- 學位論文
擇期性橈動脈冠狀動脈介入性治療,當日出院之可行性評估
The practical assessment of same-day discharge with scheduled trans-radial percutaneous coronary intervention
摘要
目的： 因應TW-DRG之實施，如何在安全的前提下，經由橈動脈行心導管介入性治療，儘早出院，進而節省醫療成本，創造病人與醫院之雙贏。 方法： 回溯性收集2006年1月1日至2010年12月31日屏東寶建醫院心導管室病歷資料，收集282份完整病歷資料。 結果： 在住院≦24H這組(129位男性 & 51位女性)平均年齡64.3±12.5歲(mean± s.d.)，在住院>24H這組(74位男性 & 28位女性)平均年齡69.1±11.5歲。本研究發現年齡小於65歲與術後於24H內出院有關，Lesion>2大多於手術後住院超過12H，Complication是否發生跟Troponin–I有相關(p=0.001)，術後complications多在6H內發生，使用stents病人術後多於24H內出院，血管嚴重度於B2, C大多術後住院超過24H出院。使用Logistic Regression Analysis評估risk factor，年齡?T 65歲(RR 1.683)、心肌旋轉蛋白?T 1 ug/L(RR 1.963)、病患病灶數目?T 2(RR 1.402)、血管處置方法(Stent)(RR 1.963)、個案血管型態(A & B1)(RR 1.683)、無術後併發症發生(RR 2.153)。 結論： 病人若有年齡?T 65歲、心肌旋轉蛋白?T 1 ug/L、病患病灶數目?T 2、血管處置方法(Stent)、個案血管型態(A & B1)、無術後併發症發生，以上幾種特質偏向術後24小時內出院。
並列摘要
Aims: In response to TW-DRG implementation, based on safety, through the radial artery cardiac catheterization intervention, how to make patients discharged earlier, save health care costs and create a win-win between patients and hospitals. Methods: In this retrospective study in Pingtung Paochien Hospital, Taiwan, we enrolled 282 cases from January 1 in 2006 to December 31 in 2010. Results: In the admission less than 24 hours after the PCI treatment, there were 129 males and 51 females (64.3±12.5 years, mean ± s.d.). Besides, in other group over 24 hours, there were 74 males and 28 females (69.1±11.5 years). We also found several associations that age under 65 years had a positive association with discharge in 24H, most cases with over 2 lesions tended to hospitalize over 12H, the incidence of complications had relationship with Troponin–I (p=0.001), complications frequently happened in 6H, patients using stents admitted over 24H, and the severity of lesion type , B2 or C, hospitalized over 24H. Using Logistic Regression Analysis, age ?T 65 years (RR 1.683)、Troponin-I ?T 1 ug/L (RR 1.963)、lesion numbers ?T 2 (RR 1.402)、Treatments using stents (RR 1.963)、vascular type such as A & B1 (RR 1.683)、non-complication (RR 2.153). Conclusion： If patients have characteristics like age ?T 65 years, Troponin-I ?T 1 ug/L, lesion numbers less than 2, treated with stents, vascular type diagnosed as A and B1, and non-complication, they could tend to discharge in 24 hours after PCI treatment.