縮短ST段上升之急性心肌梗塞病患執行緊急冠狀動脈介入術時間之政策評估分析－以北區某區域醫院為例

Assess the Strategies for Reducing the Door-to-Balloon Time in ST Segment Elevation Acute Myocardial Infarction in North District Hospital

韋詩娟(Shih-Chuan Wei)

指導教授 ： 楊哲銘

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2015年)

摘要

一、前言
心血管疾病多年來均為全球十大死因之首。2010年我國的統計資料顯示，心臟疾病高居國內十大死因第二位，一整年死亡人數共15675人，相當於每天會有42.7人死於心臟病。而緊急心導管介入術可以有效地降低急性心肌梗塞的死亡率，且病患從急診室至血流再灌注所花費的時間愈短，就會有較佳的預後。本研究是藉由由醫院管理層面，執行相關介入措施及流程改善，縮短病患從急診室至完成血流再灌注的時間，探討其成效分析。
二、方法
本研究回溯性研究法，以病歷回溯調查的方式，收集北區某區域醫院自民國100年1月1日至民國102年12月31日期間，病患至急診掛號，經急診醫師及會診心臟內科醫師判讀心電圖診斷為STEMI或心因性休克而至心導管室檢查之病患之臨床資料，比較介入措施執行前(民國100年1月1日至民國101年8月31日)與介入措施執行後(民國101年9月1日至民國102年12月31日)，STEMI病患自急診檢傷至送至心導管室執行心導管介入術血流灌注所花費之時間，以及其相關品質指標。而介入措施包括建立標準作業流程、將藥物設入急診醫令套餐、建立資源分享平台、建立胸痛流程、制定流程時間登記表、建立回饋機制、定期召開跨科檢討會議及繼續教育課程。
三、結果
本研究收案共計101人，前組48人、後組53人，根據研究收集之數據，期前後組之各品質指標會因改善措施之介入而有明顯的差異，同時希望藉此得知：北區某區域醫院所提出之改善措施成功的降低Door to balloon time，也同時的以此措施提升醫療品質及降低病患死亡率。

關鍵字

ST段上升急性心肌梗塞 ； Door to Balloon time ； 品質指標 ； 介入改善措施

並列摘要

Background: Acute coronary syndrome is the first leading cause of death in the middle-income and high-income countries as well as the second leading cause of death in Taiwan. How to increase the clinical quality of care for acute coronary syndromes (ACS) has become the most critical issue worldwide. The aim of this study is to investigate whether the clinical quality of care for acute coronary syndromes was improved after accreditation of emergency medical competency executed by the department of health of Taiwan.
Method: Cross-sectional research was applied to this study. The data was obtained from reviewing charts of STEMI patients admitted to emergency department of a medical center in north district hospital. The policy of improvements of ACS routine processes in ER was started at September 2012, so the triaged cases in ER from 1 January 2011 to 31 August 2012 were collected as the before-intervention group, and the triaged cases in ER from 1 September 2012 to 31 December 2013 were collected as the after-intervention group. There are total 48 and 53 persons in the controlled and experimental group respectively. We used "STEMI case checklists" to conduct the patients' data and statistic analysis followed by means, standard deviation, multiple linear regression of SPSS 20.0 software to analyze the data.
Results: Totally 101 consecutive AMI subjects recruited, male accounted for 86.14%. There were no significant difference in patient’s characteristics between before-intervention group (48 cases) and after-intervention group (53 cases).The result indicated:(1) there were no significant difference in the time of first ECG between before-intervention group and after-intervention group (p>0.05). (2) There were statistically significant differences in the door to balloon time between before-intervention group and after-intervention group (p<0.001).
Conclusion: This is the study show that intra-hospital administration effort including education, inter-department coordination, regular combined meeting and cardiology specialist standby in hospital in off-time can short the door-to-balloon time and provide better clinical outcome in patients who received PCI for acute myocardial infarction.

並列關鍵字

ST segment elevation myocardial infarction ； Door to Balloon time ； quality indicators ； interventional improvements

參考文獻

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