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1
題名:專責救護隊是否能改善到院前心跳停止病患的預後     (22點)
Can a Designated Ambulance Crew Improve the Outcome of Out-of-Hospital Cardiac Arrest
著者:黃彥璋(Yen-Chang Huang) ;林宏榮(Hung-Jung Lin) ;郭浩然(How-Ran Guo) ;嚴元隆(Yuan-Lung Yen) ;蔡明哲(Ming-Che Tsai) ;吳政龍(Chen-Long Wu) ;吳彥良(Yen-Liang Wu) ;符凌斌(Ning-Ping Foo)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:專責救護隊 ; 到院前心跳停止 ; 緊急醫療系統 ; 喉頭面罩 ; 自動體外電擊器 ; 高級救護技術員 ; designated ambulance crew ; out of hospital cardiac arrest ; emergency medical service system ; laryngeal mask airway ; automated external defibrillator ; paramedic
刊名:中華民國急救加護醫學會雜誌
卷期:18卷1期(2007.3)
頁碼:1-11
語言:繁體中文
摘要: 中文摘要PDF ; 英文摘要PDF

前言:到院前心跳停止(Out of hospital cardiac arrest, OHCA),意謂著存活率渺茫。然而,我們可以藉由緊急醫療系統的進步,來改善這類病人的預後。 目的:本研究目的在於討論專責救護隊的成立,是否能改善OHCA病人的預後? 材料與方法:此研究?回溯性研究,時間?2004年1月至2005年4月,連續收集16個月南部某一城市的救護資料,分別比較專責救護隊與非專責救護隊所急救的OHCA病人各項急救品質指標的差異,並探討其對預後的影響。 結果:專責救護隊的現場時間較長(平均值12.7分鐘vs.9.1分鐘,p<0.001), 心肺復甦時間也較長(平均值14.0分鐘vs10.2分鐘,p<0.001)。而喉罩呼吸道的使用率(82.7% vs. 42.8%, p<0.0011),自動體外電擊器的使用率(91.9% vs. 787%, p<0.001),在專責救護隊也是顯著的較多。在預後方面,最終模式顯示OHCA病人的年齡(勝算比0.973,95%信賴區間?0.950-0.996,p=0.021),心肺復甦時間(勝算比0.873,95%信賴區間?0.787-0.969,p=0.011),專責救護隊(勝算比2.982,95%信賴區間?1.106-8.035,p=0.031)是病人存活至出院的預測因子。 討論:此研究確認了專責救護隊的成立,能改善OHCA病人的預後。因此,我們建議緊急醫療系統應朝向設置專責救護隊的方向努力,同時也應設法再縮短病人由心跳停止至送達醫院的時間,以期更能改善病人的預後。
This retrospective cohort study aimed to determine the ability of a designated ambulance crew to improve the outcome of out-of-hospital cardiac arrest (OHCA). We consecutively collected data from OHCA patients from a southern city in Taiwan from January 2004 to April 2005. We compared the resuscitation core measurements between designated and non-designated ambulance crews. The scene interval (mean 12.7 minutes vs. 9.1 minutes, p<0.001) and cardio-pulmonary resuscitation interval (mean 14.0 minutes vs. 10.2 minutes, p<0.001) were markedly increased for designated ambulance crews. The ratios for using laryngeal mask airways (82.7% vs. 42.8%, p<0.001) and automated external defibrillators (91.9% vs. 78.7%, p<0.001) were also statistically significantly increased for designated ambulance crews. In the final model of analysis, the ratio of survival to hospital discharge was decreased by aging (Odds ratio 0.973, 95% Confidence Interval 0.950~0.996, p=0.021) and prolonged cardio-pulmonary resuscitation interval (Odds ratio 0.873, 95% Confidence Interval 0.787~0.969, p=0.011). However, it was statistically higher when resuscitation was performed by a designated ambulance crew (Odds ratio 2.982, 95% Confidence Interval 1.106~8.035, p=0.031). This study highlights the establishment of designated ambulance crews in order to improve the outcome of OHCA. A prolonged cardio-pulmonary resuscitation interval has been shown to decrease the survival rate from OHCA. We suggest the development of emergency medical services should include establishing more designated ambulance crews, as well as shortening the interval between cardiac arrest and arrival at a hospital, in order to improve the outcome of OHCA.




本卷期目次
中華民國急救加護醫學會雜誌 18卷1期 (2007.3)
專責救護隊是否能改善到院前心跳停止病患的預後/ 黃彥璋林宏榮郭浩然嚴元隆蔡明哲吳政龍吳彥良符凌斌
Clinical Characteristics of Bacteremia Patients in the Intensive Care Unit of a Referral Teaching Hospital in Taiwan/ Boon-Siang KhorHow-Chin LiaoMei-Chih YehShiumn-Jen Liaw
Time Survey of Triage Emergency Department Patients during Rush and Non-Rush Periods/ Wen-Han ChangChie-Hsuan HuangCheng-Ho Tsai
Telephone Reminder Calls of Scheduled Clinics on Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease after Emergency Department Discharge/ Chia-Ying TsengTsung-Cheng TsaoHsien-Hao HuangDavid Hung-Tsang YenLee-Min WangChun-I Huang
Hamman氏症候群(自發性氣縱膈)/ 胡松原詹毓哲胡?雄
Carbon Monoxide Poisoning
 
   
 
   

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