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題名:近五年澎湖離島空中緊急醫療轉送心臟血管科病患治療結果之分析     (32點)
OUTCOME OF PATIENTS WITH CARDIOVASCULAR DISEASE TRANSFERRED BY EMERGENCY AIR MEDICAL TRANSPORTATION FROM PENGHU ISLANDS TO TAIWAN: 5 YEARS STUDY
著者:蘇慶祥(Chiing-Hsiang Su) ;吳清平(Chin-Pyng Wu) ;蔡行瀚(Shin-Han Tsai) ;白璐(Lu Pai) ;杜宗明(Chung-Ming Tu) ;張芳誠(Fang-Cherng Chang) ;廖美珍(Mei-Chen Liao)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:澎湖離島 ; 空中緊急醫療轉送 ; 心臟血管疾病 ; 醫學中心 ; Remote Penghu islands ; Emergency air medical transportation (EAMT) ; Cardiovascular disease (CVD) ; Medical center
刊名:重症醫學雜誌
卷期:10卷4期(2009.12)
頁碼:283-298
語言:繁體中文
摘要: 中文摘要PDF ; 英文摘要PDF

目的:澎湖離島醫師多數為一般科,處理急重症人力十分缺乏,急重症病患僅能仰賴空中緊急醫療轉送至本島救治。為了改善當地醫療品質,民國92年軍醫局加派專科醫師群,配合衛生署空中轉診審核中心轉送病患。95年7月三軍總醫院主導之醫療團隊介入後,心臟血管疾病空中緊急醫療轉送率不降反增,病患治療結果則有待探討。
方法:回溯性收集民國93年1月1日至97年12月31日,由澎湖地區空中緊急醫療轉送到高雄三家醫學中心之病歷與相關資料,加以統計分析。
結果:五年內後送109人,男性87人(79.82%)為主,年齡層61-75歲居多。三軍總醫院介入後,轉送量明顯上升,季節反以6-8月39人(35.78%)最多(P=0.020),病人死亡率則有下降(P=0.028)。且在調整性別、年齡、GCS (odds ratio 0.015; 95% [CI], 0.027-0.672)、及APACHE Ⅱ (odds ratio 0.181; 95% [CI], 0.035-0.946)後,死亡率確有減少。而病人於平日或假日住院死亡率則無差異(P=0.858);降落高雄榮總院內停機坪或小港機場後再由救護車轉送也無明顯差異(P=0.093),但減少繁複搬運過程,可避免非預期之風險。
結論:醫學中心介入後,整體死亡率下降,顯示出醫學中心專科醫師群支援的重要性。但後送率增加,則表示仍需搭配良好的政策與適當的審核制度,方可兼顧醫療資源利用及提昇病患的預後。
Objective: In the remote Penghu islands, there is a shortage of manpower in emergency and critical care medicine. Critical ill patient rely solely on emergency air medical transportation (EAMT) to transfer to Taiwan. For conquering the difficulty, dispatching specialist physicians from Taiwan and video-telemedicine systems for screening of patients requesting EAMT were established since 2003. However the demand of EAMT had increased after joint collaboration of Tri-Service General Hospital (TSGH) in 2006. In this study, we investigated the outcome of patients with cardiovascular disease (CVD) requesting EAMT service.
Methods: This study is a retrospective survey that reviewed medical records of patients with CVD transferred to three medical centers in Kaohsiung city by EAMT between January, 2004 and December, 2008. Data were analyzed by using SPSS 12.0.
Results: During the study period, total of 109 patients with CVD were transferred. There were 87 male patients (79.82%); majority of patients were 61-75 years old. Although the number of transferred patients had significantly increased during the summer (June to August; p=0.002) after the intervention of TSGH, the mortality had reduced significantly even after adjusting for demographic characteristics, GCS (odds ratio: 0.015; 95% [CI]: 0.027-0.672) and APACHE II (odds ratio: 0.181; 95% [CI]: 0.035-0.946). There were no significant differences between weekday and weekend of admission (P=0.858) or between the landing sites (P=0.093).
Conclusions: Our study suggested that in order to upgrade the local capacity for emergency and critical CVD, it is necessary to establish a sustainable medical support program for Penghu islands. The program should be under better financial scheme by the National Health Insurance and monitored by National Aeromedical Approval Center under the Department of Health. The numbers of EAMT and mortality rate could be reduced much more if the above efforts are cooperated with the medical guidelines.




本卷期目次
重症醫學雜誌 10卷4期 (2009.12)
近五年澎湖離島空中緊急醫療轉送心臟血管科病患治療結果之分析/ 蘇慶祥吳清平蔡行瀚白璐杜宗明張芳誠廖美珍
在出現嚴重生命徵象不穩定之器官捐贈者中運用葉克膜輔助接受腦死判定之經驗探討/ 謝佳恩陳堯俐柯志燃張雅音涂力圖崔玉珠
ULTRASONIC CARDIAC OUTPUT MEASUREMENT FOR NONINVASIVE CARDIAC OUTPUT MONITORING: UPDATE AND LITERATURE REVIEW/ Kun Hsi WuMency Chan
SUDDEN CARDIAC DEATH CAUSED BY AN OBSTRUCTIVE LEFT ATRIAL BALL THROMBUS/ Chung-Yueh HsiehAn-Ning FengWei-Hsian YinMason-Shing Young
INFECTIVE ENDOCARDITIS AT BICUSPID AORTIC VALVE COMPLICATED WITH SEVERE AORTIC REGURGITATION AND RUPTURE OF INTRACRANIAL INFECTIVE ANEURYSM: REPORT OF A CASE WITH LITERATURE REVIEW/ Sir-Chen LinShih-Chi LiuChuen-Den Tseng
SUCCESSFUL EMERGENCY MANAGEMENT FOR INTERNAL HEMORRHAGE FOLLOWING BLUNT ABDOMINAL TRAUMA WITH PELVIC FRACTURE-CASE REPORT/ Ming-Yu TsaiMing-Chih ChouChao-Bin Yeh
ACUTE STROKE AND LEFT ATRIAL MYXOMA SUCCESSFULLY TREATED WITH INTRAVENOUS THROMBOLYTIC THERAPY AND SURGICAL RESECTION- CASE REPORT/ Pan LinHsing-Hui WuShih-Chieh YuChun-Hua Ke
TAKOTSUBO CARDIOMYOPATHY TRIGGERED BY ACUTE BRONCHITIS WITH AIRWAY HYPERRESPONSIVENESS WITH CO-MORBIDITY OF PULMONARY EMBOLISM-A CASE REPORT/ Yun-Chieh LuYung-Hsu Chen
DELAYED TRAUMATIC TENSION GASTROTHORAX: A CASE REPORT/ Chung-Hsin HuangChung-Jen HuangPei-Shan TsaiMeng-Ching Yeh
THE ROLE OF THE ANTI GQ1B ANTIBODY IN DIFFERENTIAL DIGNOSIS OF ACUTE OPTHALMOPARESIS/ Chih-Ming Lin
 
   
 
   

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