或心跳快的症狀可能會有改善。</span></span></p><p><span style="font-size: large;"><br /></span></p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiU6-FbpgXTdT4brHRbw2uHwCVAdK5WPfdFqIG1TilZL2SBTdOtfScIGo4cVVpPOacuAlC9r0I2PH9h5YkPmzNVamEnhkjufQPKTXmG5gD1pX6BltF9o-rQmVcU9eb6s7wVs8Vf6OGh5o0ohmwgObZPhuidF6yv2TuM4t10cEPmBdnGtB1CLAGRfMVDKQ=s1200" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://blogger.googleusercontent.com/img/a/AVvXsEiU6-FbpgXTdT4brHRbw2uHwCVAdK5WPfdFqIG1TilZL2SBTdOtfScIGo4cVVpPOacuAlC9r0I2PH9h5YkPmzNVamEnhkjufQPKTXmG5gD1pX6BltF9o-rQmVcU9eb6s7wVs8Vf6OGh5o0ohmwgObZPhuidF6yv2TuM4t10cEPmBdnGtB1CLAGRfMVDKQ=w640-h334" width="640" /></a></div><br /><p><span style="font-size: large;"> 星狀神經節並不直接支配三叉神經或聽神經,但是在交感神經鏈的路徑上,旁邊就有三叉神經以及其它腦神經。有可能是因為交感神經與這些週邊神經太靠近了,所以當自律神經失調的時候,交感神經一直在開火,在旁邊的神經就被波及了。這也是為什麼有的人的顏面神經失調或疼痛,在經過了星狀神經節阻斷術的治療後,竟然疼痛就改善了</span></p><h2 style="text-align: left;"><span style="color: #2b00fe; font-size: x-large;">星狀神經節阻斷的方法</span></h2><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhA2g2KHkvgmsNBebNzx8CBxP5AHTOFOJtNS7vu9-qvULb5AyhxCA4mDekHggCa8Nst4EJUqU7uB4ebA8EPsHX9stqfyVn35RFLNlCf3i90b8LBn1HCRNJPlH5hRIHaUJOm-xKw8nu_TlnvWCs8V8vIscy282rmrvllb0poLcUBAV5HCk0bl6K5Wa76yA=s1200" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://blogger.googleusercontent.com/img/a/AVvXsEhA2g2KHkvgmsNBebNzx8CBxP5AHTOFOJtNS7vu9-qvULb5AyhxCA4mDekHggCa8Nst4EJUqU7uB4ebA8EPsHX9stqfyVn35RFLNlCf3i90b8LBn1HCRNJPlH5hRIHaUJOm-xKw8nu_TlnvWCs8V8vIscy282rmrvllb0poLcUBAV5HCk0bl6K5Wa76yA=w640-h334" width="640" /></a></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: large;">星狀神經節阻斷術的施實並不難。</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: large;">在早期,是找到人體頸部的相對位置,下針打麻醉藥。</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: large;">不過這樣的方式,可能藥物施打的準確度可能會有比較大的偏差,進而影響到療效。</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: large;">現在的星狀神經節阻斷術的施實方法,</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: large;">很多醫師會用超音波做更精確的定位,</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: large;">比較不容易傷害到旁邊的組織。</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: large;">如上圖所示,星狀神經節位在頸長肌以及頸椎橫突的附近。</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: large;">經由超音波導引下針注射麻醉劑,</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: large;">可以避免傷害到頸動脈或是避免傷害到下甲狀腺動脈,</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: large;">而且麻醉藥注射的劑量可能需要的更少。</span></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: large;">附註:</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: large;">1.<span face=""system-ui", -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif" style="background-color: white; color: #212121;">Liu LD, Duricka DL. Stellate ganglion block reduces symptoms of Long COVID: A case series. J Neuroimmunol. 2022 Jan 15;362:577784.</span></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: large;"><span face=""system-ui", -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif" style="background-color: white; color: #212121;"><br /></span></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: large;"><span><span face=""system-ui", -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif" style="background-color: white; color: #212121;">2.</span></span><span face=""system-ui", -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif" style="background-color: white; color: #212121;">Perin PC, Maule S, Quadri R. Sympathetic nervous system, diabetes, and hypertension. Clin Exp Hypertens. 2001 Jan-Feb;23(1-2):45-55. </span></span></div><div class="separator" style="clear: both; text-align: left;"><span face=""system-ui", -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif" style="background-color: white; color: #212121;"><span style="font-size: large;"><br /></span></span></div><div class="separator" style="clear: both; text-align: left;"><span face=""system-ui", -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif" style="background-color: white; color: #212121;"><span style="font-size: large;">3.Nielsen FS, Hansen HP, Jacobsen P, Rossing P, Smidt UM, Christensen NJ, Pevet P, Vivien-Roels B, Parving HH. Increased sympathetic activity during sleep and nocturnal hypertension in Type 2 diabetic patients with diabetic nephropathy. Diabet Med. 1999 Jul;16(7):555-62. </span></span></div><div class="separator" style="clear: both; text-align: left;"><span face=""system-ui", -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif" style="background-color: white; color: #212121; font-size: 16px;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><div style="background-color: white; border: 0px; color: #585858; font-family: "pingfang tc"; font-size: 14px; font-stretch: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; color: blue; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">作者</span></div><div style="background-color: white; border: 0px; font-stretch: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><div style="border: 0px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><div style="border: 0px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: large;"><span style="color: #585858; font-family: inherit; font-style: inherit; font-variant-caps: inherit; font-variant-ligatures: inherit; font-weight: inherit;"><span face=""carrois gothic" , sans-serif" style="background-color: rgba(255, 255, 255, 0.498); border: 0px; color: #222222; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">鹿港基督教醫院內分泌暨新陳代謝科</span></span></span><br style="line-height: 23.4px; margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">莊武龍醫師</span></span></span><br style="line-height: 23.4px; margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">專長於</span></span></span></span></span></span><span style="color: #222222; font-family: heiti tc;">甲狀腺射頻消融術、</span><span style="background-color: rgba(255, 255, 255, 0.498); color: #222222; font-family: inherit; font-style: inherit; font-variant-caps: inherit; font-variant-ligatures: inherit; font-weight: inherit;">週邊神經的超音波評估與營養評估</span></span></div><div style="border: 0px; color: #585858; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: large;"><span face=""carrois gothic" , sans-serif" style="background-color: rgba(255, 255, 255, 0.498); border: 0px; color: #222222; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">引用或是轉貼請注明出處,謝謝。</span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 22px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 22px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">文章僅供醫療衛教分享以及促進健康之用,請勿做為商業用途及其它不法的宣傳之用</span></span></span></span></span></span></div></div></div></div><p></p>莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-18324969016360875622022-03-01T04:37:00.007-08:002022-03-17T02:14:36.878-07:00梅尼爾氏症與甲狀腺疾病的關係<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgA4DraG9diM3hCFgG11vllh1Z2PBcvIZdTA0QRvlp9KMP7GX_QluWbxGJme2CE-9-bC1TLYjaVugUx5ln0VGyhP0FiO9G5N8icXZH_e_uGMeikVJj5UyVQFk0fcTPi7ZY8QdmIQfKgjSBKe5Jv5-rVh9K0fH6KBLGEALSfBwut1boe2MIJSVN9CHcBeA/s1200/梅尼爾氏症400.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgA4DraG9diM3hCFgG11vllh1Z2PBcvIZdTA0QRvlp9KMP7GX_QluWbxGJme2CE-9-bC1TLYjaVugUx5ln0VGyhP0FiO9G5N8icXZH_e_uGMeikVJj5UyVQFk0fcTPi7ZY8QdmIQfKgjSBKe5Jv5-rVh9K0fH6KBLGEALSfBwut1boe2MIJSVN9CHcBeA/s16000/梅尼爾氏症400.png" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div><div><span style="font-size: large;">患有梅尼爾氏症(Ménière's Disease)的人,可能會有暈眩、耳鳴、聽力喪失的症狀。甲狀腺功能低下的患者,其實有很多人也常常會有頭暈的症狀。</span></div><div><span style="font-size: large;"><br /></span></div><div><span style="color: #2b00fe; font-size: large;">甲狀腺功能異常與梅尼爾氏症的相關性</span></div><div><span style="font-size: large;">2004年,在一篇來自美國的研究指出,在回朔了有頭暈症狀的2000位患者資料之後。發現其中有50個符合梅尼爾氏症的診斷,而在這其中有16位患者(32%)有在服用甲狀腺荷爾蒙(1)。在2019年,一篇來自台灣健保資料庫的研究發現,甲狀腺功能低下為發生梅尼爾氏症的獨立風險因子(independent risk factor)(2)。另外一篇2020年來自韓國的研究,使用了大數據分析,並校正了一些風險因子後發現,有甲狀腺問題或是甲狀腺亢進或是甲狀腺功能低下的人,有較高的風險有梅尼爾氏症(Ménière's Disease)(3)。</span></div><div><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;"><br /></span></div><div><span style="color: #2b00fe; font-size: large;">治療甲狀腺功能低下,會改善梅尼爾氏症嗎?</span></div><div><span style="font-size: large;">有一個研究指出,在診斷有梅尼爾氏症(Ménière's Disease)的患者中篩檢甲狀腺功能,35個梅尼爾氏症患者之中,竟然有12個有甲狀腺功能低下問題。比較特別的是這些有甲狀腺功能低下的患者,在治療甲狀腺功能低下之後,梅尼爾氏症竟然也有跟著改善(4)。目前關於梅尼爾氏症是否能用甲狀腺荷爾蒙改善的研究並不多,不過要診斷出甲狀腺功能低下比診斷出梅尼爾氏症還要容易,通常只要簡單的抽血檢查就可以知道。</span></div><div><span style="font-size: large;">如果有難以治療的暈眩、耳鳴問題的人,可以跟醫師討論是否有甲狀腺功能低下的可能性。</span></div><div><span style="font-size: large;"><br /></span></div><div><span style="color: #2b00fe; font-size: large;">參考論文:</span></div><div><span style="font-size: large;">1.<span style="white-space: pre;"> </span>Brenner M, Hoistad DL, Hain TC. Prevalence of thyroid dysfunction in patients with Meniere's disease. Arch Otolaryngol Head Neck Surg. 2004;130(2):226-8.</span></div><div><span style="font-size: large;">2.<span style="white-space: pre;"> </span>Lin WL, Chen CY, Hsu TY, Chen WK, Lin CL, Chen HC. Hypothyroidism is an independent risk factor for Meniere's disease: A population-based cohort study. Medicine (Baltimore). 2019;98(15):e15166.</span></div><div><span style="font-size: large;">3.<span style="white-space: pre;"> </span>Kim SY, Song YS, Wee JH, Min C, Yoo DM, Choi HG. Association between Meniere's disease and thyroid diseases: a nested case-control study. Sci Rep. 2020;10(1):18224.</span></div><div><span style="font-size: large;">4.<span style="white-space: pre;"> </span>Santosh UP, Rao MS. Incidence of Hypothyroidism in Meniere's Disease. J Clin Diagn Res. 2016;10(5):MC01-3.</span></div><div><span style="font-size: large;"><br /></span></div><div><div style="background-color: white; border: 0px; color: #585858; font-family: "pingfang tc"; font-size: 14px; font-stretch: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; color: blue; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">作者</span></div><div style="background-color: white; border: 0px; font-stretch: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><div style="border: 0px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><div style="border: 0px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; 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font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">鹿港基督教醫院內分泌暨新陳代謝科</span></span></span><br style="line-height: 23.4px; margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">莊武龍醫師</span></span></span><br style="line-height: 23.4px; margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">專長於</span></span></span></span></span></span><span style="color: #222222; font-family: heiti tc;">甲狀腺射頻消融術、</span><span style="background-color: rgba(255, 255, 255, 0.498); color: #222222; font-family: inherit; font-style: inherit; font-variant-caps: inherit; font-variant-ligatures: inherit; font-weight: inherit;">週邊神經的超音波評估與營養評估</span></span></div><div style="border: 0px; color: #585858; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: large;"><span face=""carrois gothic" , sans-serif" style="background-color: rgba(255, 255, 255, 0.498); border: 0px; color: #222222; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">引用或是轉貼請注明出處,謝謝。</span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 22px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 22px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">文章僅供醫療衛教分享以及促進健康之用,請勿做為商業用途及其它不法的宣傳之用</span></span></span></span></span></span></div></div></div></div><div><br /></div></div>莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-72630478998332222332021-12-09T06:27:00.010-08:002022-03-17T02:08:06.368-07:00注射新冠肺炎COVID-19疫苗對血糖的影響<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-ObONc5x9IIY/YbIWPeeg4fI/AAAAAAAAHes/-fFEownLeUMCDSQWzJv0991yn2HegYQrwCNcBGAsYHQ/s1200/%25E6%2596%25B0%25E5%2586%25A0%25E8%2582%25BA%25E7%2582%258E%25E7%2596%25AB%25E8%258B%2597%25E5%25B0%258D%25E8%25A1%2580%25E7%25B3%2596%25E7%259A%2584%25E5%25BD%25B1%25E9%259F%25BF2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" src="https://1.bp.blogspot.com/-ObONc5x9IIY/YbIWPeeg4fI/AAAAAAAAHes/-fFEownLeUMCDSQWzJv0991yn2HegYQrwCNcBGAsYHQ/s16000/%25E6%2596%25B0%25E5%2586%25A0%25E8%2582%25BA%25E7%2582%258E%25E7%2596%25AB%25E8%258B%2597%25E5%25B0%258D%25E8%25A1%2580%25E7%25B3%2596%25E7%259A%2584%25E5%25BD%25B1%25E9%259F%25BF2.png" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p><p><span style="color: #2b00fe; font-size: large;">注射新冠肺炎COVID-19疫苗對血糖的影響</span></p><p><span style="font-size: large;">注射新冠肺炎COVID-19疫苗對血糖控制會有影響嗎?</span></p><p><span style="font-size: large;">在義大利有個研究指引在自體免疫問題造成的糖尿病患者中,注射COVID-19疫苗前後的血糖變化並沒有顯著差異(D'Onofrio et al., 2021)。</span></p><p><span style="font-size: large;">2021年,在歐洲又另外發表了一個小型的觀察性研究(Aberer et al., 2021)。一共有161人參加研究,最後有74個人有完整的連續血糖記錄,58個為第一型糖尿病患者,16個為第二型糖尿病患者。連續血糖記錄從注射疫苗前就開始記錄,記錄到疫苗注射後3天。注射COVID-19疫苗的種類有AZ(AstraZeneca)、莫德納(Moderna)、BNT(Pfizer-BioNTech)疫苗。觀察並統計連續血糖記錄後發現,關於血糖控制在目標範圍內的時間(Time in range, TIR),血糖低於範圍時間(time below range, TBR) ,血糖高於範圍時間(time above range ,TAR),在疫苗注射前後,並沒有顯著的影響。不過,若是以是有無疫苗注射後的副作用的分組來做比較,第一型糖尿病患者,若是有疫苗注射後症狀或是發燒,血糖控制在目標範圍內的時間(TIR)會變差。在第二型糖尿病患者則無明顯差別。</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="color: #2b00fe; font-size: large;">所以注射COVID-19疫苗真的不會影響血糖嗎?</span></p><p><span style="font-size: large;">其實有一些少數個案案例發表在PUDMED上。這些個案在注射COVID-19疫苗後,有些個案會有血糖變化(Abu-Rumaileh et al., 2021; Lee et al., 2021; Mishra et al., 2021)。例如有3個案例在注射COVID-19疫苗的2到10天內,因為產生高血糖危象(糖尿病酮症酸中毒diabetic ketoacidos, 或高滲透壓高血糖狀態hyperosmolar hyperglycemic state)而住院治療。不過這3位個案的HbA1c在12~13%左右,代表平常的血糖控制,控制得很差(Lee et al., 2021)。有些個案研究並沒有指出HbA1c的數值,只有顯示注射疫苗後的差別。平常血糖控制很差的患者,即使不接種疫苗,本身就隨時可能因為高血糖危象而需要緊急住院治療,疫苗在血糖控制良好的人身上,是否會引起高血糖危象,仍需更多研究跟數據證實。</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="color: #2b00fe; font-size: large;">總結</span></p><p><span style="font-size: large;">目前注射COVID-19疫苗前後的血糖變化可能仍需更多大型研究證實。疫苗對於血糖波動的變化,可能會影響到的人很有限。平時做好血糖量測,其實可以更確保知道注射疫苗後的血糖波動。若是第一型糖尿病的患者,尤其是接種疫苗後有症狀的人,更要多注意一下血糖的波動變化。</span></p><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;">參考論文:</span></p><p><span style="font-size: medium;">Aberer, F., Moser, O., Aziz, F., Sourij, C., Ziko, H., Lenz, J., Abbas, F., Obermayer, A. M., Kojzar, H., Pferschy, P. N., Muller, A., Unteregger, C., Leitner, M., Banfic, T., Eckstein, M. L., Wachsmuth, N., Kaser, S., Mader, J. K., Tripolt, N. J., Sourij, H., & Group, C.-D. S. (2021). Impact of COVID-19 Vaccination on Glycemia in Individuals With Type 1 and Type 2 Diabetes: Substudy of the COVAC-DM Study. Diabetes Care. https://doi.org/10.2337/dc21-1563 </span></p><p><span style="font-size: medium;">Abu-Rumaileh, M. A., Gharaibeh, A. M., & Gharaibeh, N. E. (2021). COVID-19 Vaccine and Hyperosmolar Hyperglycemic State. Cureus, 13(3), e14125. https://doi.org/10.7759/cureus.14125 </span></p><p><span style="font-size: medium;">D'Onofrio, L., Coraggio, L., Zurru, A., Carlone, A., Mignogna, C., Moretti, C., Maddaloni, E., & Buzzetti, R. (2021). Short-term safety profile of Sars-Cov2 vaccination on glucose control: Continuous glucose monitoring data in people with autoimmune diabetes. Diabetes Res Clin Pract, 179, 109022. https://doi.org/10.1016/j.diabres.2021.109022 </span></p><p><span style="font-size: medium;">Lee, H. J., Sajan, A., & Tomer, Y. (2021). Hyperglycemic Emergencies Associated With COVID-19 Vaccination: A Case Series and Discussion. J Endocr Soc, 5(11), bvab141. https://doi.org/10.1210/jendso/bvab141 </span></p><p><span style="font-size: medium;">Mishra, A., Ghosh, A., Dutta, K., Tyagi, K., & Misra, A. (2021). Exacerbation of hyperglycemia in patients with type 2 diabetes after vaccination for COVID19: Report of three cases. Diabetes Metab Syndr, 15(4), 102151. https://doi.org/10.1016/j.dsx.2021.05.024 </span></p><p><br /></p><div style="background-color: white; border: 0px; color: #585858; font-family: "pingfang tc"; font-size: 14px; font-stretch: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; color: blue; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">作者</span></div><div style="background-color: white; border: 0px; font-stretch: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><div style="border: 0px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><div style="border: 0px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: large;"><span style="color: #585858; font-family: inherit; font-style: inherit; font-variant-caps: inherit; font-variant-ligatures: inherit; font-weight: inherit;"><span face=""carrois gothic" , sans-serif" style="background-color: rgba(255, 255, 255, 0.498); border: 0px; color: #222222; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">鹿港基督教醫院內分泌暨新陳代謝科</span></span></span><br style="line-height: 23.4px; margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">莊武龍醫師</span></span></span><br style="line-height: 23.4px; margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">專長於</span></span></span></span></span></span><span style="color: #222222; font-family: heiti tc;">甲狀腺射頻消融術、</span><span style="background-color: rgba(255, 255, 255, 0.498); color: #222222; font-family: inherit; font-style: inherit; font-variant-caps: inherit; font-variant-ligatures: inherit; font-weight: inherit;">週邊神經的超音波評估與營養評估</span></span></div><div style="border: 0px; color: #585858; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: large;"><span face=""carrois gothic" , sans-serif" style="background-color: rgba(255, 255, 255, 0.498); border: 0px; color: #222222; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">引用或是轉貼請注明出處,謝謝。</span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 22px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 22px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">文章僅供醫療衛教分享以及促進健康之用,請勿做為商業用途及其它不法的宣傳之用</span></span></span></span></span></span></div></div></div><p><br /></p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-VcJtFXSeVAw/YbIWCcKATvI/AAAAAAAAHeo/vslnlfVL3PAW-YAV7zTV__HfPqSi2J-9ACNcBGAsYHQ/s1200/%25E6%2596%25B0%25E5%2586%25A0%25E8%2582%25BA%25E7%2582%258E%25E7%2596%25AB%25E8%258B%2597%25E5%25B0%258D%25E8%25A1%2580%25E7%25B3%2596%25E7%259A%2584%25E5%25BD%25B1%25E9%259F%25BF2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="167" src="https://1.bp.blogspot.com/-VcJtFXSeVAw/YbIWCcKATvI/AAAAAAAAHeo/vslnlfVL3PAW-YAV7zTV__HfPqSi2J-9ACNcBGAsYHQ/s320/%25E6%2596%25B0%25E5%2586%25A0%25E8%2582%25BA%25E7%2582%258E%25E7%2596%25AB%25E8%258B%2597%25E5%25B0%258D%25E8%25A1%2580%25E7%25B3%2596%25E7%259A%2584%25E5%25BD%25B1%25E9%259F%25BF2.png" width="320" /></a></div><br />莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-84604232628081855112021-01-21T04:42:00.040-08:002021-01-21T19:22:42.324-08:00線上BMI計算機 <div class="separator" style="clear: both;"><a href="https://1.bp.blogspot.com/-2T_ZfKrve20/YAmLNysoFzI/AAAAAAAAHC8/MPfT9w8SKeI2TTOvZBiQmWr8qhwPNqB7wCNcBGAsYHQ/s1200/BMI%25E8%25A8%2588%25E7%25AE%2597%25E6%25A9%259F.png" style="display: none; width: 0px;"><img alt="" border="0" width="400" data-original-height="628" data-original-width="1200" src="https://1.bp.blogspot.com/-2T_ZfKrve20/YAmLNysoFzI/AAAAAAAAHC8/MPfT9w8SKeI2TTOvZBiQmWr8qhwPNqB7wCNcBGAsYHQ/s400/BMI%25E8%25A8%2588%25E7%25AE%2597%25E6%25A9%259F.png"/></a></div>
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padding-right: 15px;
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@media screen and (max-width: 300px) {
span.psw {
display: block;
float: none;
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</style>
<section class="calculator">
<section class="fields">
<h1 >BMI 計算機</h1>
<hr/>
<div class="bmi_calcu">
<div class="container">
<label for="uname" style="font-size: 2em;"><strong>身高(cm) </strong></label>
<input type="text" class="bodyHeight" placeholder="輸入身高" name="uname" required>
<label for="psw"style="font-size: 2em;" ><strong>體重(kg)</strong></label>
<input type="text" class="bodyWeight" placeholder="輸入體重" name="psw" required>
</div>
</div>
<div class="btn_block">
<button2 type="submit" value="計算" class="calcualteBMI">計算
</button2>
<button2 type="submit" style="background-color:#b3b3cc" value="重新整理" class="undoreset">重新整理
</button2>
</div>
</section>
<section class="result">
<h2 style="font-size: 2em;" class="result_txt">你的BMI:</h2>
<p style="font-size: 2em;" id="bmiText"></p>
<p style="font-size: 2em;" id="resultText"></p>
</section>
<section class="bottom">
</section>
</section>
<script type="text/JavaScript">
//BMI = 體重(公斤) / (身高(公尺) x 身高(公尺))
// 計算功能寫在外面,另外的功能應另外寫出來。
// 宣告 DOM
let bmiText =document.querySelector('#bmiText');
bmiText.style.display="none";
//事件點擊按鈕
let btn =document.querySelector('.calcualteBMI');
let reset =document.querySelector('.undoreset');
//計算BMI
function bmi(weight,height){
let w = parseInt(weight);
let h = parseInt(height)/100;//因為公分要轉公尺所以除以100
let bmi = (w/(h*h)).toFixed(2);//toFixed讓小數點4捨5入只有2位
return bmi;
}
// 取出輸入值寫入畫面
function calculateBMI(){
let bodyWeight =document.querySelector('.bodyWeight').value;
let bodyHeight =document.querySelector('.bodyHeight').value;
let resultText =document.querySelector('#resultText');
let bmiText =document.querySelector('#bmiText');
// 印出值來
if((bodyWeight !="" ) && (bodyHeight != "")){
bmiText.style.display="block";
resultText.innerHTML = bmi(bodyWeight,bodyHeight);
bmiText.innerHTML = checkBMI(bmi(bodyWeight,bodyHeight));
}else{
bmiText.style.display="none";
alert("請輸入身高體重")
return
}
resultText.innerHTML = bmi(bodyWeight,bodyHeight);
}
// bmi 範圍
function checkBMI(bmi){
if( bmi < 18.5){
return "太輕了"
}else if( bmi >=18.5 && bmi < 24){
return "體重正常 "
}else if( bmi >=24 && bmi < 27){
return "過重 "
}else if( bmi >=27 && bmi < 30){
return "輕度肥胖 "
}else if( bmi >=30 && bmi < 35){
return "中度肥胖 "
}else if( bmi >=35){
return "重度肥胖 "
}
}
//清空值
function undo(e){
document.querySelector('.bodyWeight').value ='';
document.querySelector('.bodyHeight').value ='';
bmiText.style.display="none";
resultText.innerHTML ="";
return
}
//事件監聽
btn.addEventListener('click',calculateBMI);
reset.addEventListener('click',undo);
</script> 莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-67078217572354867322021-01-18T06:14:00.002-08:002021-01-18T06:14:21.099-08:002021年-美國及世界各國的糖尿病治療指引<div class="separator" style="clear: both; text-align: center;"><a href="https://4.bp.blogspot.com/-wPbAl4cjKn0/WFNQejSwjSI/AAAAAAAAE78/0fJomg1OEi0XfZLQu8OzzzDK91bi8gd4QCPcBGAYYCw/s1600/%25E4%25B8%2596%25E7%2595%258C%25E5%259C%25B0%25E5%259C%2596-%25E7%25B3%2596%25E5%25B0%25BF%25E7%2597%2585-%25E5%25BD%25A9%25E8%2589%25B2%25E7%2589%2588.png" style="margin-left: 1em; margin-right: 1em;"><br class="Apple-interchange-newline" /><img border="0" data-original-height="628" data-original-width="1200" src="https://4.bp.blogspot.com/-wPbAl4cjKn0/WFNQejSwjSI/AAAAAAAAE78/0fJomg1OEi0XfZLQu8OzzzDK91bi8gd4QCPcBGAYYCw/s1600/%25E4%25B8%2596%25E7%2595%258C%25E5%259C%25B0%25E5%259C%2596-%25E7%25B3%2596%25E5%25B0%25BF%25E7%2597%2585-%25E5%25BD%25A9%25E8%2589%25B2%25E7%2589%2588.png" /></a></div><p><span style="background-color: #674ea7; color: white; font-size: x-large;"><br /></span><span style="background-color: #674ea7; color: white; font-size: x-large;">America-美國</span><br /><span style="color: #e06666; font-size: large;"><br /></span><span style="color: #e06666; font-size: large;">美國糖尿病協會-ADA-American Diabetes Association</span><br /></p><div style="font-family: "heiti tc";"></div><p><br /></p><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="margin: 0px;"><span style="font-size: 20px;">指引名稱:</span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;">2021 Standards of Medical Care in Diabetes</span></b></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div><div style="margin: 0px;"><div style="font-size: 20px;">網址連結:</div><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;"><a href="https://care.diabetesjournals.org/content/44/Supplement_1">https://care.diabetesjournals.org/content/44/Supplement_1</a></span></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><br /></span><span style="color: black; font-family: "heiti tc"; text-align: start;"><br /></span><br /><div style="color: black; font-family: "PingFang TC"; margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif;"><span style="font-size: 20px;">指引名稱:</span></div><span style="font-family: "heiti tc"; font-size: large;"><b>Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)</b></span><br /><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif;"><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div></div><span style="color: black; font-family: "heiti tc"; text-align: start;"></span><br /><div style="margin: 0px;"><div style="font-size: 20px;">網址連結:</div><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="text-align: start;"><span style="font-size: large;"><a href="https://goo.gl/dKZwfE">https://goo.gl/dKZwfE</a></span></span></div></div></div><p><span style="color: #e06666; font-size: large;"><br /></span><span style="color: #e06666; font-size: large;">美國臨床內分泌專家協會-AACE THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS</span><br /></p><div style="font-family: "heiti tc";"></div><p><br /></p><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="margin: 0px;"><span style="font-size: 20px;">指引名稱:</span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;"><b>AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm 2020 – Executive Summary</b></span></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div><div style="margin: 0px;"><div style="font-size: 20px;">網址連結:</div><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;"><a href="Comprehensive Type 2 Diabetes Management Algorithm (2020) - EXECUTIVE SUMMARY">Comprehensive Type 2 Diabetes Management Algorithm (2020) - EXECUTIVE SUMMARY</a></span></span><br /><div><span style="color: black; font-family: "heiti tc"; text-align: start;"><br /></span></div></div></div><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; text-align: justify;"></div><p><br /><span style="color: #e06666; font-size: large;">美國醫師協會-</span><span style="color: #e06666; font-size: large;">American College of Physicians</span><br /></p><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif;"><span style="font-size: 20px;">指引名稱:</span></div><span style="font-family: "heiti tc"; font-size: large;"><b>Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus: A Clinical Practice Guideline Update From the American College of Physicians</b></span><br /><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif;"><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div></div><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><div style="font-size: 20px;">網址連結:</div><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="text-align: start;"><span style="font-size: large;"><a href="https://goo.gl/t7Q2gN">https://goo.gl/t7Q2gN</a></span></span><br /><div><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="text-align: start;"><br /></span></div></div></div><p><br /><br /><span style="background-color: #674ea7; color: white; font-size: x-large;">Australia-澳洲</span><br /><span style="color: #e06666; font-size: large;"><br /></span><span style="color: #e06666; font-size: large;">澳洲糖尿病足網路-Australian Diabetes Foot Network</span><br /><br /></p><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="margin: 0px;"><span style="font-size: 20px;">指引名稱:</span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;">Diabetic Foot Australia guideline on footwear for people with diabetes</span></b></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div><div style="margin: 0px;"><div style="font-size: 20px;">網址連結:</div><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;"><a href="https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-017-0244-z">https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-017-0244-z</a></span></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><br /></span></div></div><p><span style="color: #e06666; font-size: large;"><br /></span><span style="color: #e06666; font-size: large;">美國臨床內分泌專家協會-AA</span><br /><br /><span style="background-color: #674ea7; color: white; font-size: x-large;">Canada-加拿大</span><br /><span style="color: #e06666; font-size: large;"><br /></span><span style="color: #e06666; font-size: large;">加拿大糖尿病協會-Canadian Diabetes Association</span><br /></p><div style="font-family: "heiti tc";"></div><p><br /></p><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="margin: 0px;"><span><div style="margin: 0px;"><span face=""biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif" style="color: #444444; font-size: 20px;">指引名稱:</span><br /><div style="text-align: start;"><span style="font-family: heiti tc; font-size: large;"><b>2020 Update</b></span></div><div style="text-align: start;"><span style="font-family: heiti tc; font-size: large;"><b>Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 Update</b></span></div><span style="color: black; font-family: "heiti tc"; font-size: medium; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><div style="font-size: 20px;">網址連結:</div><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;"><a href="http://guidelines.diabetes.ca/2020-Update">http://guidelines.diabetes.ca/2020-Update</a></span></span></div><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><span style="color: black; font-family: "heiti tc"; text-align: start;"><br /></span></div></span></div><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><span style="font-size: 20px;">指引名稱:</span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;">2018 Clinical practice guidelines</span></b></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><div style="font-size: 20px;">網址連結:</div><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;"><a href="https://goo.gl/ZLwA3h">https://goo.gl/ZLwA3h</a></span></span></div></div><p><br /><span style="background-color: #674ea7; color: white; font-size: x-large;"><br class="Apple-interchange-newline" />China-中國</span><br /><span style="color: #e06666; font-size: large;"><br /></span><span style="color: #e06666; font-size: large;">中华医学会糖尿病学分会-Chinese Diabetes Society</span><br /></p><div style="font-family: "heiti tc";"></div><p><br /></p><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="margin: 0px;"><span style="font-size: 20px;">指引名稱:</span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;"><b>中国2型糖尿病防治指南2013年版</b></span></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div><div style="margin: 0px;"><div style="font-size: 20px;">網址連結:</div><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;"><a href="https://goo.gl/TJbmjT">https://goo.gl/TJbmjT</a></span></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><br /></span><div style="font-size: 20px;">網址連結:(PDF檔)</div><span style="color: black; font-family: "heiti tc"; text-align: start;"></span><br /><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="text-align: start;"><span style="font-size: x-large;"><a href="https://goo.gl/CVSvNT">https://goo.gl/CVSvNT</a></span></span></div></div><p><span style="background-color: #674ea7; color: white; font-size: x-large;">Europe-歐洲</span><br /><span style="color: #e06666; font-size: large;"><br /></span><span style="color: #e06666; font-size: large;">歐洲糖尿病研究學會-European Association for the Study of Diabetes</span><br /></p><div style="font-family: "heiti tc";"></div><p><br /><span style="background-color: #674ea7; color: white; font-size: x-large;"></span><br /></p><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif;"><span style="font-size: 20px;">指引名稱:</span></div><span style="font-family: "heiti tc"; font-size: large;"><b>Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)</b></span><br /><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif;"><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div></div><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><div style="font-size: 20px;">網址連結:</div><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="text-align: start;"><span style="font-size: large;"><a href="https://goo.gl/dKZwfE">https://goo.gl/dKZwfE</a></span></span><br /><div><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="text-align: start;"><br /></span></div></div></div><p><span style="color: #e06666; font-size: large;">歐洲心臟病學會-European Society of Cardiology</span><br /></p><div style="font-family: "heiti tc";"></div><p><br /><span style="background-color: #674ea7; color: white; font-size: x-large;"></span><br /><span style="background-color: #674ea7; color: white; font-size: x-large;"></span><br /></p><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif;"><span style="font-size: 20px;">指引名稱:</span></div><span style="font-family: "heiti tc"; font-size: large;"><b>2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD)</b></span><br /><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif;"><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div></div><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><div style="font-size: 20px;">網址連結:</div><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="text-align: start;"><span style="font-size: large;"><a href="https://ppt.cc/fhQthx">https://ppt.cc/fhQthx</a></span></span><br /><div><br /></div></div></div><p><span style="background-color: #674ea7; color: white; font-size: x-large;"><br /></span><span style="background-color: #674ea7; color: white; font-size: x-large;">India-印度</span><br /><span style="color: #e06666; font-size: large;"><br /></span><span style="color: #e06666; font-size: large;">印度糖尿病研究學會-RSSDI</span><br /><span style="color: #e06666; font-size: large;">Research Society for the Study of Diabetes in India</span><br /></p><div style="font-family: "heiti tc";"></div><p><br /></p><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif;"><span style="font-size: 20px;">指引名稱:</span></div><span style="font-family: "heiti tc"; font-size: large;"><b>RSSDI clinical practice recommendations for the management of type 2 diabetes mellitus 2017</b></span><br /><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif;"><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div></div><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; font-size: 20px;">網址連結:</div><div style="text-align: start;"><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="color: #444444;"><a href="https://goo.gl/kBn1Gf"><span style="font-size: large;">https://goo.gl/kBn1Gf</span></a></span></div></div></div><p><span style="background-color: #674ea7; color: white; font-size: x-large;"></span><br /></p><div><br /></div><p><span style="background-color: #674ea7; color: white; font-size: x-large;"><br class="Apple-interchange-newline" />Japan-日本</span><br /><span style="color: #e06666; font-size: large;"><br /></span><span style="color: #e06666; font-size: large;">日本糖尿病學會</span><br /></p><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><span style="font-size: 20px;">指引名稱:</span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;"><b>糖尿病診療ガイドライン2019</b></span></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; font-size: 20px;">網址連結:</div><div style="text-align: start;"><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="color: #444444;"><span style="font-size: x-large;"><a href="https://ppt.cc/fmW4jx">https://ppt.cc/fmW4jx</a></span></span></div></div></div><p><br /></p><div style="font-family: "heiti tc";"></div><p><br /></p><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><span style="font-size: 20px;">指引名稱:</span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;"><b>糖尿病診療ガイドライン2016-2017</b></span></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; font-size: 20px;">網址連結:</div><div style="text-align: start;"><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="color: #444444;"><span style="font-size: x-large;"><a href="https://goo.gl/fqmae7">https://goo.gl/fqmae7</a></span></span></div></div></div><div><br /><br class="Apple-interchange-newline" /><br /><div><span style="background-color: #674ea7; color: white; font-size: x-large;">Scottish-蘇格蘭</span><br /><span style="color: #e06666; font-size: large;"><br /></span><div><span style="color: #e06666; font-size: large;">蘇格蘭學院間指引網絡(Scottish Intercollegiate Guidelines Network, SIGN)</span></div><div style="font-family: "heiti tc";"></div><br /><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><div style="margin: 0px;"><span style="font-size: 20px;">指引名稱:</span></div><div style="margin: 0px;"><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;">2017 Update:</span></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;">Management of diabetes</span></span></div><div style="margin: 0px;"><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div></div><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; font-size: 20px;"><div style="margin: 0px;">網址連結:</div></div><div style="margin: 0px; text-align: start;"><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="color: #444444;"><a href="https://www.sign.ac.uk/our-guidelines/pharmacological-management-of-glycaemic-control-in-people-with-type-2-diabetes/"><span style="font-size: x-large;">https://www.sign.ac.uk/our-guidelines/pharmacological-management-of-glycaemic-control-in-people-with-type-2-diabetes/</span></a></span><br /><div><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="color: #444444;"><br /></span></div></div></div></div></div><span style="background-color: #674ea7; color: white; font-size: x-large;"><br class="Apple-interchange-newline" />Taiwan-台灣</span><br /><span style="color: #e06666; font-size: large;"><br /></span><span style="color: #e06666; font-size: large;">中華民國糖尿病學會-The Diabetes Association of the Republic of China</span><br /><div><br /></div><div style="font-family: "heiti tc";"></div><br /><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><span style="font-size: 20px;">指引名稱:</span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;">2018糖尿病臨床照護指引 (含2020指引UPDATE版)</span></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; font-size: 20px;">網址連結:</div><div style="text-align: start;"><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="color: #444444;"><a href="https://goo.gl/VL87Ve"><span style="font-size: large;">https://goo.gl/VL87Ve</span></a></span></div></div></div><div><br /><br class="Apple-interchange-newline" /><span style="color: #e06666; font-size: large;">中華民國糖尿病衛教學會-Taiwanese Association of Diabetes Educators</span><br /><div style="font-family: "heiti tc";"></div><br /><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><span style="font-size: 20px;">指引名稱:</span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;">「臺灣糖尿病年鑑2019第2型糖尿病」</span></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; font-size: 20px;">網址連結:</div><div style="text-align: start;"><span style="color: #0000ee; font-size: large;"><u><a href="https://www.tade.org.tw/download/index.asp?Type=11">https://www.tade.org.tw/download/index.asp?Type=11</a></u></span></div></div></div><br /><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><span style="font-size: 20px;">指引名稱:</span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;">臺灣胰島素注射指引-2015</span></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; font-size: 20px;">網址連結:</div><div style="text-align: start;"><span style="font-size: large;"><a href="https://goo.gl/5uwV2b">https://goo.gl/5uwV2b</a></span></div></div></div><div><br /><div style="font-family: "heiti tc";"></div><br /><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><div style="margin: 0px;"><span style="font-size: 20px;">指引名稱:</span></div><div style="margin: 0px;"><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;"><b>2013胰島素幫浦治療指南</b></span></span></div><div style="margin: 0px;"><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div></div><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; font-size: 20px;"><div style="margin: 0px;">網址連結:</div></div><div style="margin: 0px; text-align: start;"><span style="font-size: large;"><a href="https://goo.gl/FnvRpp">https://goo.gl/FnvRpp</a></span></div></div></div></div><div><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><span style="font-size: 20px;">指引名稱:</span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;"><b>2013</b></span></span><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;">連續性葡萄糖監測指南</span></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; font-size: 20px;">網址連結:</div><div style="text-align: start;"><span style="font-size: large;"><a href="https://goo.gl/ZLkoao">https://goo.gl/ZLkoao</a></span></div></div></div></div></div><div><br /><span style="background-color: #674ea7; color: white; font-size: x-large;">United Kingdom-英國</span><br /><span style="color: #e06666; font-size: large;"><br /></span><div><span style="color: #e06666; font-size: large;">英國國家健康與照顧卓越研究院(The National Institute for Health and Care. Excellence, NICE)</span></div><div style="font-family: "heiti tc";"></div><br /><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><div style="margin: 0px;"><span style="font-size: 20px;">指引名稱:</span></div><div style="margin: 0px;"><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;">2017 Update:</span></span><br /><span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;">Type 2 diabetes in adults: management</span></span></div><div style="margin: 0px;"><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div></div><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; font-size: 20px;"><div style="margin: 0px;">網址連結:</div></div><div style="margin: 0px; text-align: start;"><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="color: #444444;"><span style="font-size: x-large;"><a href="https://goo.gl/rQTrB6">https://goo.gl/rQTrB6</a></span></span></div></div></div></div></div><p><br /><br /><span style="background-color: #674ea7; color: white; font-size: x-large;">World Health Organization-世界衛生組織</span><br /><br /></p><div style="font-family: "heiti tc";"></div><p><br /></p><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><span style="font-size: 20px;">指引名稱:</span></div><div style="margin: 0px;"><span style="font-family: "heiti tc"; font-size: large;">Medicines for Treatment Intensification in Type 2 Diabetes and Type of Insulin in Type 1 and Type 2 Diabetes in Low-Resource Settings: Synopsis of the World Health Organization Guidelines on Second- and Third-Line Medicines and Type of Insulin for the Control of Blood Glucose Levels in Nonpregnant Adults With Diabetes Mellitus</span></div><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; margin: 0px;"><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div></div><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; font-size: 20px;"><div style="margin: 0px;">網址連結:</div></div><div style="margin: 0px; text-align: start;"><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="color: #444444;"><span style="font-size: large;"><a href="https://goo.gl/Z1QXxy">https://goo.gl/Z1QXxy</a></span></span></div><div><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="color: #444444;"><br /></span></div></div></div>莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-35877416416209874942020-12-30T17:34:00.006-08:002020-12-30T17:37:37.114-08:00短期冷曝露改善糖尿病的胰島素阻抗<div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-cOodaet5AzY/X-0lZFqCE8I/AAAAAAAAHA8/M2qX9aNwNJcGHw91hf47EF29AAAfqfelQCNcBGAsYHQ/s1200/%25E5%2586%25B7%25E6%259B%259D%25E9%259C%25B2%25E6%2594%25B9%25E5%2596%2584%25E8%2583%25B0%25E5%25B3%25B6%25E7%25B4%25A0%25E6%2595%258F%25E6%2584%259F%25E6%2580%25A7.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" src="https://1.bp.blogspot.com/-cOodaet5AzY/X-0lZFqCE8I/AAAAAAAAHA8/M2qX9aNwNJcGHw91hf47EF29AAAfqfelQCNcBGAsYHQ/s16000/%25E5%2586%25B7%25E6%259B%259D%25E9%259C%25B2%25E6%2594%25B9%25E5%2596%2584%25E8%2583%25B0%25E5%25B3%25B6%25E7%25B4%25A0%25E6%2595%258F%25E6%2584%259F%25E6%2580%25A7.png" /></a></div><h1 style="text-align: left;"><span style="color: #2b00fe; font-size: x-large;">短期冷曝露改善糖尿病的胰島素阻抗</span></h1><div style="text-align: left;"><span style="font-size: large;">有研究指出(註1)<br />短時間的冷曝露後的身體適應<br />可以改善糖尿病患者的胰島素阻抗喔!<br />研究是10天曝露在14-15℃的環境下<br />利用影像學的檢查、肌肉切片以及抽血檢驗發現<br />患者的胰島素敏感性有增加<br />而且…增加的幅度<br />竟然不輸給運動帶來的效果</span></div><div style="text-align: left;"><span style="font-size: large;"><br /></span></div><h2 style="text-align: left;"><span style="color: #2b00fe; font-size: x-large;">為什麼能改善胰島素敏感性呢?</span></h2><div style="text-align: left;"><span style="font-size: large;">參與實驗的人,棕色脂肪的活性,</span></div><div style="text-align: left;"><span style="font-size: large;">並沒有因為</span><span style="font-size: x-large;">冷曝露而改善。</span></div><div style="text-align: left;"><span style="font-size: x-large;">而肌肉裏面的脂肪量,</span></div><div style="text-align: left;"><span style="font-size: x-large;">也沒有因為</span><span style="font-size: x-large;">冷曝露而減少。</span></div><div style="text-align: left;"><span style="font-size: large;"><br /></span></div><div style="text-align: left;"><span style="font-size: large;">一般而言,在肌肉吸收利用血糖的途徑中,</span></div><div style="text-align: left;"><span style="font-size: large;">會用到GLUT1及GLUT4。</span></div><div style="text-align: left;"><span style="font-size: large;">研究人員經由肌肉切片發現,</span></div><div style="text-align: left;"><span style="font-size: x-large;">冷曝露後的肌肉,</span></div><div style="text-align: left;"><span style="font-size: x-large;">GLUT1沒有增加,而</span><span style="font-size: x-large;">GLUT4卻增加了很多。</span></div><div style="text-align: left;"><span style="font-size: x-large;">或許這能夠解釋為什麼</span><span style="font-size: x-large;">冷曝露後,</span></div><div style="text-align: left;"><span style="font-size: x-large;">胰島素敏感性會改善。</span></div><div style="text-align: left;"><span style="font-size: large;"><br /></span></div><div style="text-align: left;"><h2 style="text-align: left;"><span style="color: #2b00fe; font-size: x-large;">關於這研究的心得與注意事項</span></h2><span style="font-size: large;">雖然冷曝露對血糖跟胰島素阻抗<br />可能有一些好處<br />不過寒冷的氣候<br />也會誘發心血管或是肺阻塞的疾病<br />所以想要用冷曝露改善胰島素阻抗<br />要很小心會得不償失<br />適度的運動反而是安全又有效的方法<br /><strike>只是很多人就是懶…</strike></span></div><div style="text-align: left;"><span style="font-size: large;"><br />這個研究算是很短期,患者數也很少。<br />長期會不會有效又安全,不知道。<br />不過臨床的觀察經驗上<br />有的人,真的會天氣寒冷<br />血糖就下降多一些,<br />但是也有人反而往上爬的。<br />而血壓是普偏上昇的居多。<br />所以建議寒流來的時候,<br />要記得多測血糖、血壓,<br />防止急性的心血管疾病發作。</span></div><p><span style="color: #2b00fe; font-size: large;">註記:</span><br /><span style="font-size: large;"><span>1.</span>Short-term cold acclimation improves insulin sensitivity in patients with type 2 diabetes mellitus.Nature Medicine volume 21, pages863–865(2015)</span><br /><br /></p><div style="background-color: white; border: 0px; color: #585858; font-family: "pingfang tc"; font-size: 14px; font-stretch: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; color: blue; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">作者</span></div><div style="background-color: white; border: 0px; font-stretch: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><div style="border: 0px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><div style="border: 0px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: large;"><span style="color: #585858; font-family: inherit; font-style: inherit; font-variant-caps: inherit; font-variant-ligatures: inherit; font-weight: inherit;"><span face=""carrois gothic" , sans-serif" style="background-color: rgba(255, 255, 255, 0.498); border: 0px; color: #222222; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">鹿港基督教醫院內分泌暨新陳代謝科</span></span></span><br style="line-height: 23.4px; margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">莊武龍醫師</span></span></span><br style="line-height: 23.4px; margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">專長於</span></span></span></span></span></span><span style="color: #222222; font-family: heiti tc;">甲狀腺射頻消融術、</span><span style="background-color: rgba(255, 255, 255, 0.498); color: #222222; font-family: inherit; font-style: inherit; font-variant-caps: inherit; font-variant-ligatures: inherit; font-weight: inherit;">週邊神經的超音波評估與營養評估</span></span></div><div style="border: 0px; color: #585858; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: large;"><span face=""carrois gothic" , sans-serif" style="background-color: rgba(255, 255, 255, 0.498); border: 0px; color: #222222; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">引用或是轉貼請注明出處,謝謝。</span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 22px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 22px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">文章僅供醫療衛教分享以及促進健康之用,請勿做為商業用途及其它不法的宣傳之用</span></span></span></span></span></span></div></div></div>莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-7370756193587793372020-10-04T01:25:00.007-07:002020-10-04T01:28:10.057-07:002020-2021 糖尿病病人流感的預防及注意事項<p> <span style="color: blue; font-size: xx-large;">2020-2021 糖尿病病人流感的預防及注意事項</span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-KFrr4WyzmGA/VtuDFOSSLTI/AAAAAAAAELQ/0PKFE71lzsU/s1600/%25E6%25B5%2581%25E6%2584%259F%25E9%25A0%2590%25E9%2598%25B2%25E5%25B0%2581%25E9%259D%25A2.jpg" style="margin-left: 1em; margin-right: 1em;"><img alt="糖尿病病人流感的預防及注意事項" border="0" src="https://1.bp.blogspot.com/-KFrr4WyzmGA/VtuDFOSSLTI/AAAAAAAAELQ/0PKFE71lzsU/s1600/%25E6%25B5%2581%25E6%2584%259F%25E9%25A0%2590%25E9%2598%25B2%25E5%25B0%2581%25E9%259D%25A2.jpg" title="糖尿病病人流感的預防及注意事項" /></a></div><div style="text-align: center;"><span style="font-size: large;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif" style="background-color: white; color: #999999; font-size: x-large;">”</span><span style="background-color: white; color: #999999; font-size: x-large;">血糖若是超過250 mg/dl,免疫力就有可能會下降。</span></span></div><h2><span style="color: blue; font-size: x-large;"></span></h2><h2><span style="background-color: white; color: blue; font-size: x-large;"></span></h2><br /><div><span style="color: red; font-size: large;">糖尿病患者若是得到流感、肺炎鏈球菌感染或是</span><span style="color: red; font-size: x-large;">新型冠狀病毒感染,</span><span style="color: red; font-size: x-large;">有較高的機會變成重症,有較高的致死率。</span></div><div><span style="font-size: large;">如何在流行季節守護自己的健康是個必須學會的課題。</span></div><div><h2><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif" style="color: blue; font-size: x-large;">糖尿病病患如何在流感季節守護自己的健康?</span></h2><span style="font-size: large;">真心想要守護個人或是家人的健康,</span><br /><span style="font-size: large;">可以把『一個可以預防的疾病』,</span><br /><span style="font-size: large;">視為一個事故來看待!</span><br /><span style="font-size: large;">每一個事故的發生,前面一定都有很多防線被突破。</span><br /><span style="font-size: large;">瑞士乳酪理論(Swiss cheese model)是醫療人員用來提昇病人安全的方法之一。</span><br /><span style="font-size: large;">預防流感,也可以用這個理論方法來看待。</span><br /><span style="font-size: large;"><br /></span><span style="font-size: large;">預防流感,我們可以多給自己好幾層的保護。</span><br /><span style="font-size: large;">每一層的保護,不可能有100%的保護力。</span><br /><span style="font-size: large;">但是你越沒有做好保護,病毒穿透保護的機會越高,</span><br /><span style="font-size: large;">你得到流感或甚至流感併發症的機會也越高。</span><br /><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;">文章的最後面附有</span><span style="font-size: x-large;">2020年1月版</span></div><div><span style="font-size: large;">最新的『衛生福利部疾病管制署』 成人預防接種建議時程表</span><br /><h2><span style="color: blue; font-size: x-large;"><br /><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">健康保謢多一層,有效預防流感、遠離重症</span></span></h2><span style="font-size: large;"><br /></span><span style="font-size: large;"></span><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://4.bp.blogspot.com/-oW5IsxdcNw0/VtAXT_t9PBI/AAAAAAAAEKU/5ulFZnPQXXM/s1600/%25E6%25B5%2581%25E6%2584%259F%25E9%25A0%2590%25E9%2598%25B21.jpg" style="margin-left: 1em; margin-right: 1em;"><img alt="瑞士乳酪理論(Swiss cheese model-預防流感" border="0" height="360" src="https://4.bp.blogspot.com/-oW5IsxdcNw0/VtAXT_t9PBI/AAAAAAAAEKU/5ulFZnPQXXM/s640/%25E6%25B5%2581%25E6%2584%259F%25E9%25A0%2590%25E9%2598%25B21.jpg" title="增加保護步驟預防流感" width="640" /></a></div><div><br /></div><span style="font-size: large;">以下是預防流感的建議</span><br /><span style="color: red; font-size: large;">1.保持距離</span><br /><span style="font-size: large;"> 避免在流感大流行的時候去人潮多的地方。</span><br /><span style="font-size: large;"> 得到流感或是遇到有感冒的人,也要適度的保持距離。</span><br /><span style="font-size: large;"><br /></span><span style="color: red; font-size: large;">2.戴口罩</span><br /><span style="font-size: large;"> 可減少吸入病毒的機會。降低空氣及飛沫傳染。</span></div><div><span style="font-size: large;"> 這個很重要,因為像是2020年的新冠狀病毒疫情就證實了,</span></div><div><span style="font-size: large;"> 有戴口罩可以減少傳播病毒的機會。<br /></span><span style="font-size: large;"><br /></span><span style="color: red; font-size: large;">3.不碰觸</span><br /><span style="font-size: large;"> 因為流感病毒,在天氣冷跟天氣潮濕的情況下,仍可存活好幾小時。</span><br /><span style="font-size: large;"> 所以如果接觸到汙染物,再接觸本身的眼睛、鼻 子、嘴巴,就有可能</span><br /><span style="font-size: large;"> 因為接觸而傳染。</span><br /><span style="font-size: large;"><br /></span><span style="color: red; font-size: large;">4.勤洗手</span><br /><span style="font-size: large;"> 勤洗手,維持手部清潔。打噴嚏或是咳嗽後也要洗手。</span><br /><span style="font-size: large;"> 保護自己也保護他人。</span><br /><span style="font-size: large;"><br /></span><span style="color: red; font-size: large;">5.血糖控制:</span><br /><span style="font-size: large;"> 有醫學研究指出,血糖若是超過250 mg/dl,免疫力就有可能會下降。</span><br /><span style="font-size: large;"> 做好血糖量測,做好血糖控制,有助於免疫力的改善。</span><br /><span style="font-size: large;"><br /></span><span style="color: red; font-size: large;">6.疫苗接種</span><br /><span style="font-size: large;"> 按時接種流感疫苗是有效預防流感的方法之一。</span><br /><span style="font-size: large;"> 因為得到流感可能會併發肺炎或是細菌感染。</span><br /><span style="font-size: large;"> 施打肺炎鏈球菌疫苗可以同時降低住院率及死亡率,</span><br /><span style="font-size: large;"> 2015年起,已列入幼兒常規疫苗接種政策。</span><br /><span style="font-size: large;"><br /></span><span style="font-size: large;"> 目前,75歲以上的年長者有公費的肺炎鏈球菌疫苗注射。</span><br /><span style="font-size: large;"> 但是,糖尿病病人感染肺炎鏈球菌風險較健康者高出 3.4 倍 。</span><br /><span style="font-size: large;"> 若不小心感染肺炎鏈球菌,除了可能造成肺炎、敗血症、菌血症、</span><br /><span style="font-size: large;"> 腦膜</span><span style="font-size: large;">炎等嚴重疾病外,</span><br /><span style="font-size: large;"> 原有的糖尿病也可能惡化,甚至死亡。</span><br /><span style="font-size: large;"> 年長者,有施打肺炎鏈球菌疫苗的人,死亡率會降低。</span><br /><span style="font-size: large;"> 真的認真想給自己多一層保護的人,</span><br /><span style="font-size: large;"> 不一定要等到75歲以上,才來施打公費疫苗。</span><br /><span style="font-size: large;"> 因為</span><span style="font-size: large;">肺炎鏈球菌感染,不會等到</span><span style="font-size: large;">75歲以上才發生。</span><br /><span style="font-size: large;"> </span><br /><span style="font-size: large;"> 目前美國糖尿病照護指引建議,過去未接種肺炎鏈球菌多醣體疫苗的</span><br /><span style="font-size: large;"> 65歲以上糖尿病友,建議先施打一劑肺炎鏈球菌結合型疫苗,再施打</span><br /><span style="font-size: large;"> 肺炎鏈球菌多醣體疫苗。</span><br /><span style="font-size: large;"> 過去曾施打過種肺炎鏈球菌多醣體疫苗的65歲以上糖尿病友,則建議</span><br /><span style="font-size: large;"> 間隔一年後再施打一劑肺炎鏈球菌結合型疫苗。</span><br /><span style="font-size: large;"><br /></span><span style="font-size: large;"> 有的人贊同打疫苗,當然也有人反對的。</span><br /><span style="font-size: x-large;"> </span><br /><span style="color: #ea9999; font-size: x-large;">"老話一句,要幾層的保護自己決定!</span><span style="font-size: large;"> </span><br /><br /><div><span style="color: red; font-size: large;">7.多休息</span></div><div><span style="font-size: large;"> 睡眠充足,每天至少七小時。</span><br /><span style="font-size: large;"> 睡眠的質與量都兼顧了,免疫力自然會提升</span><br /><span style="font-size: large;"> 良好睡眠也有助於維持血糖的穩定,一舉數得</span></div><div><span style="font-size: large;"><br /></span></div><div><span style="color: red; font-size: large;">8.免疫力</span></div><div><span style="font-size: large;"> 這個平常就要保養,不是等到流感來才做。</span></div><div><span style="font-size: large;"> 維持良好的生活型態、運動及飲食跟營養,都是不可或缺的一環。</span></div><div><span style="font-size: large;"> 絕對不是補充了什麼健康食品,就有好的免疫力,其他都不用做。</span></div><br /><br /><br /><h2><span style="color: blue;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif" style="font-size: x-large;">糖尿病病人還要注意什麼?</span></span></h2><span style="font-size: large;">平日就要做好流感的保護,</span><br /><span style="font-size: large;">免得流感像下面的圖示一樣,</span><br /><span style="font-size: large;">病毒一層又一層的穿過,產生更嚴重的併發症。</span><br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://4.bp.blogspot.com/-Rjptqhoqo9Y/VtAXalpoivI/AAAAAAAAEKY/EE9MniQFk-Q/s1600/%25E6%25B5%2581%25E6%2584%259F%25E9%25A0%2590%25E9%2598%25B22.jpg" style="margin-left: 1em; margin-right: 1em;"><img alt="流感的併發症" border="0" height="360" src="https://4.bp.blogspot.com/-Rjptqhoqo9Y/VtAXalpoivI/AAAAAAAAEKY/EE9MniQFk-Q/s640/%25E6%25B5%2581%25E6%2584%259F%25E9%25A0%2590%25E9%2598%25B22.jpg" title="流感的併發症" width="640" /></a></div><div class="separator" style="clear: both;"><span style="font-size: large;">若是得到流感,請多注意一下血糖的變化。</span></div><div class="separator" style="clear: both;"><span style="font-size: large;">如下圖所示,<span style="color: red;">得到感冒的時候,胰島素的需求可能會增加。</span></span></div><div class="separator" style="clear: both;"><span style="font-size: large;">若是沒有調整藥物或是調整胰島素劑量,可能血糖就會暴衝。</span></div><div class="separator" style="clear: both;"><span style="font-size: large;">建議多量測血糖,適度調整藥物。</span></div><div class="separator" style="clear: both;"><span style="color: red; font-size: large;">如果感冒就醫,也請跟醫師表明說有糖尿病,</span></div><div class="separator" style="clear: both;"><span style="color: red; font-size: large;">用感冒糖漿可能會使血糖上昇,</span></div><div class="separator" style="clear: both;"><span style="color: red; font-size: large;">請醫生開立別的處方藥物。</span></div><div class="separator" style="clear: both;"><span style="font-size: large;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-size: large;">而感冒好了後,胰島素的需求也不會馬上恢復。</span></div><div class="separator" style="clear: both;"><span style="font-size: large;">建議多量測血糖,適度調降藥物劑量。</span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-jwv6kEKgr1c/VtAXjH5IbHI/AAAAAAAAEKc/Sz4bduCcKWw/s1600/%25E6%25B5%2581%25E6%2584%259F%25E9%25A0%2590%25E9%2598%25B2-%25E8%25A1%2580%25E7%25B3%2596%25E6%25B3%25A2%25E5%258B%2595.jpg" style="margin-left: 1em; margin-right: 1em;"><img alt="感冒時胰島素需求的變化" border="0" height="360" src="https://1.bp.blogspot.com/-jwv6kEKgr1c/VtAXjH5IbHI/AAAAAAAAEKc/Sz4bduCcKWw/s640/%25E6%25B5%2581%25E6%2584%259F%25E9%25A0%2590%25E9%2598%25B2-%25E8%25A1%2580%25E7%25B3%2596%25E6%25B3%25A2%25E5%258B%2595.jpg" title="感冒時胰島素需求的變化" width="640" /></a></div><div class="separator" style="clear: both;"><br /></div><span style="font-size: large;"><br /></span><br /><div class="separator" style="clear: both;"><span style="font-size: large;">另外,因為有的人會有腹瀉或是嘔吐等現象,或者是食慾變差,</span></div><div class="separator" style="clear: both;"><span style="font-size: large;">這時候,可能反而要<span style="color: red;">減低藥物劑量或是降低胰島素劑量</span>,</span></div><div class="separator" style="clear: both;"><span style="font-size: large;">以避免低血糖的發生。</span></div><div class="separator" style="clear: both;"><span style="font-size: large;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-size: large;">如果血糖波動不穩,可以考慮回診跟醫師討論。</span></div><span style="font-size: large;"><br /></span><h2><span style="color: blue; font-size: xx-large;">成人預防接種建議時程表</span></h2><div><span style="color: blue;"><span style="font-size: medium;">(</span></span><span style="color: blue; font-size: large;">2020年1月版『衛生福利部疾病管制署』</span><span style="color: blue; font-size: medium;">成人預防接種建議時程表</span><span style="color: blue; font-size: large;">)</span></div><div class="separator" style="clear: both; text-align: center;"></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-XvlGUGa1HbQ/X3mDVrdIf9I/AAAAAAAAG5Q/3FW1uzRSIEkO5xr5IpkQ7FiZg96e9kBdgCNcBGAsYHQ/s1067/%25E8%259E%25A2%25E5%25B9%2595%25E5%25BF%25AB%25E7%2585%25A7%2B2020-10-04%2B%25E4%25B8%258B%25E5%258D%25884.02.35.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="588" data-original-width="1067" height="352" src="https://1.bp.blogspot.com/-XvlGUGa1HbQ/X3mDVrdIf9I/AAAAAAAAG5Q/3FW1uzRSIEkO5xr5IpkQ7FiZg96e9kBdgCNcBGAsYHQ/w640-h352/%25E8%259E%25A2%25E5%25B9%2595%25E5%25BF%25AB%25E7%2585%25A7%2B2020-10-04%2B%25E4%25B8%258B%25E5%258D%25884.02.35.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><span style="color: blue; font-size: x-large;"><br /></span></div><span style="color: blue; font-size: x-large;"><b>2020-21 流感疫苗的施打時間及注意事項</b></span><br /><span style="font-size: large;"><br /></span><span style="font-size: large;">流感疫苗接種各類對象之開打時程</span></div><div><span style="font-size: large;">2020-10-05 開始施打</span></div><div><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;">公費疫苗施打對象:</span></div><div><div style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; touch-action: pan-y;"><span style="box-sizing: border-box; font-weight: 700; letter-spacing: 0px; touch-action: pan-y;"><span style="font-size: large;">實施對象</span></span></div><ul style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; list-style: square; margin-bottom: 10px; margin-left: 20px; margin-top: 0px; padding: 0px; touch-action: pan-y;"><li style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;">滿6個月以上至國小入學前幼兒</li></ul><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">109年度流感疫苗接種計畫各類實施對象,需具中華民國國民身分〔如為外籍人士,需持有居留證(包含外交官員證、國際機構官員證及外國機構官員證)〕,並符合下列條件。</span><ul style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; list-style: square; margin-bottom: 10px; margin-left: 20px; margin-top: 0px; padding: 0px; touch-action: pan-y;"><li style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;">滿6個月以上至國小入學前幼兒</li></ul><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">出生滿6個月以上至國小註冊就學前之幼兒(幼兒及其父母均為外國人,且均無加入健保及無居留證之幼兒需自費接種;針對在臺無國籍弱勢幼兒,請主管機關或收容機關洽地方政府衛生局(所)[下稱衛生局(所)]協處。</span><ul style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; list-style: square; margin-bottom: 10px; margin-left: 20px; margin-top: 0px; padding: 0px; touch-action: pan-y;"><li style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;">國小、國中、高中、高職、五專1至3年級學生,符合下列條件之一者</li></ul><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">一、109學年度第一學期註冊為我國國小學生(含境外臺校,但不含附設補習學校)。</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">二、109學年度第一學期註冊為我國國中學生(含境外臺校,但不含附設補習學校)。</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">三、109學年度第一學期註冊為我國高中、高職或五專1-3年級學生(含進修部學生與境外臺校)。</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">四、少年矯正學校及輔育院學生,以及屬「中途學校-在園教育」性質之兒童及少年安置(教養)機構學生。</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">五、依據107年1月31日公布「高級中等以下教育階段非學校型態實驗教育實施條例」所稱之自學學生。</span><ul style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; list-style: square; margin-bottom: 10px; margin-left: 20px; margin-top: 0px; padding: 0px; touch-action: pan-y;"><li style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;">50歲以上成人</li></ul><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">以「接種年」減「出生年」計算大於等於50歲者。</span><ul style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; list-style: square; margin-bottom: 10px; margin-left: 20px; margin-top: 0px; padding: 0px; touch-action: pan-y;"><li style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;">具有潛在疾病,符合下列條件之一者</li></ul><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">一、高風險慢性病人,符合下列條件之一者:</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">(一)具有</span><span style="background-color: white; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;"><span style="color: red;">糖尿病</span></span><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">、慢性肝病(含肝硬化)、心血管疾病(不含單純高血壓)、慢性肺病、腎臟疾病及免疫低下(HIV感染者)等疾病之門、住診紀錄之患者(疾病代碼供參如附件1)</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">(二)無法取得上開疾病之門、住診紀錄,但經醫師評估符合者。</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">(三)BMI≧30者。</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">二、罕見疾病患者(健保卡內具註記或持相關證明文件者,疾病代碼詳如附件2,並以國民健康署最新公告為準)。</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">三、重大傷病患者(健保卡內具註記或領有重大傷病證明紙卡者)。</span><ul style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; list-style: square; margin-bottom: 10px; margin-left: 20px; margin-top: 0px; padding: 0px; touch-action: pan-y;"><li style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;">孕婦及6個月內嬰兒之父母</li></ul><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">一、已領取國民健康署編印「孕婦健康手冊」之懷孕婦女,若尚未發給孕婦健康手冊,則可檢附診斷證明書。</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">二、持有嬰兒出生證明文件或完成新生嬰兒登記之戶口名簿之6個月內嬰兒之父母(以「嬰兒之父母接種年月」減「嬰兒出生年月」計算小於等於6個月)。</span><ul style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; list-style: square; margin-bottom: 10px; margin-left: 20px; margin-top: 0px; padding: 0px; touch-action: pan-y;"><li style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;">幼兒園托育人員及托育機構專業人員</li></ul><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">一、幼兒園托育人員:依據104年7月1日公布之幼兒教育及照顧法所稱教保服務人員,包含在幼兒園服務之園長、教師、教保員及助理教保員等。</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">二、托育機構專業人員:托嬰中心(含社區公共托育家園)之主管人員、托育人員、教保人員及助理教保人員等。</span><ul style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; list-style: square; margin-bottom: 10px; margin-left: 20px; margin-top: 0px; padding: 0px; touch-action: pan-y;"><li style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;">安養、養護、長期照顧等機構之受照顧者及所屬工作人員</li></ul><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">一、安養機構、養護機構、長期照顧機構、長期照顧服務機構(含居家式、社區式及機構住宿式服務類)、護理之家(不含產後護理之家)、榮民之家、身心障礙福利服務機構(不含福利服務中心)、呼吸照護中心、精神醫療機構(係指設有急/慢性精神病床或精神科日間留院服務之醫院,不含精神科診所)、精神復健機構(含日間型及住宿型機構)等機構之受照顧者、榮民醫院公務預算床榮患及居家護理個案等。</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">二、直接照顧上述機構之受照顧者或個案之機構所屬工作人員。</span><ul style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; list-style: square; margin-bottom: 10px; margin-left: 20px; margin-top: 0px; padding: 0px; touch-action: pan-y;"><li style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;">醫事及衛生等單位之防疫相關人員,符合下列條件之一者</li></ul><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">一、具執業登記醫事人員及醫療院所非醫事人員:</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">本項人員之涵蓋範圍如下:</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">(一)具執業登記醫事人員</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">依據95年5月17日公布之醫事人員人事條例所稱醫事人員,並具執業登記者,包含醫師、中醫師、牙醫師、藥師、醫事檢驗師、護理師、助產師、營養師、物理治療師、職能治療師、醫事放射師、臨床心理師、諮商心理師、呼吸治療師、藥劑生、醫事檢驗生、護士、助產士、物理治療生、職能治療生、醫事放射士,以及其他經中央衛生主管機關核發醫事專門職業證書之人員,如語言治療師、聽力師、牙體技術師、鑲牙生、牙體技術生、驗光師、驗光生等。</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">(二)醫療院所非醫事人員</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">本計畫所指之醫療院所係為醫院及診所,不包括非以直接診治病人為目的而辦理之醫療業務之其他醫療或醫事機構(如捐血機構、病理機構、醫事檢驗所、醫事放射所、物理治療所、職能治療所、鑲牙所…等),本項人員之涵蓋範圍如下:</span><ol style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; margin-bottom: 10px; margin-top: 0px; touch-action: pan-y;"><li style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;">醫院<ol style="box-sizing: border-box; letter-spacing: 0px; margin-bottom: 0px; margin-top: 0px; touch-action: pan-y;"><li style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;">醫院編制內非醫事人員<br style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;" />包括醫療輔助技術人員(如臨床心理、感染控制、聽力與語言治療、麻醉、呼吸治療、核子醫學、醫學物理、牙科技術等人員)、工程技術人員(如醫學工程、臨床工程、工務、建築、電機、電子、空調等人員)、社會工作人員、醫務行政人員、一般行政人員、資訊技術人員、研究人員、庶務人員(係指看護工、清潔工、洗衣工、技工、工友、司機、駐衛警等,如為外包人力,請洽公司確認承攬工作之單位是否單獨或跨多家醫院提供服務,以避免重複申請,醫院並應確認承攬廠商提供之冊列人員確實符合接種條件)。</li><li style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;">醫院值勤之醫事實習學生<br style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;" />本項人員指於計畫執行期間,在地區級以上教學醫院值勤之醫事實習學生。</li><li style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;">衛生保健志工<br style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;" />本項人員指長期固定服務於醫療院所(含有門診的衛生所)之衛生保健志工,且領有志願服務紀錄冊,並於衛生局登記有案者。</li></ol></li><li style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;">診所<br style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;" />由於診所之設置標準、經營型態與醫院不同,為使有限疫苗資源確實使用於高危險群,每一診所行政人員接種名額以2名為限。</li></ol><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">二、衛生等單位之防疫相關人員</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">(一)衛生單位第一線防疫人員:包括衛生福利部疾病管制署(下稱疾病管制署)與各區管制中心及衛生局(所)之編制人員、第一線聘僱或派遣人員、司機、工友等。</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">(二)各消防隊實際執行救護車緊急救護人員。</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">(三)第一線海巡、岸巡人員。</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">(四)國際機場、港口入境安全檢查、證照查驗及第一線關務人員。</span><br style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; touch-action: pan-y;" /><span style="background-color: white; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px;">(五)實施空中救護勤務人員:係指內政部空中勤務總隊所屬空中救護勤務人員。</span><ul style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Noto Sans TC", sans-serif, "Open Sans"; font-size: 16px; list-style: square; margin-bottom: 10px; margin-left: 20px; margin-top: 0px; padding: 0px; touch-action: pan-y;"><li style="box-sizing: border-box; letter-spacing: 0px; touch-action: pan-y;">禽畜養殖等相關行業工作人員、動物園工作人員及動物防疫人員,符合下列條件之一者(各類對象定義及說明詳如附件3)</li></ul></div><div><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;">參考資料來源:</span></div><div><span style="font-size: large;">『衛生福利部疾病管制署』</span><span style="font-size: x-large;">年度流感疫苗接種計畫</span></div><div><span style="font-size: large;"><a href="https://www.cdc.gov.tw/Category/MPage/JNTC9qza3F_rgt9sRHqV2Q">https://www.cdc.gov.tw/Category/MPage/JNTC9qza3F_rgt9sRHqV2Q</a><br /></span><span style="font-size: large;"></span><br /><div><br /><div><span style="color: #e06666; font-size: large;">--------------------------------------------</span></div><div><span style="font-size: large;">民眾可到各醫療院所、診所或衛生所,可就近施打,不受戶籍地影響。</span></div><div><span style="font-size: large;">不知道附近診所或醫院有無提供施打,可以查詢下面的網址。</span></div><div><span style="font-size: large;"><br /></span></div><span style="font-size: large;">流感疫苗及抗病毒藥劑的合約院所查詢網站:</span><br /><div><span style="font-size: large;"><a href="https://antiflu.cdc.gov.tw/">https://antiflu.cdc.gov.tw/</a></span></div></div><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="color: blue; font-size: x-large;"><b>相關參考資源:</b></span><br /><span style="font-size: large;">衛生福利部疾病管制署:流感衛教及宣導</span><br /><span style="font-size: large;"><a href="http://www.cdc.gov.tw/home/Influenza">http://www.cdc.gov.tw/home/Influenza</a></span><br /><span style="font-size: large;"><br /></span><span style="font-size: large;">衛生福利部疾病管制署:侵襲性肺炎鏈球菌感染症</span><br /><span style="font-size: large;"><a href="http://www.cdc.gov.tw/professional/neumococcus">http://www.cdc.gov.tw/professional/neumococcus</a></span><br /><br /><br /><div><span style="color: blue; font-size: large;"><span style="font-size: x-large;"><b>相關新聞及連結:</b></span></span></div><div><div><span style="color: blue; font-size: large;">糖尿病患者免疫力低 易感染肺炎併發重症</span></div><span style="color: blue; font-size: large;"></span><br /><div><span style="color: blue; font-size: large;"><span style="font-size: large;"><a href="https://health.ltn.com.tw/article/paper/1356074">https://health.ltn.com.tw/article/paper/1356074</a></span></span></div><span style="color: blue; font-size: large;"></span></div><div><span style="color: blue; font-size: x-large;"><b><br /></b></span><div><span style="color: blue; font-size: large;">冬天吃多血糖飆高細菌感染變肺炎的風險增加?</span></div><span style="color: blue; font-size: large;"></span><br /><div><span style="color: blue; font-size: large;"><span style="font-size: large;"><a href="http://www.ettoday.net/news/20160128/620737.htm">http://www.ettoday.net/news/20160128/620737.htm</a></span></span></div><span style="color: blue; font-size: large;"></span><br /><div><span style="color: blue; font-size: large;"><br /></span></div><span style="color: blue; font-size: large;"></span><br /><div><span style="color: blue; font-size: large;">研究:肺炎鏈球菌疫苗 可降低9成死亡率</span></div><span style="color: blue; font-size: large;"></span><br /><div><span style="color: blue; font-size: large;"><span style="font-size: large;"><a href="http://www.appledaily.com.tw/realtimenews/article/new/20151104/725591/">http://www.appledaily.com.tw/realtimenews/article/new/20151104/725591/</a></span></span></div><span style="color: blue; font-size: large;"></span><br /><div><span style="color: blue; font-size: large;"><br /></span></div><span style="color: blue; font-size: large;"></span><br /><div><span style="color: blue; font-size: large;">流感季雙重保護!醫籲:接種流感和肺炎鏈球菌疫苗</span></div><span style="color: blue; font-size: large;"></span><br /><div><div><span style="color: blue; font-size: large;"><span style="font-size: large;"><a href="https://www.top1health.com/Article/29/43323">https://www.top1health.com/Article/29/43323</a></span></span></div><div><span style="color: blue; font-size: large;"><br /></span></div><span style="color: blue; font-size: large;"><br /></span><span style="color: blue; font-size: large;">白袍旅人的育兒知識:為什麼要打流感疫苗?<br /><a href="http://twkid.com/p/1999">http://twkid.com/p/1999</a></span></div><span style="color: blue; font-size: large;"></span></div><div><span style="color: blue; font-size: x-large;"><br /></span></div><h2 style="background-color: rgba(255, 255, 255, 0.498); font-family: "carrois gothic", sans-serif; margin: 0px; outline: none; padding: 0px; position: relative; vertical-align: baseline;"><span style="color: blue; font-size: x-large;">作者</span></h2><div style="font-family: "heiti tc"; margin: 0px;"><span face=""carrois gothic" , sans-serif" style="background-color: rgba(255, 255, 255, 0.498); color: #222222; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="font-size: large;"><span style="margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">鹿港基督教醫院內分泌暨新陳代謝科</span></span></span><br style="line-height: 23.4px;" /><span style="line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">莊武龍醫師</span></span></span><br style="line-height: 23.4px;" /><span style="line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><br /></span><span style="margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">引用或是轉貼請注明出處,謝謝。</span><span style="line-height: 22px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><br /></span><span style="line-height: 22px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;">文章僅供醫療衛教分享以及促進健康之用,請勿做為商業用途及其它不法的宣傳之用</span></span></span></span></span><br /><div><span face=""carrois gothic" , sans-serif" style="background-color: rgba(255, 255, 255, 0.498); color: #222222; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="font-size: large;"><span style="line-height: 23.4px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><span style="line-height: 22px; margin: 0px; outline: none; padding: 0px; vertical-align: baseline;"><br /></span></span></span></span></span></div></div></div>莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-54955517167824142562020-05-24T23:32:00.000-07:002020-05-24T23:35:06.822-07:00一頁式心得筆記:《賺錢,更賺自由的FIRE理財族》<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-vi14iz50wzE/XssHB-hMozI/AAAAAAAAGuY/z4-sQCYr-5UlqJ1GYyDf4i6AeK6EV9CoQCNcBGAsYHQ/s1600/%25E6%2596%25B0%25E6%259B%25B8%25E6%258E%25A8%25E8%2596%25A6-%25E8%25B2%25A1%25E7%25B6%2593-%25E8%25B3%25BA%25E9%258C%25A2%25E6%259B%25B4%25E8%25B3%25BA%25E8%2587%25AA%25E7%2594%25B1%25E7%259A%2584FIRE%25E7%2590%2586%25E8%25B2%25A1%25E6%2597%258F.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="332" src="https://1.bp.blogspot.com/-vi14iz50wzE/XssHB-hMozI/AAAAAAAAGuY/z4-sQCYr-5UlqJ1GYyDf4i6AeK6EV9CoQCNcBGAsYHQ/s640/%25E6%2596%25B0%25E6%259B%25B8%25E6%258E%25A8%25E8%2596%25A6-%25E8%25B2%25A1%25E7%25B6%2593-%25E8%25B3%25BA%25E9%258C%25A2%25E6%259B%25B4%25E8%25B3%25BA%25E8%2587%25AA%25E7%2594%25B1%25E7%259A%2584FIRE%25E7%2590%2586%25E8%25B2%25A1%25E6%2597%258F.png" width="640" /></a></div>
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<h3 style="background-color: white; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; margin-bottom: 6px;">
<span style="color: #e06666; font-size: large;">為什麼會推薦看這本書?</span></h3>
<div style="background-color: white; color: #1c1e21; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; margin-bottom: 6px;">
<span style="font-size: large;">最近在看FIRE相關的書。</span></div>
<div style="background-color: white; color: #1c1e21; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; margin-bottom: 6px;">
<span style="font-size: large;">FIRE指的是<span style="color: black; font-family: "pingfang tc";">financial independence, retire early。也就是經濟獨立,提早退休的意思。</span></span></div>
<div style="background-color: white; margin-bottom: 6px;">
<span style="font-size: large;">在門診常看到,<br /><span style="color: #1c1e21; font-family: , , , , sans-serif;">有些人拚死拚活工作,</span><span style="color: #1c1e21; font-family: , , , , sans-serif;">拚到一身毛病,</span><span style="color: #1c1e21; font-family: , , , , sans-serif;">失去了健康,</span><br /><span style="color: #1c1e21; font-family: , , , , sans-serif;">甚至離婚,失去了家庭。</span><br /><span style="color: #1c1e21; font-family: , , , , sans-serif;">但是他們真的知道自己在拚什麼嗎?</span><br /><span style="color: #1c1e21; font-family: , , , , sans-serif;">花大錢住豪宅就會快樂嗎?</span><br /><span style="color: #1c1e21; font-family: , , , , sans-serif;">生活上的每筆花費真的都是必須的嗎?</span><br /><span style="color: #1c1e21; font-family: , , , , sans-serif;">很多時候我們不知不覺被廣告洗腦</span><br /><span style="color: #1c1e21; font-family: , , , , sans-serif;">被置入了很多不理性的想法</span></span></div>
<div style="background-color: white; color: #1c1e21; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="font-size: large;">這本書的故事中,<br />作者跟太太寫下各自會快樂的清單後發現,<br />原來『倆個人一起喝杯咖啡』</span></div>
<div style="background-color: white; color: #1c1e21; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="font-size: large;">竟然是清單上的交集項目。<br />也就是說,努力生活工作的目標<br />應該是,<br />想辦法增加兩個人喝咖啡的時間,<br />而不是單純把買豪宅買名車,<br />當做會讓彼此快樂的指標。</span></div>
<div style="background-color: white; color: #1c1e21; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="font-size: large;">門診中看到很多人,為了賺更多的錢,忙到沒時間運動,</span></div>
<div style="background-color: white; color: #1c1e21; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="font-size: large;">忙到睡眠出問題,需要助眠藥渡日。</span></div>
<div style="background-color: white; color: #1c1e21; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="font-size: large;">如果這些人先了解自己為什麼需要賺錢,</span></div>
<div style="background-color: white; color: #1c1e21; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="font-size: large;">還有能寫下讓自己會快樂的十件事,</span></div>
<div style="background-color: white; color: #1c1e21; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; margin-bottom: 6px; margin-top: 6px;">
<span style="font-size: large;">會不會反而不會落到如此悲慘的人生呢?</span></div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-9bZOfYIiqGA/XstbFVr9hII/AAAAAAAAGuk/8wrCOE65S8sMPzMFqVKc-uJrGdHH6YYjwCNcBGAsYHQ/s1600/%25E6%2596%25B0%25E6%259B%25B8%25E6%258E%25A8%25E8%2596%25A6-%25E7%25AD%2586%25E8%25A8%2598-%25E8%25B3%25BA%25E9%258C%25A2%25E6%259B%25B4%25E8%25B3%25BA%25E8%2587%25AA%25E7%2594%25B1%25E7%259A%2584FIRE%25E7%2590%2586%25E8%25B2%25A1%25E6%2597%258F.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-9bZOfYIiqGA/XstbFVr9hII/AAAAAAAAGuk/8wrCOE65S8sMPzMFqVKc-uJrGdHH6YYjwCNcBGAsYHQ/s640/%25E6%2596%25B0%25E6%259B%25B8%25E6%258E%25A8%25E8%2596%25A6-%25E7%25AD%2586%25E8%25A8%2598-%25E8%25B3%25BA%25E9%258C%25A2%25E6%259B%25B4%25E8%25B3%25BA%25E8%2587%25AA%25E7%2594%25B1%25E7%259A%2584FIRE%25E7%2590%2586%25E8%25B2%25A1%25E6%2597%258F.png" width="640" /></a></div>
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<br />
<h3>
<span style="color: #e06666; font-size: large;">如何達成<span style="background-color: white;">經濟獨立、提早退休</span></span></h3>
<span style="font-size: large;">要存到多少錢才夠呢?</span><br />
<span style="font-size: large;">如果每年只從投資金額提領4%金額花費,</span><br />
<span style="font-size: large;">存下年度開銷的25倍金額就可以退休。</span><br />
<span style="font-size: large;">該如何賺更多的錢呢?</span><br />
<span style="font-size: large;">作者建議選擇指數基金投資,</span><br />
<span style="font-size: large;">以及利用複利的效應,讓錢滾錢,越滾越多。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">花錢是可以得到快樂,但是每次花錢不一定能更快樂。</span><br />
<span style="font-size: large;">我們應該做的是定期檢示會讓自己快樂的十件事。</span><br />
<span style="font-size: large;">即使是需要花錢的,也才更能把錢花在刀口上。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">存錢就是賺得多,花得少。</span><br />
<span style="font-size: large;">養成記帳習慣,可以減少或縮減不必要的花費。</span><br />
<span style="font-size: large;">書中,作者提到『地理套利』的想法。</span><br />
<span style="font-size: large;">要如何做到地理套利?</span><br />
<span style="font-size: large;">例如從台北市搬到其他縣市住,</span><br />
<span style="font-size: large;">生活最常需要花費的住房、交通、飲食也會減低,</span><br />
<span style="font-size: large;">自然而然,能存下的錢也可能會更多。</span><br />
<span style="font-size: large;">不過…這也要注意,</span><br />
<span style="font-size: large;">離開大城市,能夠增加收入的機會或許也會減少。</span><br />
<span style="font-size: large;">這個地理套利其實也適用在自助旅行上!</span><br />
<span style="font-size: large;">之前我還是學生,</span><br />
<span style="font-size: large;">靠著兼差打工賺的錢去歐洲自助旅行。</span><br />
<span style="font-size: large;">要訂荷蘭阿姆斯特丹的住宿時,</span><br />
<span style="font-size: large;">要嘛就是很貴,要嘛就是日期根本訂不到想要的日子。</span><br />
<span style="font-size: large;">苦惱了很久,</span><br />
<span style="font-size: large;">最後,我選擇去住哈連(Haarlem),</span><br />
<span style="font-size: large;">離</span><span style="font-size: large;">阿姆斯特丹只要15分鐘車程。</span><br />
<span style="font-size: large;">不只花費低,沒人跟我搶訂住宿。</span><br />
<span style="font-size: large;">真的去住了之後,因為要從逛完美術館,</span><br />
<span style="font-size: large;">要從阿姆斯特丹回到</span><span style="font-size: large;">哈連(Haarlem),</span><br />
<span style="font-size: large;">我又還多了一段在荷蘭搭火車的經驗。</span><br />
<span style="font-size: large;">更最重要的是,我想去逛的</span><span style="font-size: large;">阿姆斯特丹還是有玩到。</span><br />
<span style="font-size: large;">更意外的是,</span><br />
<span style="font-size: large;">我住的地方的主人在</span><span style="font-size: large;">阿姆斯特丹上班,</span><br />
<span style="font-size: large;">有一天的早上,我是坐他的車一起去</span><span style="font-size: large;">阿姆斯特丹的,</span><br />
<span style="font-size: large;">連一張火車票錢都沒有花到,</span><br />
<span style="font-size: large;">而且他還跟我講解一路上有趣的建築。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">省錢省到沒生活怎麼辦</span><br />
<span style="font-size: large;">節省開銷該節省到什麼程度,</span><br />
<span style="font-size: large;">會因人而異,</span><br />
<span style="font-size: large;">但是如果過度節省,</span><br />
<span style="font-size: large;">就連作者也會遇到兩難的情形。</span><br />
<span style="font-size: large;">又不能亂花,但又不能都沒有生活享受,</span><br />
<span style="font-size: large;">該怎麼辦嗎?</span><br />
<span style="font-size: large;">我覺得還是該回歸思考那十件會讓自己快樂的十件事,</span><br />
<span style="font-size: large;">還有就是花費背後的動機是什麼。</span><br />
<span style="font-size: large;">就像我現在的筆電還是在用2012年出產的Macbook Air。</span><br />
<span style="font-size: large;">在二、三年前,每次看完蘋果發表會後,</span><br />
<span style="font-size: large;">都很想衝去買一部新的Macbook 。</span><br />
<span style="font-size: large;">但是…停下來個幾週再想想,</span><br />
<span style="font-size: large;">其實會發現,</span><br />
<span style="font-size: large;">目前在用的2012年版Macbook Air,</span><br />
<span style="font-size: large;">效能已經夠我平日的工作使用,</span><br />
<span style="font-size: large;">反而是因為資料量變多,使得原來的硬碟容量不夠我使用。</span><br />
<span style="font-size: large;">後來,我反而就是自己買一個1T的SSD硬碟改裝,</span><br />
<span style="font-size: large;">改裝筆電的硬碟後,又順利用了好幾年到現在。</span><br />
<br />
<span style="color: #e06666; font-size: large;">如果你想了解更多有關於退休以及FIRE的細節,</span><br />
<span style="color: #e06666; font-size: large;">可以點下面的連結,購買新書來看</span><br />
<h3>
<span style="color: #e06666; font-size: large;">博客來網路書店連結:</span></h3>
<div>
<span style="color: blue; font-size: large;">《賺錢,更賺自由的FIRE理財族》</span></div>
<h3>
<div style="font-size: medium; font-weight: 400;">
<a href="https://lihi1.com/h08Tx">https://www.books.com.tw/products/0010855945</a><br />
<br />
<br /></div>
</h3>
<h3 style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: bold; line-height: normal; margin: 0px 0px 0.6em; padding: 0px; position: relative; vertical-align: baseline;">
<span style="border: 0px; color: #e06666; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: large;">作者</span></span></h3>
<h3>
<div style="font-weight: 400;">
<div style="background-color: white; border: 0px; color: #585858; font-family: arial, sans-serif; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">
</div>
<div style="background-color: white; border: 0px; color: #585858; font-family: arial, sans-serif; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">
<span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: large;">莊武龍醫師</span></span></div>
<div style="background-color: white; border: 0px; color: #585858; font-family: arial, sans-serif; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">
<span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: large;">專長主治糖尿病及甲狀腺疾病患者。</span></span></div>
<div style="background-color: white; border: 0px; color: #585858; font-family: arial, sans-serif; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">
<span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: large;">並提供健康諮詢、週邊神經以及關節軟組織的超音波評估與營養評估。</span></span></div>
<div style="background-color: white; border: 0px; color: #585858; font-family: arial, sans-serif; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">
<span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: large;">喜愛分享簡報技巧以及商業、管理、醫學等書籍的觀後心得。</span></span></div>
</div>
</h3>
莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-5041592538276429792020-05-23T23:11:00.000-07:002020-05-24T00:25:32.353-07:00新書讀後心得筆記:《侍酒師的表現力》<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-Gj8Zo6DuQw0/XsJAvmhQoAI/AAAAAAAAGtY/QvjRfo6mhDwKUw91yh44BpYlcv9BKZmgACNcBGAsYHQ/s1600/%25E6%2596%25B0%25E6%259B%25B8%25E6%258E%25A8%25E8%2596%25A6-%25E4%25BA%25BA%25E6%2596%2587-%25E4%25BE%258D%25E9%2585%2592%25E5%25B8%25AB%25E7%259A%2584%25E8%25A1%25A8%25E7%258F%25BE%25E5%258A%259B.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-Gj8Zo6DuQw0/XsJAvmhQoAI/AAAAAAAAGtY/QvjRfo6mhDwKUw91yh44BpYlcv9BKZmgACNcBGAsYHQ/s640/%25E6%2596%25B0%25E6%259B%25B8%25E6%258E%25A8%25E8%2596%25A6-%25E4%25BA%25BA%25E6%2596%2587-%25E4%25BE%258D%25E9%2585%2592%25E5%25B8%25AB%25E7%259A%2584%25E8%25A1%25A8%25E7%258F%25BE%25E5%258A%259B.png" width="640" /></a></div>
<h3>
<span style="color: #e06666; font-size: large;">為什麼我會看這本書?</span></h3>
<span style="font-size: large;">常常會有人問我關於食物的問題,我能回答關於科學的面向部份,</span><br />
<span style="font-size: large;">例如:食物的昇糖指數、營養素、營養組成。</span><br />
<span style="font-size: large;">但是…</span><br />
<span style="font-size: large;">要我形容食物的美味與口感時,</span><br />
<span style="font-size: large;">我發現我不太會形容,或者說是詞窮。</span><br />
<span style="font-size: large;">我一開始先是研究youtuber怎麼形容美食,</span><br />
<span style="font-size: large;">我發現很多youtuber形容美食的詞彙很貧乏,</span><br />
<span style="font-size: large;">大多就是聽到『份量很多,很好吃,C/P值很好…』。</span><br />
<span style="font-size: large;">關於美食要怎麼形容呢?</span><br />
<span style="font-size: large;">沒想到有人推薦看這本《侍酒師的表現力》的書,</span><br />
<span style="font-size: large;">雖然書名好像是在講酒,</span><br />
<span style="font-size: large;">但是書的內容卻是作者在教大家如何感受美食與形容美食。</span><br />
<span style="font-size: large;"><br /></span>
<br />
<h3>
</h3>
<a href="https://lihi1.com/9SgNT"><br /></a>
<a href="https://lihi1.com/9SgNT"><br /></a>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://lihi1.com/9SgNT"><img alt="https://lihi1.com/9SgNT" border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-uc0sugBaqfE/XsJNXB1uTsI/AAAAAAAAGtk/EvQVT6-jddQ_8KXk1jlIhdkUHwYKpGruwCNcBGAsYHQ/s640/%25E6%2596%25B0%25E6%259B%25B8%25E6%258E%25A8%25E8%2596%25A6-%25E7%25AD%2586%25E8%25A8%2598-%25E4%25BE%258D%25E9%2585%2592%25E5%25B8%25AB%25E7%259A%2584%25E8%25A1%25A8%25E7%258F%25BE%25E5%258A%259B.png" width="640" /></a></div>
<br />
<h3>
<span style="color: #e06666; font-size: large;">先入為主的偏見</span></h3>
<span style="font-size: large;">有時候我們形容美味的話,不是很精確。</span><br />
<span style="font-size: large;">例如會形容食物有金黃色、外軟內酥。</span><br />
<span style="font-size: large;">這是視覺或觸覺形容</span><br />
<span style="font-size: large;">但是金黃色不代表好吃啊?</span><br />
<span style="font-size: large;">如果是這樣,那每家臭豆腐都是好吃的美食了。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">也例如:形容酒容易入口。</span><br />
<span style="font-size: large;">酒容易入口,或許只能表容易讓大眾接受,</span><br />
<span style="font-size: large;">但不能代表一定是瓶好酒。</span><br />
<span style="font-size: large;">如果每款酒都這樣,長久下來,</span><br />
<span style="font-size: large;">市面上的酒會容易失去獨特的個性。。</span><br />
<span style="font-size: large;">另外,只要有下面詞語,也會被錯認為一定是美食。</span><br />
<span style="font-size: large;">『xx產地、有機、國產、進口、</span><br />
<span style="font-size: large;">手工、祖傳、份量、長時間烹煮』</span><br />
<span style="font-size: large;"><br /></span>
<br />
<h3>
<span style="color: #e06666; font-size: large;">會失禮的形容話語</span></h3>
<span style="font-size: large;">如果接受人家招待,這類的話要少說。</span><br />
<span style="font-size: large;">例如:</span><br />
<span style="font-size: large;">吃羊肉卻說沒有羊騷味</span><br />
<span style="font-size: large;">吃牛肉卻形容成飽滿的鮪魚肚</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">要依據聽者的情境,選擇合宜的表達</span><br />
<span style="font-size: large;">站在正面、肯定立場來表現。</span><br />
<span style="font-size: large;">範例:對擦香水的女生說:『今天的很香味很棒呢。』</span><br />
<span style="font-size: large;"><br /></span>
<br />
<h3>
<span style="color: #e06666; font-size: large;">如何改善對於美食的言語表現力?</span></h3>
<span style="font-size: large;">享用美食前,先捨棄那些偏見的詞語,</span><br />
<span style="font-size: large;">多用自已五官感受,尤其是嗅覺</span><br />
<span style="font-size: large;">並適度搭盲測練習,</span><br />
<span style="font-size: large;">並且將感覺形諸語言。</span><br />
<span style="font-size: large;">範例:</span><br />
<span style="font-size: large;">每天和小魚乾的海產氣味,與豚骨熬者出來的動物系香氣,取得絕妙的平衡。</span><br />
<span style="font-size: large;"> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">初入口是豚骨濃厚豐郁的口感,不過後味卻有著海鮮風味帶來的爽口餘韻。</span><br />
<br />
<br />
<h3>
<span style="color: #e06666; font-size: large;">博客來網路書店連結:</span></h3>
<div>
<span style="color: blue; font-size: large;">《侍酒師的表現力》</span></div>
<h3>
<div style="font-size: medium; font-weight: 400;">
<a href="https://lihi1.com/9SgNT">https://www.books.com.tw/products/0010793766</a></div>
</h3>
<span style="font-size: large;"><br /></span>
<br />
<div style="color: #585858; font-family: arial, sans-serif;">
<h3>
<span style="border: 0px; color: #e06666; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">作者</span></h3>
</div>
<div style="color: #585858; font-family: arial, sans-serif;">
<span style="border: 0px; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">莊武龍醫師</span></div>
<div style="color: #585858; font-family: arial, sans-serif;">
<span style="border: 0px; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">專長主治糖尿病及甲狀腺疾病患者。</span></div>
<div style="color: #585858; font-family: arial, sans-serif;">
<span style="border: 0px; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">並提供健康諮詢、週邊神經以及關節軟組織的超音波評估與營養評估。</span></div>
<div style="color: #585858; font-family: arial, sans-serif;">
<span style="font-size: large;">喜愛分享簡報技巧以及商業、管理、醫學等書籍的觀後心得。</span><br />
<span style="font-size: large;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">引用或是轉貼請注明出處,謝謝。</span></span></div>
<div style="color: #585858; font-family: arial, sans-serif;">
<span style="border: 0px; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">文章僅供醫療衛教分享以及促進健康之用,請勿做為商業用途及其它不法的宣傳之用</span></div>
<br />莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-61266614096352573732020-04-27T01:56:00.003-07:002020-05-24T00:25:43.133-07:00新書讀後心得筆記:《與家人的財務界線》<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-hiWfKQxm8eI/XoK-HMJG3XI/AAAAAAAAGoY/__41sBVBlOschpZ6le95uE6ef2qoN246ACNcBGAsYHQ/s1600/%25E6%2596%25B0%25E6%259B%25B8%25E6%258E%25A8%25E8%2596%25A6-%25E8%25B2%25A1%25E7%25B6%2593-%25E8%2588%2587%25E5%25AE%25B6%25E4%25BA%25BA%25E7%259A%2584%25E8%25B2%25A1%25E5%258B%2599%25E7%2595%258C%25E7%25B7%259A.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-hiWfKQxm8eI/XoK-HMJG3XI/AAAAAAAAGoY/__41sBVBlOschpZ6le95uE6ef2qoN246ACNcBGAsYHQ/s640/%25E6%2596%25B0%25E6%259B%25B8%25E6%258E%25A8%25E8%2596%25A6-%25E8%25B2%25A1%25E7%25B6%2593-%25E8%2588%2587%25E5%25AE%25B6%25E4%25BA%25BA%25E7%259A%2584%25E8%25B2%25A1%25E5%258B%2599%25E7%2595%258C%25E7%25B7%259A.png" width="640" /></a></div>
<br />
<h3>
<span style="color: #e06666; font-size: large;">關於這本書的心得筆記</span></h3>
<div>
<span style="font-size: large;">工作中的摩擦或許下班後就可以不去想,</span></div>
<div>
<span style="font-size: large;">人際關係的摩擦,或許封殺對方的電話、臉書,就不用看到對方了。</span></div>
<div>
<span style="font-size: large;">但是金錢上的摩擦,除了傷心,還會傷了退休老本。</span></div>
<div>
<span style="font-size: large;">如果你看過韓國電影「雞不可失」中的警察在失去了退休金,</span></div>
<div>
<span style="font-size: large;">失去到一無所有時的痛哭畫面時,</span></div>
<div>
<span style="font-size: large;">你就會體會對於一個體力漸差,頭髮變白的人,</span></div>
<div>
<span style="font-size: large;">保住退休金,是有多麼的重要。</span></div>
<br />
<a href="https://www.books.com.tw/exep/assp.php/tmaker/products/0010849952?utm_source=tmaker&utm_medium=ap-books&utm_content=recommend&utm_campaign=ap-202004"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-sHg2gSANcJQ/XqaVLsb0d0I/AAAAAAAAGrk/CX13Owb7-WY8mP15ShkqI81gaFLri_FOQCNcBGAsYHQ/s640/%25E6%2596%25B0%25E6%259B%25B8%25E6%258E%25A8%25E8%2596%25A6-%25E7%25AD%2586%25E8%25A8%2598-%25E8%2588%2587%25E5%25AE%25B6%25E4%25BA%25BA%25E7%259A%2584%25E8%25B2%25A1%25E5%258B%2599%25E7%2595%258C%25E7%25B7%259A.png" width="640" /></a><b><br /></b><br />
<span style="font-size: large;">結婚前的財務界線只需要訂定自己的,</span><br />
<span style="font-size: large;">但是結婚後的理財觀,是會影響夫妻的。</span><br />
<span style="font-size: large;">兩個相愛的人,為什麼講到錢就會傷感情呢?</span><br />
<span style="font-size: large;">作者把這些質性及情感性問題,整理出理性的參考解決答案。</span><br />
<span style="font-size: large;">配偶間的問題可以用金錢性格問題、金錢藍圖問題來分解討論。</span><br />
<span style="font-size: large;">而配偶以外,例如親友、朋友間的問題,</span><br />
<span style="font-size: large;">可能可以用金錢圈、金錢依賴、金錢義務問題來分解找出解答。</span><br />
<span style="font-size: large;"><br /></span>
<br />
<h3>
<span style="color: #e06666; font-size: large;">關於本書</span></h3>
<span style="font-size: large;">為什麼要讀這本書?</span><br />
<span style="font-size: large;">本書提供了理性的方法,解決帶有情感性的財務界線問題。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">什麼人適合讀這本書?</span><br />
<span style="font-size: large;">我個人推薦每個要邁入婚姻的人都應該拿來看,也思考一本自己跟另一半的價值觀是否不同。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">如何讀這本書?</span><br />
<span style="font-size: large;">作者寫的順序像是本工具書,依序念完,或是先看章節頁目的架構分次閱讀也可以。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">何時讀這本書?</span><br />
<span style="font-size: large;">有人說理財要趁早,有的父母小孩從小學開始就教導理財的觀念。</span><br />
<span style="font-size: large;">我覺得大概最晚就是當小孩有開始賺錢的時候,就可以學習了。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<br />
<h3>
<span style="color: #e06666; font-size: large;">延伸閱讀:</span></h3>
<span style="font-size: large;">《愛在金錢蔓延時》</span><br />
<span style="font-size: large;"><br /></span>
<br />
<h3>
<span style="color: #e06666; font-size: large;">延伸問題:</span></h3>
<span style="font-size: large;">小孩的財務界線是從父母學習而來的嗎? </span><br />
<span style="font-size: large;">父母該幫小孩訂這些財務界線嗎?</span><br />
<span style="font-size: large;"><br /></span>
<br />
<h3>
<span style="color: #e06666; font-size: large;">博客來網路書店連結:</span></h3>
<span style="font-size: large;"><a href="https://www.books.com.tw/exep/assp.php/tmaker/products/0010849952?utm_source=tmaker&utm_medium=ap-books&utm_content=recommend&utm_campaign=ap-202004">與家人的財務界線:富媽媽教你釐清家人的金援課題,妥善管理親情的金錢漏洞</a></span><br />
<span style="font-size: large;"><a href="https://lihi1.com/EamCi">https://lihi1.com/EamCi</a></span><br />
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<h3>
<span style="border: 0px; color: #e06666; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">作者</span></h3>
</div>
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<span style="border: 0px; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">莊武龍醫師</span></div>
<div style="color: #585858; font-family: arial, sans-serif;">
<span style="border: 0px; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">專長主治糖尿病及甲狀腺疾病患者。</span></div>
<div style="color: #585858; font-family: arial, sans-serif;">
<span style="border: 0px; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">並提供健康諮詢、週邊神經以及關節軟組織的超音波評估與營養評估。</span></div>
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<span style="font-size: large;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">喜愛分享簡報技巧以及商業、管理、醫學等書籍的觀後心得。</span></span><br />
<span style="font-size: large;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">引用或是轉貼請注明出處,謝謝。</span></span></div>
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<br />莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-72870792610501645662020-04-23T19:22:00.001-07:002020-04-23T19:22:03.905-07:00週邊神經病變的原因:血管瘤或內出血壓迫神經<h2 style="clear: both; text-align: center;">
<span style="color: blue; font-size: x-large;">週邊神經病變的原因:血管瘤或內出血壓迫神經</span></h2>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-XR2IKyFakrM/XqI1Cf3XVcI/AAAAAAAAGq8/0zQS4IrQRp0nPdzXRMO7M0twIFTGRZ0jgCNcBGAsYHQ/s1600/%25E9%2580%25B1%25E9%2582%258A%25E7%25A5%259E%25E7%25B6%2593%25E7%2597%2585%25E8%25AE%258A-%25E8%25A1%2580%25E7%25AE%25A1%25E7%2598%25A4%25E9%2580%25A0%25E6%2588%2590%25E7%25A5%259E%25E7%25B6%2593%25E5%25A3%2593%25E8%25BF%25AB.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-XR2IKyFakrM/XqI1Cf3XVcI/AAAAAAAAGq8/0zQS4IrQRp0nPdzXRMO7M0twIFTGRZ0jgCNcBGAsYHQ/s640/%25E9%2580%25B1%25E9%2582%258A%25E7%25A5%259E%25E7%25B6%2593%25E7%2597%2585%25E8%25AE%258A-%25E8%25A1%2580%25E7%25AE%25A1%25E7%2598%25A4%25E9%2580%25A0%25E6%2588%2590%25E7%25A5%259E%25E7%25B6%2593%25E5%25A3%2593%25E8%25BF%25AB.png" width="640" /></a></div>
<span style="font-size: large;">週邊神經病變的症狀有:手麻、腳麻,或是手腳無力。</span><br />
<span style="font-size: large;">嚴重一點,甚至還會有疼痛的感覺。</span><br />
<span style="font-size: large;">週邊神經病變常見的原因有</span><br />
<span style="font-size: large;">糖尿病週邊神經病變、感染、營養缺乏、藥物副作用。</span><br />
<span style="font-size: large;">另外其實還有一些比較特殊的原因:</span><br />
<span style="font-size: large;">例如外傷,出血、腫瘤或是血管瘤壓迫。</span><br />
<span style="font-size: large;">一般而言,軟組織內出血或是有腫瘤或是有血管瘤,</span><br />
<span style="font-size: large;">照X光是看不出來的。</span><br />
<span style="font-size: large;">也因此,通常患者都可能會拖上好一陣子,</span><br />
<span style="font-size: large;">遇到對的醫師對的檢查,</span><br />
<span style="font-size: large;">才發現原來有出血、腫瘤或是血管瘤壓迫週邊神經的問題。</span><br />
<span style="font-size: large;"><br /></span>
<h3>
<span style="font-size: large;"><span style="color: #cc0000;">關節軟組織超音波檢查可以協助診斷</span></span></h3>
<span style="font-size: large;">要診斷是否有出血、腫瘤或是血管瘤壓迫神經的問題,</span><br />
<span style="font-size: large;">最常用的檢查是關節軟組織超音波。</span><br />
<span style="font-size: large;">例如上圖所示,可以明確地看到在患者的腳部有一顆動脈瘤,</span><br />
<span style="font-size: large;">也因為動脈瘤腫大壓迫到神經,</span><br />
<span style="font-size: large;">使得患者會有腳麻、腳痛的症狀。</span><br />
<span style="font-size: large;">如果是因為動脈瘤腫大壓迫到神經,</span><br />
<span style="font-size: large;">吃藥治療週邊神經病變的症狀可能效果不會太好。</span><br />
<span style="font-size: large;">反過來說,</span><br />
<span style="font-size: large;">如果糖尿病患者連吃藥治療週邊神經病變的症狀,</span><br />
<span style="font-size: large;">症狀的改善還是不太理想,</span><br />
<span style="font-size: large;">或許要考慮是否有其它原因,</span><br />
<span style="font-size: large;">千萬別一味的認為只要一直控制血糖,</span><br />
<span style="font-size: large;">這些酸、麻、痛的症狀,以後就會慢慢好。</span><br />
<span style="font-size: large;"><br /></span>
<h3>
<span style="color: #cc0000; font-size: large;">沒有外傷的病史,會有出血的可能嗎?</span></h3>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-0T8YKJ6-0dE/XqJMzI9eEjI/AAAAAAAAGrI/lRNMmB4Q0BY_a8PtUvgnHzC3orh3S-5ygCNcBGAsYHQ/s1600/%25E9%2580%25B1%25E9%2582%258A%25E7%25A5%259E%25E7%25B6%2593%25E7%2597%2585%25E8%25AE%258A-%25E8%25BB%259F%25E7%25B5%2584%25E7%25B9%2594%25E5%2585%25A7%25E5%2587%25BA%25E8%25A1%2580%25E7%259A%2584%25E5%258E%259F%25E5%259B%25A0.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-0T8YKJ6-0dE/XqJMzI9eEjI/AAAAAAAAGrI/lRNMmB4Q0BY_a8PtUvgnHzC3orh3S-5ygCNcBGAsYHQ/s640/%25E9%2580%25B1%25E9%2582%258A%25E7%25A5%259E%25E7%25B6%2593%25E7%2597%2585%25E8%25AE%258A-%25E8%25BB%259F%25E7%25B5%2584%25E7%25B9%2594%25E5%2585%25A7%25E5%2587%25BA%25E8%25A1%2580%25E7%259A%2584%25E5%258E%259F%25E5%259B%25A0.png" width="640" /></a></div>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">關於這個問題,我蠻常被患者問到。</span><br />
<span style="font-size: large;">在臨床上,其實我蠻常遇到腿部或是手部腫大的患者。</span><br />
<span style="font-size: large;">常常都是在別的地方吃抗生素或是利尿劑,</span><br />
<span style="font-size: large;">一直都沒有改善,</span><br />
<span style="font-size: large;">之後才輾轉經由別人介紹,</span><br />
<span style="font-size: large;">來我這邊評估原因。</span><br />
<span style="font-size: large;">通常我做完關節軟組織超音波,</span><br />
<span style="font-size: large;">跟患者解釋腿部或是手部腫大是因為有內出血的時候,</span><br />
<span style="font-size: large;">患者都會一副不可置信的表情,</span><br />
<span style="font-size: large;">然後問我說『我沒有撞到,怎麼會內出血?』</span><br />
<span style="font-size: large;">通常,我的經驗是,</span><br />
<span style="font-size: large;">這類的患者常常有吃所謂『通血管』的藥物,</span><br />
<span style="font-size: large;">也就是所謂的抗凝血劑。</span><br />
<span style="font-size: large;">雖然抗凝血劑比較讓人熟知的症狀是腸胃道出血,</span><br />
<span style="font-size: large;">但是軟組織內出血的個案,其實也不少見。</span><br />
<span style="font-size: large;">一般我們都以為軟組織內出血,</span><br />
<span style="font-size: large;">出血的血塊會慢慢吸收,然後自然消腫。</span><br />
<span style="font-size: large;">但是…事實常常不是這樣,</span><br />
<span style="font-size: large;">臨床上我遇過蠻多患者,</span><br />
<span style="font-size: large;">即使等待一個月甚至三個月以上,</span><br />
<span style="font-size: large;">血塊都還不會吸收的。</span><br />
<span style="font-size: large;">而且血塊造成的壓迫腫脹進而造成的疼痛,</span><br />
<span style="font-size: large;">也因為血塊沒有吸收變小,也一直沒有改善。</span><br />
<span style="font-size: large;">其實要處理軟組織內出血的血塊並不難,</span><br />
<span style="font-size: large;">通常只要能夠用適當的針,</span><br />
<span style="font-size: large;">定位下針後抽吸,血塊就可以吸出來的,</span><br />
<span style="font-size: large;">吸出來後,患者的症狀也會馬上立即有改善。</span><br />
<span style="font-size: large;"><br /></span>
<span style="color: #e06666; font-size: large;">備註:</span><br />
<span style="font-size: large;">1.Neuropathy Induced by Hemorrhage</span><br />
<span style="font-size: large;">Arch Neurol. 1969;21(4):381-386. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">2.Peripheral nerve lesions associated with missile-induced pseudoaneurysms.</span><br />
<span style="font-size: large;">J Neurosurg. 2007 Oct;107(4):765-75.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">3.Median nerve compression caused by a venous aneurysm. Case report.</span><br />
<span style="font-size: large;">J Neurosurg. 2001 Apr;94(4):624-6.</span><br />
<span style="font-size: large;"><br /></span>
<div style="color: #585858; font-family: arial, sans-serif;">
<span style="border: 0px; color: #e06666; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">作者</span></div>
<div style="color: #585858; font-family: arial, sans-serif;">
<span style="border: 0px; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">莊武龍醫師</span></div>
<div style="color: #585858; font-family: arial, sans-serif;">
<span style="border: 0px; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">專長主治糖尿病及甲狀腺疾病患者。</span></div>
<div style="color: #585858; font-family: arial, sans-serif;">
<span style="border: 0px; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">並提供健康諮詢、週邊神經以及關節軟組織的超音波評估與營養評估。</span></div>
<div style="color: #585858; font-family: arial, sans-serif;">
<span style="font-size: large;"><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">引用或是轉貼請注明出處,謝謝。</span></span></div>
<div style="color: #585858; font-family: arial, sans-serif;">
<span style="border: 0px; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">文章僅供醫療衛教分享以及促進健康之用,請勿做為商業用途及其它不法的宣傳之用</span></div>
<br />
<br />莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-6372433799370104782020-04-01T19:29:00.002-07:002020-04-01T19:47:12.546-07:00I131-放射碘治療與懷孕的相關問題<h2 style="clear: both; text-align: center;">
<span style="color: blue; font-size: x-large;">I131-放射碘治療與懷孕的相關問題</span></h2>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-jYCD6jaU6E4/XoMLw13fsLI/AAAAAAAAGoo/6KvJs2omIF0YmxmmEqsBqF6n29peLLS-ACNcBGAsYHQ/s1600/%25E7%2594%25B2%25E7%258B%2580%25E8%2585%25BA-%25E6%2594%25BE%25E5%25B0%2584%25E7%25A2%2598%25E6%25B2%25BB%25E7%2599%2582%25E8%2588%2587%25E6%2587%25B7%25E5%25AD%2595.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-jYCD6jaU6E4/XoMLw13fsLI/AAAAAAAAGoo/6KvJs2omIF0YmxmmEqsBqF6n29peLLS-ACNcBGAsYHQ/s640/%25E7%2594%25B2%25E7%258B%2580%25E8%2585%25BA-%25E6%2594%25BE%25E5%25B0%2584%25E7%25A2%2598%25E6%25B2%25BB%25E7%2599%2582%25E8%2588%2587%25E6%2587%25B7%25E5%25AD%2595.png" width="640" /></a></div>
<span style="font-size: large;">甲狀腺癌,特別是甲狀腺乳突癌患者或是</span><br />
<span style="font-size: large;">甲狀腺亢進的患者,可能需要接受I131-放射碘治療。</span><br />
<span style="font-size: large;">但是因為甲狀腺疾病的患者,</span><br />
<span style="font-size: large;">有一大部份是發生在年輕的患者身上,</span><br />
<span style="font-size: large;">所以臨床上會遇到接受I131-放射碘治療後,</span><br />
<span style="font-size: large;">能否懷孕的問題。</span><br />
<span style="font-size: large;"><br /></span>
<br />
<h3>
<span style="color: #e06666; font-size: large;">I131-放射碘治療會影響懷孕嗎?</span></h3>
<span style="font-size: large;">接受I131-放射碘治療的女性患者,可能有20~27%的人可能會發生暫時性的無月經或月經過少,時間可能會維持4~10個月。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">有些小規模的研究指出接受I131-放射碘治療的女性患者,不會增加流產或是胎兒畸形的機會。</span><span style="font-size: large;">但是也有研究建議應該於接受I131-放射碘治療1年後才懷孕,否則流產率可能會增加</span><span style="font-size: large;">[註1]</span><span style="font-size: large;">。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">對於男性的生殖力而言,接受I131-放射碘治療會短暫地影響精子的數目,並增加血液促濾泡素(follicle stimulating hormone , FSH)濃度水平。如果接受了累積達500–800 mCi I131-放射碘治療的劑量,可能會永久使血液促濾泡素FSH濃度水平增加。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">美國甲狀腺學會的治療指引指出可藉由補充充足的水份、多排尿並且避免便祕來減少對生殖器官的輻射傷害</span><span style="font-size: large;">[註1]</span><span style="font-size: large;">。</span><br />
<br />
<h3>
<span style="color: #e06666; font-size: large;">I131-放射碘治療後,要多久才能懷孕?</span></h3>
<span style="font-size: large;">對於女性患者,目前的美國甲狀腺學會的治療指引建議在接受I131-放射碘治療後的6~12個月懷孕</span><span style="font-size: large;">[註1]</span><span style="font-size: large;">。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">目前台灣內分泌學會於2018出的『甲狀腺結節及分化型癌臨床手冊』,並無明確指出在接受I131-放射碘治療後,可於何時懷孕。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">對於男性患者,</span><br />
<span style="font-size: large;">根據美國甲狀腺學會的治療指引,有些專家建議男性在接受I131-放射碘治療三個月後,才能與伴侶嘗試懷孕,否則可能會有染色體異常的風險。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">目前美國甲狀腺學會的治療指引建議若是會接受累積超過400 mCi I131-放射碘治療劑量的患者,要考慮諮詢評估是否會有喪失生殖功能的風險。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">目前台灣內分泌學會於2018出的『甲狀腺結節及分化型癌臨床手冊』,並無明確提及關於男性生殖功能的問題與建議。</span><br />
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<span style="color: #ea9999; font-size: large;">懷孕中或哺乳中的女性可以接受I131-放射碘治療嗎?</span></h3>
<span style="font-size: large;">目前I131-放射碘治療不可以用在懷孕中或哺乳中的女性患者。胎兒的甲狀腺組織會累積放射碘,使得生出來的胎兒可能會有甲狀腺功能低下或是呆小症的可能,所以懷孕中的患者,不建議接受I131-放射碘治療。</span><br />
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<span style="font-size: large;">由於放射碘也會在哺乳的乳房組織集中,所以不建議哺乳中的女性患者接受I131-放射碘治療。</span><span style="font-size: large;">目前美國甲狀腺學會的治療指引建議,</span><span style="font-size: large;">需要接受</span><span style="font-size: large;">I131-放射碘治療的哺乳中患者,可依情形考慮在停止哺乳三個月後接受</span><span style="font-size: large;">I131-放射碘治療。</span><span style="font-size: large;">台灣內分泌學會於2018出的『甲狀腺結節及分化型癌臨床手冊』指出,若真的需要接受</span><span style="font-size: large;">I131-放射碘治療,</span><span style="font-size: large;">必須在治療前至少三個月停止哺乳</span><span style="font-size: large;">[註2]</span><span style="font-size: large;">。</span><br />
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<span style="color: #e06666; font-size: large;">註解:</span><br />
<span style="font-size: large;">1.</span><span style="font-size: large;">2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer</span><br />
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<span style="font-size: large;">2. 中華民國內分泌學會 2018 甲狀腺結節及分化型癌臨床手冊</span><br />
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<span style="border: 0px; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">主治糖尿病及甲狀腺疾病。</span></div>
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<span style="border: 0px; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">專長於週邊神經的超音波評估與營養評估。</span></div>
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<span style="border: 0px; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">文章僅供醫療衛教分享以及促進健康之用,請勿做為商業用途及其它不法的宣傳之用</span></div>
<br />莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-27799549392723266532020-04-01T01:08:00.003-07:002021-01-18T05:49:25.749-08:00世界各國甲狀腺癌的治療指引<div class="separator" style="clear: both; text-align: center;">
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<span style="background-color: #674ea7; color: white; font-size: x-large;">America-美國</span><br />
<span style="color: #e06666; font-size: large;"><br /></span><span style="color: #e06666; font-size: large;">美國甲狀腺醫學會-ATA-American Thyroid Association</span><br />
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<span style="font-size: 20px;">指引名稱:</span></div>
<span style="font-family: "heiti tc"; font-size: large;"><b>2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer</b></span><br />
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網址連結:</div>
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<span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;"><a href="https://www.liebertpub.com/doi/full/10.1089/thy.2015.0020">https://www.liebertpub.com/doi/full/10.1089/thy.2015.0020</a></span></span></div>
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<span style="font-size: 20px;">指引名稱:</span></div>
<span style="font-family: "heiti tc"; font-size: large;"><b>2015 Revised American Thyroid Association Guidelines for the Management of Medullary Thyroid Carcinoma prepared by the American Thyroid Association Guidelines Task Force on Medullary Thyroid Carcinoma</b></span><br />
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網址連結:</div>
<span face=""roboto" , "helvetica" , "arial" , sans-serif" style="text-align: start;"><span style="font-size: large;"><a href="https://online.liebertpub.com/doi/full/10.1089/thy.2014.0335">https://online.liebertpub.com/doi/full/10.1089/thy.2014.0335</a></span></span><br />
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<span style="font-size: 20px;">指引名稱:</span></div>
<span style="font-family: "heiti tc"; font-size: large;"><b>所有關於甲狀腺疾病的指引</b></span><br />
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網址連結:</div>
<span face=""roboto" , "helvetica" , "arial" , sans-serif" style="text-align: start;"><span style="font-size: large;"><a href="https://www.thyroid.org/professionals/ata-professional-guidelines/">https://www.thyroid.org/professionals/ata-professional-guidelines/</a></span></span></div>
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<span style="color: #e06666; font-size: large;"><br /></span><span style="color: #e06666; font-size: large;">美國臨床內分泌專家協會-AACE THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS</span><br />
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<span style="font-size: 20px;">指引名稱:</span></div>
<span style="font-family: "heiti tc"; font-size: large;"><b>AACE/ACE/AME Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules – 2016 Update - © 2016</b></span><br />
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網址連結:</div>
<span style="color: black; font-family: "heiti tc"; text-align: start;"><span style="font-size: large;"><a href="https://www.aace.com/disease-state-resources/thyroid/clinical-practice-guidelines/aaceaceame-medical-guidelines-clinical">https://www.aace.com/disease-state-resources/thyroid/clinical-practice-guidelines/aaceaceame-medical-guidelines-clinical</a></span></span><br />
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<span style="background-color: #674ea7; color: white; font-size: x-large;">Europe-歐洲</span><br />
<span style="color: #e06666; font-size: large;">歐洲甲狀腺學會-</span><span style="color: #e06666; font-size: large;">European Thyroid Association. </span><br />
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<span style="font-size: 20px;">指引名稱:</span></div>
<span face=""biaodian pro sans cns" , "helvetica neue" , "helvetica" , "arial" , "zhuyin heiti" , "han heiti" , sans-serif" style="color: #444444; font-size: large;">所有關於甲狀腺疾病的指引</span><br />
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網址連結:</div>
<span face=""roboto" , "helvetica" , "arial" , sans-serif" style="text-align: start;"><span style="font-size: large;"><a href="https://www.eurothyroid.com/guidelines/eta_guidelines.html">https://www.eurothyroid.com/guidelines/eta_guidelines.html</a></span></span><br />
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<span style="color: #444444; font-family: "heiti tc"; font-size: large;">2017<b> </b></span><span style="color: #444444; font-family: "heiti tc"; font-size: large;"><b>European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS</b></span><br />
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網址連結:</div>
<span face=""roboto" , "helvetica" , "arial" , sans-serif" style="text-align: start;"><span style="font-size: large;"><a href="https://www.karger.com/Article/FullText/478927">https://www.karger.com/Article/FullText/478927</a></span></span><br />
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<span style="font-family: "heiti tc"; font-size: large;"><b>2012 European Thyroid Association Guidelines for Metastatic Medullary Thyroid Cancer</b></span><br />
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網址連結:</div>
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<span face=""roboto" , "helvetica" , "arial" , sans-serif" style="text-align: start;"><span style="font-size: large;"><a href="https://www.karger.com/Article/FullText/336977">https://www.karger.com/Article/FullText/336977</a></span></span></div>
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<span style="font-family: "heiti tc"; font-size: large;"><b>2013 European Thyroid Association Guidelines for Cervical Ultrasound Scan and Ultrasound-Guided Techniques in the Postoperative Management of Patients with Thyroid Cancer</b></span><br />
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網址連結:</div>
<span face=""roboto" , "helvetica" , "arial" , sans-serif" style="text-align: start;"><span style="font-size: large;"><a href="https://www.karger.com/Article/FullText/354537">https://www.karger.com/Article/FullText/354537</a></span></span></div>
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<span style="background-color: #674ea7; color: white; font-size: x-large;">Japan-日本</span><br />
<span style="color: #e06666; font-size: large;">日本内分泌外科学会</span><br />
<span style="color: #e06666; font-size: large;">日本甲状腺外科学会</span><br />
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<span style="font-size: 20px;">指引名稱:</span></div>
<span style="font-family: "heiti tc"; font-size: large;"><b>甲状腺腫瘍診療ガイドライン2018</b></span><br />
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網址連結:</div>
<span face=""roboto" , "helvetica" , "arial" , sans-serif" style="text-align: start;"><span style="font-size: large;"><a href="https://minds.jcqhc.or.jp/n/med/4/med0114/G0001117">https://minds.jcqhc.or.jp/n/med/4/med0114/G0001117</a></span></span><br />
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<span style="background-color: #674ea7; color: white; font-size: x-large;">Taiwan-台灣</span><br />
<span style="color: #e06666; font-size: large;">中華民國內分泌學會</span><br />
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<span style="font-size: 20px;">指引名稱:</span></div>
<span style="font-family: "heiti tc"; font-size: large;"><b>2018 甲狀腺結節及分化型癌臨床手冊 (限會員)</b></span><br />
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網址連結:</div>
<span face=""roboto" , "helvetica" , "arial" , sans-serif" style="text-align: start;"><span style="font-size: large;"><a href="http://www.endo-dm.org.tw/endo/events/Book.asp">http://www.endo-dm.org.tw/endo/events/Book.asp</a></span></span><br />
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<br /><div><span style="background-color: #674ea7; color: white; font-size: x-large;">World -世界</span><br /><span style="color: #e06666; font-size: large;">亞洲腫瘤消融大會 Asian Conference on Tumor Ablation</span><br /><div class="note" style="background-color: #e6e6ff; box-sizing: inherit; margin-bottom: 25px; overflow: hidden; padding: 30px; text-align: justify;"><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif;"><span style="font-size: 20px;">指引名稱:</span></div><span style="font-family: "heiti tc"; font-size: large;"><b>2021 </b></span><span style="font-family: heiti tc; font-size: large;"><b>Radiofrequency ablation of benign thyroid nodules: recommendations from the Asian Conference on Tumor Ablation Task Force</b></span><br /><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif;"><span style="color: black; font-family: "heiti tc"; text-align: start;"><b><span style="font-size: large;"><br /></span></b></span></div></div><div style="margin: 0px;"><div style="color: #444444; font-family: "biaodian pro sans cns", "helvetica neue", helvetica, arial, "zhuyin heiti", "han heiti", sans-serif; font-size: 20px;">網址連結:</div><div><span face=""roboto" , "helvetica" , "arial" , sans-serif" style="color: #0000ee; font-family: biaodian pro sans cns, helvetica neue, helvetica, arial, zhuyin heiti, han heiti, sans-serif; font-size: large; text-align: start;"><u><a href="https://www.e-ultrasonography.org/journal/view.php?number=1142">https://www.e-ultrasonography.org/journal/view.php?number=1142</a></u></span></div></div></div></div>莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-33087421167541908762020-03-24T02:20:00.002-07:002020-03-24T02:20:30.794-07:00甲狀腺乳突癌手術後的超音波追蹤建議<h2>
<span style="color: blue; font-size: x-large;">甲狀腺乳突癌手術後的超音波追蹤建議</span></h2>
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<a href="https://1.bp.blogspot.com/-4XXRAI2Yxno/Xnm_x6T_vpI/AAAAAAAAGnY/FfAUO43hMjc5E3MicBCGcabOhE_EMvFkwCNcBGAsYHQ/s1600/%25E7%2594%25B2%25E7%258B%2580%25E8%2585%25BA-%25E7%25B5%2590%25E7%25AF%2580%25E6%2589%258B%25E8%25A1%2593%25E5%25BE%258C%25E8%25B6%2585%25E9%259F%25B3%25E6%25B3%25A2%25E8%25BF%25BD%25E8%25B9%25A4%25E6%2599%2582%25E9%2596%2593.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-4XXRAI2Yxno/Xnm_x6T_vpI/AAAAAAAAGnY/FfAUO43hMjc5E3MicBCGcabOhE_EMvFkwCNcBGAsYHQ/s640/%25E7%2594%25B2%25E7%258B%2580%25E8%2585%25BA-%25E7%25B5%2590%25E7%25AF%2580%25E6%2589%258B%25E8%25A1%2593%25E5%25BE%258C%25E8%25B6%2585%25E9%259F%25B3%25E6%25B3%25A2%25E8%25BF%25BD%25E8%25B9%25A4%25E6%2599%2582%25E9%2596%2593.png" width="640" /></a></div>
<span style="font-size: large;">有時候在門診,</span><br />
<span style="font-size: large;">幫患者檢查出甲狀腺乳突癌手術後復發的狀況後,</span><br />
<span style="font-size: large;">患者常常的反應是</span><br />
<span style="font-size: large;">『啊…怎麼之前的醫師,很久都沒有安排超音波追蹤?』</span><br />
<span style="font-size: large;">甚至有的患者還表示,</span><br />
<span style="font-size: large;">『從接受甲狀腺乳突癌手術後,一直都沒有接受過超音波檢查追蹤。』</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">甲狀腺乳突癌手術後,</span><br />
<span style="font-size: large;">到底需不需要追蹤呢?</span><br />
<span style="font-size: large;">什麼時候追蹤呢?</span><br />
<span style="font-size: large;">下面會依序說明。</span><br />
<span style="font-size: large;"><br /></span>
<span style="color: #e06666; font-size: large;">甲狀腺乳突癌手術後的超音波追蹤建議</span><br />
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<a href="https://1.bp.blogspot.com/-1_5dR7KbO3A/Xnm_6R8IscI/AAAAAAAAGnc/JjulXNc35XkamYVau9ZWo6_JUk7L2hI1gCNcBGAsYHQ/s1600/%25E7%2594%25B2%25E7%258B%2580%25E8%2585%25BA-%25E4%25B9%25B3%25E7%25AA%2581%25E7%2599%258C%25E6%2589%258B%25E8%25A1%2593%25E5%25BE%258C%25E8%25B6%2585%25E9%259F%25B3%25E6%25B3%25A2%25E8%25BF%25BD%25E8%25B9%25A4%25E6%2599%2582%25E9%2596%2593.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-1_5dR7KbO3A/Xnm_6R8IscI/AAAAAAAAGnc/JjulXNc35XkamYVau9ZWo6_JUk7L2hI1gCNcBGAsYHQ/s640/%25E7%2594%25B2%25E7%258B%2580%25E8%2585%25BA-%25E4%25B9%25B3%25E7%25AA%2581%25E7%2599%258C%25E6%2589%258B%25E8%25A1%2593%25E5%25BE%258C%25E8%25B6%2585%25E9%259F%25B3%25E6%25B3%25A2%25E8%25BF%25BD%25E8%25B9%25A4%25E6%2599%2582%25E9%2596%2593.png" width="640" /></a></div>
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<span style="font-size: large;">甲狀腺癌的種類繁多,最常見的是甲狀腺乳突癌。</span><br />
<span style="font-size: large;">依照美國甲狀腺學會的臨床指引建議,</span><br />
<span style="font-size: large;">甲狀腺乳突癌手術後,</span><br />
<span style="font-size: large;">在6~12個月內要做超音波追蹤評估。</span><br />
<span style="font-size: large;">之後視患者甲狀腺乳突癌的復發風險以及</span><br />
<span style="font-size: large;">抽血檢驗甲狀腺球蛋白(Thyroglobulin,</span><span style="font-size: large;">Tg</span><span style="font-size: large;">)</span><span style="font-size: large;">的數值做決定。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">也就是說,手術後,是需要超音波追蹤的。</span><br />
<span style="font-size: large;">最晚手術後的一年內,要先追蹤一次。</span><br />
<span style="font-size: large;">之後再依照患者的症狀、癌症風癌、超音波追蹤結果、甲狀腺球蛋白Tg的數值做考量,</span><br />
<span style="font-size: large;">為患者訂定需要追蹤的時間。</span><br />
<span style="font-size: large;"><br /></span>
<span style="color: #e06666; font-size: large;">能不能只靠抽血檢驗追蹤是否有復發的現象?</span><br />
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<a href="https://1.bp.blogspot.com/-gSuiRg-IYM4/XnnADBibo4I/AAAAAAAAGng/jxXIxRIurGQM19Xj9NpvnopaKGLQI1ddwCNcBGAsYHQ/s1600/%25E7%2594%25B2%25E7%258B%2580%25E8%2585%25BA-%25E4%25B9%25B3%25E7%25AA%2581%25E7%2599%258C%25E6%2589%258B%25E8%25A1%2593%25E5%25BE%258C%25E7%2582%25BA%25E4%25BD%2595%25E8%25A6%2581%25E7%2594%25A8%25E8%25B6%2585%25E9%259F%25B3%25E6%25B3%25A2%25E8%25BF%25BD%25E8%25B9%25A4.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-gSuiRg-IYM4/XnnADBibo4I/AAAAAAAAGng/jxXIxRIurGQM19Xj9NpvnopaKGLQI1ddwCNcBGAsYHQ/s640/%25E7%2594%25B2%25E7%258B%2580%25E8%2585%25BA-%25E4%25B9%25B3%25E7%25AA%2581%25E7%2599%258C%25E6%2589%258B%25E8%25A1%2593%25E5%25BE%258C%25E7%2582%25BA%25E4%25BD%2595%25E8%25A6%2581%25E7%2594%25A8%25E8%25B6%2585%25E9%259F%25B3%25E6%25B3%25A2%25E8%25BF%25BD%25E8%25B9%25A4.png" width="640" /></a></div>
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<span style="font-size: large;">一般而言,甲狀腺乳突癌手術後,</span><br />
<span style="font-size: large;">會抽血監控甲狀腺球蛋白Tg的數值。</span><br />
<span style="font-size: large;">如果甲狀腺球蛋白Tg有上昇的趨勢或者是數值很大,</span><br />
<span style="font-size: large;">就要強烈懷疑是否有復發的跡象。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">但是在有些情況下,</span><br />
<span style="font-size: large;">即使患者有甲狀腺乳突癌復發的情形,</span><br />
<span style="font-size: large;">可能甲狀腺球蛋白Tg還是驗不出來,</span><br />
<span style="font-size: large;">呈現陰性或是很小的數值。</span><br />
<span style="font-size: large;">例如像是患者本身有甲狀腺球蛋白抗體,</span><br />
<span style="font-size: large;">或者復發的甲狀腺癌體積很小,</span><br />
<span style="font-size: large;">都可能會使得甲狀腺球蛋白Tg驗不出來或者是數值很少,導致誤判。</span><br />
<span style="font-size: large;">再者,有些即使是甲狀腺球蛋白Tg陰性的患者,</span><br />
<span style="font-size: large;">也可能可以經由超音波診斷出淋巴結轉移的跡象,</span><br />
<span style="font-size: large;">所以使用超音波檢查追蹤患者是否癌症復發的跡象,</span><br />
<span style="font-size: large;">仍然是一個很棒的檢查方式。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">影像檢查除了超音波外,還有核醫掃描以及PET CT scan等選項。</span><br />
<span style="font-size: large;">需要安排哪種影像檢查,要依患者的情況而定。</span><br />
<span style="font-size: large;">最重要的是千萬別只看抽血數據就排除癌症復發的可能,</span><br />
<span style="font-size: large;">臨床症狀、醫學影像檢查都是要參考進去的。</span><br />
<span style="font-size: large;">之前曾經有個患者一直背痛復健都不會好,</span><br />
<span style="font-size: large;">跑來找我諮詢,</span><br />
<span style="font-size: large;">結果安排MRI檢查後,竟然發現是甲狀腺癌復發轉移到背部的脊椎骨。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">有些患者因為看完甲狀腺門診,</span><br />
<span style="font-size: large;">還要安排時間來做超音波檢查,</span><br />
<span style="font-size: large;">需要多請一次的假,</span><br />
<span style="font-size: large;">會問醫師說是不是能夠只做抽血追蹤就好?</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">目前我的甲狀腺門診都可以當天安排做超音波檢查,</span><br />
<span style="font-size: large;">患者就不需要再請假另外安排時間來做超音波追蹤。</span><br />
<span style="font-size: large;">不過不是每家醫療院所都有提供這樣的檢查流程,</span><br />
<span style="font-size: large;">如果醫師有安排超音波追蹤,建議還是要去檢查。</span><br />
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<div style="color: #585858; font-family: arial, sans-serif; font-size: 14px;">
<span style="border: 0px; color: #e06666; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">作者</span></div>
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<span style="border: 0px; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">莊武龍醫師</span></div>
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<span style="border: 0px; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">主治糖尿病及甲狀腺疾病。</span></div>
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<span style="border: 0px; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">專長於週邊神經的超音波評估與營養評估。</span></div>
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<span style="border: 0px; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">引用或是轉貼請注明出處,謝謝。</span></div>
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<span style="border: 0px; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">文章僅供醫療衛教分享以及促進健康之用,請勿做為商業用途及其它不法的宣傳之用</span></div>
莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-83615411678336057672020-03-17T02:25:00.001-07:002020-03-17T02:25:04.655-07:00會引起腕隧道症候群的內分泌疾病<h2 style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: 25.2px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: normal; margin: 0px 0px 0.6em; padding: 0px; position: relative; vertical-align: baseline;">
<span style="border: 0px; color: #0b5394; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">會引起腕隧道症候群的內分泌疾病</span></h2>
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<a href="https://1.bp.blogspot.com/--oNlPHUGQp4/Xm8_08xRNMI/AAAAAAAAGmQ/4Bs850S8q6QseqBujdzRmmUQ3f64b248ACNcBGAsYHQ/s1600/%25E9%2580%25B1%25E9%2582%258A%25E7%25A5%259E%25E7%25B6%2593%25E7%2597%2585%25E8%25AE%258A-%25E5%2585%25A7%25E5%2588%2586%25E6%25B3%258C%25E7%2596%25BE%25E7%2597%2585.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/--oNlPHUGQp4/Xm8_08xRNMI/AAAAAAAAGmQ/4Bs850S8q6QseqBujdzRmmUQ3f64b248ACNcBGAsYHQ/s640/%25E9%2580%25B1%25E9%2582%258A%25E7%25A5%259E%25E7%25B6%2593%25E7%2597%2585%25E8%25AE%258A-%25E5%2585%25A7%25E5%2588%2586%25E6%25B3%258C%25E7%2596%25BE%25E7%2597%2585.png" width="640" /></a></div>
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<span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">腕隧道症候群主要是手部的正中神經因為壓迫或受傷,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">產生了發炎、腫大的現象,進而有手麻、手痛、無力等症狀。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">嚴重的人,可能還會影響到睡眠以及生活品質。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px;"></span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">如果你的腕隧道症候群的症狀,一直很難好,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">或許可能要考慮</span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">是否</span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">有內分泌疾病的問題。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">曾經有患者接受手術治療腕隧道症候群後,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">症狀</span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">都沒有改善後,</span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">經由多次的轉介,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">才到內分泌科門診,診斷出內分泌疾病。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><br />
<h3 style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: 22.4px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: normal; margin: 0px 0px 0.6em; padding: 0px; position: relative; vertical-align: baseline;">
<span style="border: 0px; color: #e06666; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">無法靠照X光評估腕隧道症候群以及正中神經的問題所在</span></h3>
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<a href="https://1.bp.blogspot.com/-8Tqd6jX0wEE/Xm8_6QnXX1I/AAAAAAAAGmU/-1dUudgl7mQvskBY5hpRw9xbBkLlyYuQwCNcBGAsYHQ/s1600/%25E9%2580%25B1%25E9%2582%258A%25E7%25A5%259E%25E7%25B6%2593%25E7%2597%2585%25E8%25AE%258A-%25E8%2582%25A2%25E7%25AB%25AF%25E8%2582%25A5%25E5%25A4%25A7%25E7%2597%2587.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-8Tqd6jX0wEE/Xm8_6QnXX1I/AAAAAAAAGmU/-1dUudgl7mQvskBY5hpRw9xbBkLlyYuQwCNcBGAsYHQ/s640/%25E9%2580%25B1%25E9%2582%258A%25E7%25A5%259E%25E7%25B6%2593%25E7%2597%2585%25E8%25AE%258A-%25E8%2582%25A2%25E7%25AB%25AF%25E8%2582%25A5%25E5%25A4%25A7%25E7%2597%2587.png" width="640" /></a></div>
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<span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">很多人會來門診,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">問醫師說:『醫師,我的手會痛,會麻,可以照一下X光看一下嗎?』</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">實際上,X光只能看出骨頭關節的問題,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">要評估軟組織或是神經壓迫的問題,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">通常會還需要超音波做檢查評估。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px;"></span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">例如像患者肢端肥大</span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">症候群的患者,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">用超音波觀察手部的正中神經</span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">影像</span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">後會發現,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">神經有腫大的情形。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">而像這樣週邊神經的病變,X光是無法看出來的。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">所以要鑑別腕隧道症候群的原因,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">可能</span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">最好要安排超音波的影像檢查。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">有時候會發現手部的腫瘤壓迫神經,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">造成腕隧道症候群的症狀。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">開刀把腫瘤拿掉,症狀就好了。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px;"></span><br />
<h3 style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: 22.4px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: normal; margin: 0px 0px 0.6em; padding: 0px; position: relative; vertical-align: baseline;">
<span style="border: 0px; color: #e06666; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">會引起腕隧道症候群的內分泌疾病有哪些?</span></h3>
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<a href="https://1.bp.blogspot.com/-Wxi9kIeX6WM/Xm9A4jUhBTI/AAAAAAAAGms/oijQkeYEMJkLj-aH4Qu5okKQ1yiA1fL3wCNcBGAsYHQ/s1600/%25E9%2580%25B1%25E9%2582%258A%25E7%25A5%259E%25E7%25B6%2593%25E7%2597%2585%25E8%25AE%258A-%25E7%2597%2585%25E8%25AE%258A%25E5%258E%259F%25E5%259B%25A0.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-Wxi9kIeX6WM/Xm9A4jUhBTI/AAAAAAAAGms/oijQkeYEMJkLj-aH4Qu5okKQ1yiA1fL3wCNcBGAsYHQ/s640/%25E9%2580%25B1%25E9%2582%258A%25E7%25A5%259E%25E7%25B6%2593%25E7%2597%2585%25E8%25AE%258A-%25E7%2597%2585%25E8%25AE%258A%25E5%258E%259F%25E5%259B%25A0.png" width="640" /></a></div>
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<span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">會引起腕隧道症候群的常見的原因有姿勢不良、使用3C產品時或工作時手部使用過度。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">但是有時候,患者並不是這些原因造成腕隧道症候群。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">所以有的患者,即使認真做復健、甚至開刀治療了,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">可能症狀還是沒有什麼改善。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px;"></span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">還有什麼原因會造成腕隧道症候群呢?</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">在內分泌科的門診裏,主要有三種</span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">內分泌</span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">疾病</span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">患者</span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">很容易有腕隧道症候群。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">主要的三種患者為</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">肢端肥大症、甲狀腺疾病以及糖尿病的患者。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">這三種疾病造成腕隧道症候群的機制不儘相同(註1)</span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">不過可以慶幸的是,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">一般而言,只需要抽血檢查就可以篩檢是否有肢端肥大症、甲狀腺疾病或者糖尿病。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">如果你是腕隧道症候群的患者,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">你希望在手術前就先評估是否有肢端肥大症、甲狀腺疾病以及糖尿病?</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">還是等手術治療不理想後,才評估呢?</span><br />
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<h3 style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: 22.4px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: normal; margin: 0px 0px 0.6em; padding: 0px; position: relative; vertical-align: baseline;">
<span style="border: 0px; color: #e06666; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">結論及建議:</span></h3>
<span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">有腕隧道症候群症狀的人,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">如果症狀在治療以及復健過後,</span><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">還是很難好,</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">或許應該考慮一下是否篩檢是否會有腕隧道症候群症狀的內分泌疾病。</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #e06666; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">註解:</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-family: inherit; font-size: small; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">1.</span>The Pathology of Median Neuropathy in Acromegaly</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Ann Intern Med. 2000;133(3):197-201.</span><br style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px; margin: 0px; padding: 0px;" /><span style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: medium; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="background-color: white; color: #585858; font-family: Arial, sans-serif; font-size: 14px;"></span><br />
<div style="background-color: white; border: 0px; color: #585858; font-family: Arial, sans-serif; font-size: 14px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">
<span style="border: 0px; color: #e06666; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">作者</span><br style="margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">莊武龍醫師</span><br style="margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">主治糖尿病及甲狀腺疾病。</span><br style="margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">專長於週邊神經的超音波評估與營養評估。</span><br style="margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><br style="margin: 0px; padding: 0px;" /></span><span style="border: 0px; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">引用或是轉貼請注明出處,謝謝。</span><br style="margin: 0px; padding: 0px;" /><span style="border: 0px; font-family: inherit; font-size: medium; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">文章僅供醫療衛教分享以及促進健康之用,請勿做為商業用途及其它不法的宣傳之用</span></div>
<br />莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-2549570831777319932020-03-12T20:56:00.000-07:002020-03-12T21:01:36.177-07:00甲狀腺手術後,手抽筋、腳抽筋怎麼辦?<span style="color: blue; font-size: x-large;">甲狀腺手術後,手抽筋、腳抽筋怎麼辦?</span><br />
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<a href="https://1.bp.blogspot.com/-V6ks341XpTw/XmmlmLWYi5I/AAAAAAAAGlY/yPF7YSrPdQ4I4xBLHmRHgUvg7r9igZNAACNcBGAsYHQ/s1600/%25E7%2594%25B2%25E7%258B%2580%25E8%2585%25BA-%25E6%2589%258B%25E8%25A1%2593%25E5%25BE%258C%25E6%258A%25BD%25E7%25AD%258B%25E7%259A%2584%25E5%258E%259F%25E5%259B%25A0.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-V6ks341XpTw/XmmlmLWYi5I/AAAAAAAAGlY/yPF7YSrPdQ4I4xBLHmRHgUvg7r9igZNAACNcBGAsYHQ/s640/%25E7%2594%25B2%25E7%258B%2580%25E8%2585%25BA-%25E6%2589%258B%25E8%25A1%2593%25E5%25BE%258C%25E6%258A%25BD%25E7%25AD%258B%25E7%259A%2584%25E5%258E%259F%25E5%259B%25A0.png" width="640" /></a></div>
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<span style="font-size: large;">常常會遇到患者接受甲狀腺手術後,</span><br />
<span style="font-size: large;">產生手抽筋、腳抽筋或甚至是口腔周圍有麻木的現象出來。</span><br />
<span style="font-size: large;">通常一般有抽筋現象的患者,</span><br />
<span style="font-size: large;">常見的原因是因為鉀離子、鈣離子不足造成的因素居多,</span><br />
<span style="font-size: large;">通常補充電解質後就會改善。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">不過甲狀腺手術後,</span><br />
<span style="font-size: large;">才有這些手抽筋、腳抽筋或甚至是口腔周圍有麻木現象的患者,</span><br />
<span style="font-size: large;">通常都是因為血液中的鈣離子不足造成的。</span><br />
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<span style="color: #e06666; font-size: large;">甲狀腺手術後低血鈣的症狀</span><br />
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<a href="https://1.bp.blogspot.com/-rJUQkDDqEBg/Xmr5W3jlxEI/AAAAAAAAGl8/l53gGm6NO3EybJtINtBkyqG_ieQQm6NdgCNcBGAsYHQ/s1600/%25E7%2594%25B2%25E7%258B%2580%25E8%2585%25BA-%25E6%2589%258B%25E8%25A1%2593%25E5%25BE%258C%25E4%25BD%258E%25E8%25A1%2580%25E9%2588%25A3%25E7%2597%2587%25E7%258B%25802.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-rJUQkDDqEBg/Xmr5W3jlxEI/AAAAAAAAGl8/l53gGm6NO3EybJtINtBkyqG_ieQQm6NdgCNcBGAsYHQ/s640/%25E7%2594%25B2%25E7%258B%2580%25E8%2585%25BA-%25E6%2589%258B%25E8%25A1%2593%25E5%25BE%258C%25E4%25BD%258E%25E8%25A1%2580%25E9%2588%25A3%25E7%2597%2587%25E7%258B%25802.png" width="640" /></a></div>
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<span style="font-size: large;">有科學研究統計,</span><br />
<span style="font-size: large;">甲狀腺手術後若是有低血鈣的情形(註1),</span><br />
<span style="font-size: large;">患者可能會有柯沃氏徵、肢端感覺異常、口腔周圍麻木、手腳肌肉筋攣、特羅索氏徵、以及抽筋等症狀。</span><br />
<span style="font-size: large;">而其中柯沃氏徵、肢端感覺異常、口腔周圍麻木是最常見的幾個症狀。</span><br />
<span style="font-size: large;">低血鈣除了會有這些症狀外,嚴重的人,甚至會有心律不整,需要至急診就醫的情形。</span><br />
<span style="font-size: large;">所以一定要小心跟注意。</span><br />
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<span style="color: #e06666; font-size: large;">什麼是柯沃氏徵Chvostek's sign?</span><br />
<span style="font-size: large;">平常時,我們如果用手指拍打病人的臉旁,造近耳朵前面的位置,也就是顏面神經的地方,</span><br />
<span style="font-size: large;">通常不會造成同側臉部的肌肉的明顯收縮。</span><br />
<span style="font-size: large;">但是低血鈣的時候,</span><br />
<span style="font-size: large;">如果用手指拍打病人的臉旁,造近耳朵前面的位置,也就是顏面神經的地方,</span><br />
<span style="font-size: large;">會造成同側臉部的肌肉明顯的收縮。而這一現象,就稱為柯沃氏徵Chvostek's sign。</span><br />
<span style="font-size: large;">實際的操作方式可以看下方的Youtube影片。</span><br />
<span style="font-size: large;">由於這檢查蠻簡單容易的。</span><br />
<span style="font-size: large;">懷疑低血鈣的患者,也可以自我檢查看看。</span><br />
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<iframe allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/kvmwsTU0InQ" width="560"></iframe>
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<span style="font-size: large;">NEJMvideo的影片</span></div>
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<span style="font-size: large;">Chvostek's Sign and Trousseau's Sign due to Postoperative Acquired Hypoparathyroidism</span></div>
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<span style="color: #e06666; font-size: large;">什麼是特羅索氏徵Trousseau's Sign?</span><br />
<span style="font-size: large;">當我們用量血壓的壓脈帶包住患者的手臂,當壓脈帶充氣,使壓力一直上升的時候,</span><br />
<span style="font-size: large;">會出現手腕痙攣的現象。</span><br />
<span style="font-size: large;">這現象稱作特羅索氏徵Trousseau's Sign。</span><br />
<span style="font-size: large;">實際的操作方式可以看下方的Youtube影片。</span><br />
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<iframe allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/kvmwsTU0InQ?controls=0&start=8" width="560"></iframe><br />
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<span style="color: #e06666; font-size: large;">甲狀腺手術後為什麼會低血鈣?該怎麼處理?</span></div>
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<span style="color: #e06666; font-size: large;">會一輩子有這問題嗎?</span></div>
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<span style="font-size: large;">副甲狀腺緊鄰在甲狀腺旁邊,有的人在接受甲狀腺手術後,</span></div>
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<span style="font-size: large;">會因為副甲狀腺短暫性機能不足,</span></div>
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<span style="font-size: large;">會產生低血鈣的現象。</span></div>
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<span style="font-size: large;">一般只要適度的補充鈣片,低血鈣的情形就會改善。</span></div>
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<span style="font-size: large;">而且可能手術後一陣子,</span></div>
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<span style="font-size: large;">低血鈣的情形會逐漸改善,</span></div>
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<span style="font-size: large;">鈣片就可以不用額外補充了。</span></div>
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<span style="font-size: large;"><br /></span></div>
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<span style="font-size: large;">但是有些人在甲狀腺手術後,</span></div>
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<span style="font-size: large;">副甲狀腺機能完全沒有恢復,</span></div>
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<span style="font-size: large;">只要不補充鈣片,就會產生低血鈣的現象。</span></div>
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<span style="font-size: large;">這時候,可能就需要一輩子補充鈣片了。</span></div>
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<span style="font-size: large;"><br /></span></div>
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<span style="color: #e06666; font-size: large;">為什麼有的人補充鈣片還是會有抽筋或是低血鈣的症狀呢?</span></div>
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<span style="font-size: large;">人體鈣離子的平衡與吸收,除了與副甲狀腺有關之外,</span></div>
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<span style="font-size: large;">也跟維生素D有關。</span></div>
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<span style="font-size: large;">每種鈣片的吸收程度不同,</span></div>
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<span style="font-size: large;">同樣是1000 mg,有的鈣片,人體吸收是30%,</span></div>
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<span style="font-size: large;">有的可能是60%。</span></div>
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<span style="font-size: large;">而且即使是相同的鈣片,不同的人,會有略為不同的吸收率。</span></div>
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<span style="font-size: large;">要檢視鈣離子夠不夠,會抽血檢驗人體的鈣離子。</span></div>
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<span style="font-size: large;">並且依據血液中鈣離子的濃度調整每天需要補充鈣離子的劑量。</span></div>
<div class="separator" style="clear: both;">
<span style="font-size: large;">所以每個接受甲狀腺手術後產生低血鈣的患者,</span></div>
<div class="separator" style="clear: both;">
<span style="font-size: large;">每天所服用的鈣片劑量會不一樣。</span></div>
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<span style="font-size: large;"><br /></span></div>
<div class="separator" style="clear: both;">
<span style="font-size: large;">如果血液中的鈣離子濃度正常,</span></div>
<div class="separator" style="clear: both;">
<span style="font-size: large;">但是還是有類似低血鈣的症狀,</span></div>
<div class="separator" style="clear: both;">
<span style="font-size: large;">可能必需要跟醫師再討論一下是否有其他的可能原因。</span></div>
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<span style="color: #e06666; font-size: large;">註解:</span><br />
<span style="font-size: large;">1.</span><span style="font-size: large;">Tongol, M. C., & Mirasol, R. (2016). Incidence and Risk Factors for Post-thyroidectomy Hypocalcemia. Journal of the ASEAN Federation of Endocrine Societies, 31(1), 30. </span><br />
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<div>
<span style="color: #e06666; font-size: large;">作者</span><br />
<span style="font-size: large;">莊武龍醫師</span><br />
<span style="font-size: large;">主治糖尿病及甲狀腺疾病。</span><br />
<span style="font-size: large;">專長於週邊神經的超音波評估與營養評估。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;">引用或是轉貼請注明出處,謝謝。</span><br />
<span style="font-size: large;">文章僅供醫療衛教分享以及促進健康之用,請勿做為商業用途及其它不法的宣傳之用</span></div>
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莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.comtag:blogger.com,1999:blog-5551859362905699592.post-41724709338245061662020-03-05T19:58:00.000-08:002020-03-05T19:59:58.046-08:00膝蓋痛不會好?要注意是不是痛風!<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-jcqQSA-oU_o/XmDUtaKpmEI/AAAAAAAAGkY/3jgHpCiXedEgeOO_w7E04FK6tbao9pHJgCNcBGAsYHQ/s1600/%25E7%2597%259B%25E9%25A2%25A8-%25E8%2586%259D%25E9%2597%259C%25E7%25AF%2580.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-jcqQSA-oU_o/XmDUtaKpmEI/AAAAAAAAGkY/3jgHpCiXedEgeOO_w7E04FK6tbao9pHJgCNcBGAsYHQ/s640/%25E7%2597%259B%25E9%25A2%25A8-%25E8%2586%259D%25E9%2597%259C%25E7%25AF%2580.png" width="640" /></a></div>
<span style="color: #cc0000; font-size: large;">疼痛為什麼不會好?</span><br />
<span style="font-size: large;">門診常常會遇到,</span><br />
<span style="font-size: large;">一直在吃xx力藥物或是注射玻尿酸治療退化性關節炎的患者。</span><br />
<span style="font-size: large;">但是其有一些人,疼痛就是沒有改善。</span><br />
<span style="font-size: large;">還是需要一直吃止痛藥。</span><br />
<span style="font-size: large;">吃止痛藥真的要注意,尤其實腎臟功能不好的患者,</span><br />
<span style="font-size: large;">臨床上,有很多人吃止痛藥,造成腎功能下降,</span><br />
<span style="font-size: large;">甚至嚴重到要洗腎的案例。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">如果關節疼痛不會好,</span><br />
<span style="font-size: large;">有時候也要考慮一下,</span><br />
<span style="font-size: large;">是否治療的方向要調整一下。</span><br />
<span style="font-size: large;">有退化性關節炎的患者,</span><br />
<span style="font-size: large;">其實也可能併存痛風性關節炎,</span><br />
<span style="font-size: large;">有時候選用治療痛風的藥物,</span><br />
<span style="font-size: large;">關節疼痛就改善了。</span><br />
<span style="font-size: large;">或者有時候根本就不是</span><span style="font-size: large;">退化性關節炎,</span><br />
<span style="font-size: large;">就是單純的是</span><span style="font-size: large;">痛風性關節炎造成疼痛。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">痛風性關節炎的患者,也常有高尿酸血症的情形。</span><br />
<span style="font-size: large;">如果沒有一併治療</span><span style="font-size: large;">高尿酸血症的情形,</span><br />
<span style="font-size: large;">關節也可能常疼痛發作。</span><br />
<span style="font-size: large;">有很多人甚至因為關節太痛了,</span><br />
<span style="font-size: large;">甚至沒有吃止痛藥就沒有辦法上班。</span><br />
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<h3>
<span style="color: #e06666; font-size: large;">如何判斷是不是痛風造成的代謝性關節炎?</span></h3>
<span style="font-size: large;">臨床上關節疼痛會照X光,</span><br />
<span style="font-size: large;">X光可以協助我們判斷是否有退化性關節炎。</span><br />
<span style="font-size: large;">但是如果是痛風造成的代謝性關節炎,</span><br />
<span style="font-size: large;">除非已經很嚴重造成關節變形了,</span><br />
<span style="font-size: large;">X光的影像有時候,根本無法讓醫師得知是否是痛風造成的代謝性關節炎。</span><br />
<span style="font-size: large;">要更確定痛風造成的代謝性關節炎,</span><br />
<span style="font-size: large;">除了問病史、發作過程、疼痛模式之外,</span><br />
<span style="font-size: large;">超音波檢查也是可以考慮的影像工具之一。</span><br />
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<h3>
<span style="color: #e06666; font-size: large;">痛風在膝關節的超音波影像</span></h3>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-JjPoIrkU2oc/XmDU0-2qyBI/AAAAAAAAGkc/0z2c_ReUqY8MMMsLOBePhdl7yBjrfCjKQCNcBGAsYHQ/s1600/%25E7%2597%259B%25E9%25A2%25A8-%25E7%2597%259B%25E9%25A2%25A8%25E5%259C%25A8%25E8%2586%259D%25E9%2597%259C%25E7%25AF%2580%25E7%259A%2584%25E8%25B6%2585%25E9%259F%25B3%25E6%25B3%25A2%25E5%25BD%25B1%25E5%2583%258F.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="334" src="https://1.bp.blogspot.com/-JjPoIrkU2oc/XmDU0-2qyBI/AAAAAAAAGkc/0z2c_ReUqY8MMMsLOBePhdl7yBjrfCjKQCNcBGAsYHQ/s640/%25E7%2597%259B%25E9%25A2%25A8-%25E7%2597%259B%25E9%25A2%25A8%25E5%259C%25A8%25E8%2586%259D%25E9%2597%259C%25E7%25AF%2580%25E7%259A%2584%25E8%25B6%2585%25E9%259F%25B3%25E6%25B3%25A2%25E5%25BD%25B1%25E5%2583%258F.png" width="640" /></a></div>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">尿酸即使堆積在關節形成痛風石,</span><br />
<span style="font-size: large;">由於X光會穿透痛風石,</span><br />
<span style="font-size: large;">所以X光影像上,常常是看不出關節有痛風石的!</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">但是超音波的音波會被痛風石折射,</span><br />
<span style="font-size: large;">所以可以在超音波的影像上看到痛風石的產生。</span><br />
<span style="font-size: large;">但是有的人,雖然有膝蓋疼痛的現象,</span><br />
<span style="font-size: large;">但是不一定嚴重到有產生痛風石,</span><br />
<span style="font-size: large;">所以膝關節的超音波不一定能找得到有痛風石的跡象。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">另外一個可以考慮觀察的影像特徵是</span><br />
<span style="font-size: large;">雙輪廓徵象(double contour sign)。</span><br />
<span style="font-size: large;">膝關節的軟骨表面,在常期的尿酸沈積下,</span><br />
<span style="font-size: large;">會逐漸形成高回音的一條線狀沉積,</span><br />
<span style="font-size: large;">而與軟骨下方的硬骨骨面的高回音,</span><br />
<span style="font-size: large;">形成了二條白線的影像。</span><br />
<span style="font-size: large;">也就是上圖中,紅色箭頭所指出的部份(註1)。</span><br />
<span style="font-size: large;">這個超音波影像特徵的特異性很高,</span><br />
<span style="font-size: large;">能幫助我們診斷患者是否是痛風造成的代謝性關節炎。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">雖然痛風造成的代謝性關節炎,</span><br />
<span style="font-size: large;">不一定能看到這兩個徵象。</span><br />
<span style="font-size: large;">但是透過超音波的觀察,可</span><span style="font-size: large;">能可以做出更正確的診斷。</span><br />
<span style="font-size: large;">有時候患者做了超音波檢查,</span><br />
<span style="font-size: large;">才發現患者不是關節裏面在痛,而是關節附近的肌腱在痛。</span><br />
<span style="font-size: large;">只要治療肌腱,疼痛就會改善。</span><br />
<span style="font-size: large;">有了正確的診斷,才有正確的治療。</span><br />
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<span style="color: #e06666; font-size: large;">註解:</span><br />
<span style="font-size: large;">1.</span><span style="font-size: large;">Usefulness of ultrasonography for gout</span><br />
<span style="font-size: large;"> ECR 2019 / C-2250 <span style="white-space: pre;">, </span>Authors: W. Elouaer, H. Zaghouani, H. jaafer, N. chouchane, Z. alaya, D. amri, F. bouzayene, S. Majdoub, D. Bakir; SOUSSE/TN</span><br />
<span style="font-size: large;"><br /></span>
<br />
<div>
<span style="color: #e06666; font-size: large;">作者</span><br />
<span style="font-size: large;">莊武龍醫師</span><br />
<span style="font-size: large;">主治糖尿病及甲狀腺疾病。</span><br />
<span style="font-size: large;">專長於週邊神經的超音波評估與營養評估。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;">引用或是轉貼請注明出處,謝謝。</span><br />
<span style="font-size: large;">文章僅供醫療衛教分享以及促進健康之用,請勿做為商業用途及其它不法的宣傳之用</span></div>
莊武龍醫師http://www.blogger.com/profile/09637828187781354953noreply@blogger.com