- 期刊
台灣臨床成效指標系統施行後急性心肌梗塞經心導管介入之患者接受心臟復健現況
Cardiac Rehabilitation among Patients with Acute Myocardial Infarction Receiving Percutaneous Coronary Intervention after Acute Myocardial Infarction Indicator Was Activated
摘要
研究背景及目的：醫策會於2011年推動台灣臨床成效指標系統（Taiwan Clinical Performance Indicator, TCPI），期能適時反應醫療品質執行之成效，急性心肌梗塞照護指標即為其中之一。急性心肌梗塞照護指標共有20項監測指標，其中有一項即為心臟復健衛教執行率。本院訂於2012/1/1實施急性心肌梗塞照護指標。而本研究收集台北榮總2012年1月1日開始實行急性心肌梗塞照護指標後，急性心肌梗塞經心導管介入的病人接受第一期心肺復健及後續追蹤之情況。研究方法：本研究以病歷回顧的方法，收集台北榮總2012年1月到12月開始實行急性心肌梗塞照護指標之後，急性心肌梗塞經心導管介入的病人接受心肺復健的現況及後續追蹤之情形。總共174人納入統計資料，其中依據排除標準排除了54人。資料收集包括了加護病房及一般病房住院天數、心臟科醫師照會復健部時間、復健部醫師評估時間、物理治療人員開始治療時間及總治療次數、出院後門診追蹤情形之紀錄等。研究結果：2012年1月1日台北榮總實行急性心肌梗塞照護指標後，急性心肌梗塞經心導管介入的病人接受第一期心臟復健者比率為100%。平均總住院天數為8.1±8.0天，加護病房為3.3±1.9天，普通病房為4.8±6.8。病人入院到開立會診復健科醫師的時間為47.2±57.3小時。開立會診至復健科醫師完成會診時間為12.0±17.9小時。復健科醫師完成會診至第一次做到心臟復健時間為17.0±23.1小時。出院後三個月內回診心臟科者114人（95%），然而回診復健科接受第二期心臟復健評估者僅18人（15%）。結論：病人接受第一期心臟復健比率為百分之百。病患出院後之第二期心臟復健比率不高。應在出院前就加強對病患宣導第二期心臟復健之重要性，此外也應跟心臟科醫師溝通，建議病人出院時能例行性轉介至心臟復健門診就醫，改善第二期心臟復健之參與率。
並列摘要
Background and Purpose: Cardiac rehabilitation (CR) is effective in improving mortality and morbidity outcomes and may favorably influence cardiac risk factors in patients with coronary heart disease. Despite the proven benefits, CR remains considerably under-utilized worldwide. The aim of this study was to research the current status of CR for patients with acute myocardial infarction (AMI) receiving percutaneous coronary intervention (PCI) after the Taiwan Clinical Performance Indicator executes was activated in a medical center in Taiwan. Methods: The medical records of 174 patients with AMI at our hospital from January to December 2012 were retrospectively reviewed to investigate the consultation process and participation in CR after discharged. Fifty-four patients who did not meet our criteria were excluded. 120 patients who received PCI were enrolled. Baseline information, hospitalization, and the phase I CR process were all recorded. Results: All patients(100%) with AMI who received PCI underwent phase I CR during hospitalization. The mean hospitalization duration was 8.1±8.0 days. The mean duration from admission to consultation was 47.2±57.3 hours; the mean duration for completing consultation was 12.0±17.9 hours; The mean duration for initiating therapy after CR prescription was 17.0±23.1 hours. A total of 114 patients(95%) returned to the cardiology outpatient department for follow-up. However, only 18 patients(15%) continued regular follow-up at the rehabilitation outpatient department and entered phase II CR. Conclusions: After the AMI indicator was activated, all patients receiving PCI participated in the phase I CR programs at our hospital. The participation rate in phase II CR was relatively low. To improve the phase II CR participation rate in the future, emphasizing the importance of phase II CR to the patient and the cardiologist is suggested. Facilitating the process of outpatient referral should also be considered.
被引用紀錄
延伸閱讀
- 李琪、許妙如、鄭振璋（2017）。運動訓練介入對高齡慢性心衰竭接受冠狀動脈繞道手術後患者心肺功能之恢復：個案報告。物理治療，42(4)，338-339。https://doi.org/10.6215/FJPT.2017.74.P04
- 李仁婷、朱琬婷、洪素鶯（2023）。【論文摘要】心臟復健對於急性心臟衰竭合併使用經皮式心室輔助器與葉克膜個案之成效－個案報告。物理治療，48(2)，129-130。https://doi.org/10.6215/FJPT.202306.P03
- Hwang, B. T., & Kao, C. C. (2015). 介入性心導管術治療結構性心臟血管畸形異常：在台灣的發展及現況. 童綜合醫學雜誌, 9(2), 76-83. https://www.airitilibrary.com/Article/Detail?DocID=20713592-201512-201512310005-201512310005-76-83
- 陳彥勳（2012）。Characteristics of patients early discharged with acute ST segment elevation myocardial infarction undergoing successful primary percutaneous coronary intervention〔碩士論文，長榮大學〕。華藝線上圖書館。https://doi.org/10.6833/CJCU.2012.00228
- Lin, H. J., & Wang, T. D. (2017). Initiation of Intra-Aortic Balloon Counterpulsation before Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction and High-Risk Features Might be Beneficial: Questions Remain. Acta Cardiologica Sinica, 33(6), 578-580. https://doi.org/10.6515/ACS20170327A