救護車加裝心電圖機對於改善心肌梗塞病患到院時間之模擬分析－以台北市為例

ST上升型急性心肌梗塞（ST-elevation myocardial infarction，STEMI）發生於供應心臟的冠狀動脈血管完全被血栓阻塞，導致心肌無法獲得所需的氧氣及養分。心肌梗塞併發時，心肌便開始損傷與壞死，越早接受治療、傷害越低，若越長時間沒有接受緊急血栓溶解劑、經皮冠狀動脈介入治療（Percutaneous Coronary Intervention，PCI）等，傷害越大。急性心肌梗塞的治療，分秒必爭。　　本研究聚焦探討有無實施12導程心電圖（Electrocardiogram，EKG）測量，以及不同心電圖機布建率，對於到院時間的各個時間階段之影響，到院後的資料因真實世界取得不易，故在此研究不納入討論。透過台北市消防局提供之緊急救護歷史資料，模擬案件發生的時間及機率，期望透過到院前實施心電圖測量，及早發現急性心肌梗塞病患，並直接送往能行心導管手術的醫院，盡可能避免因沒有測量心電圖就直接送往無法行心導管急救醫院，後續仍須轉院至心導管手術醫院的時間延遲。　　本研究的模擬結果顯示，在台北市當前12導程心電圖機布建率20%情況下，到院前有實施心電圖測量相較於沒有實施，接獲報案至抵達第一家醫院平均時間顯著增加的。另外，相較於當前的布建率20%，本研究模擬之布建率100%情況，接獲報案至抵達第一家醫院也是平均時間顯著增加的。　　綜上所述，只要在到院前多花大約2分鐘的時間，預先測量心電圖，提早判斷病患是否為急性心肌梗塞，即可讓醫院能提早為病患做心導管室及醫護人員的準備，避免病患到院後的程序等待，以優化緊急救護流程，亦可大幅降低後續轉院的比例及機率，以達到最終目的，縮短大部分病患抵達急診至進行氣球擴張打通阻塞冠狀動脈（Door-to-balloon）的時間。

關鍵字

ST上升型急性心肌梗塞； 12導程心電圖機；院前緊急救護；系統模擬；流程改善

並列摘要

ST-elevation myocardial infarction (STEMI) is a life-threatening condition caused by lack of blood flow to the heart muscle. The Percutaneous Coronary Intervention (PCI) could quickly open blood vessels and help minimize heart damage. 　　With the pre-hospital electrocardiogram (EKG) diagnosis, the patient can be early triage and timely transferred to PCI-Capable hospital for recanalization of a chronically occluded artery and saving life. 　　The purpose of this study is to understand the impact on various time stages of hospital arrival time with different 12-lead Electrocardiogram (EKG) implementation status and different coverage rate of EKG. Based on the emergency medical service (EMS) historical data provided by the Taipei City Fire Department, this study builds simulation models and focuses on the operational efficiency of pre-hospital process. The aim goals are to implement EKG before hospitalization for early myocardial infarction detection and directly send to the PCI-Capable hospital to perform cardiac catheterization so that we could avoid the delay in the golden hour caused by sending to a Non-PCI-Capable hospital first while there’s no EKG on the scene, and still having to take a half an hour to an hour to transfer to PCI-Capable hospital. 　　The simulation results show that an EKG will increase the duration from receiving a call to arrive at the first hospital when the EKG coverage rate are 20% and 100%. If we perform EKG before hospitalization, then we can greatly decrease the referral probability and time and shorten the door-to-balloon（D2B）time.

並列關鍵字

ST-elevation myocardial infarction ； 12-lead electrocardiogram ； Prehospital Emergency Care ； System Simulation ； Process Imporvement

參考文獻

Bitner, M. J., Ostrom, A., Morgan, F. N. (2008). Service blueprinting: A practical technique for service innovation. California Management Review, 50(3), pp. 66-94. doi:https://doi.org/10.2307/41166446

Google Scholar

De Luca G, Suryapranata H, Ottervanger JP, Antman EM. (2004). Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation, 109, pp. 1223-1225.

Google Scholar

Francone M, Bucciarelli-Ducci C, Carbone I, et al. (2009). Impact of primary coronary angioplasty delay on myocardial salvage, infarct size, and microvascular damage in patients with ST-segment elevation myocardial infarction: insight from cardiovascular magnetic resonance. J Am Coll Cardiol, pp. 2145–2153.

Google Scholar

Gershlick, A. H., Banning, A. P., Myat, A., Verheugt, F. W., Gersh, B. J. (2013). Reperfusion therapy for STEMI: is there still a role for thrombolysis in the era of primary percutaneous coronary intervention? Lancet (London, England), 382(9892), pp. 624–632. doi:https://doi.org/10.1016/S0140-6736(13)61454-3

Google Scholar

Law, A.M. and Kelton, W.D. (2000). Simulation Modeling and Analysis. McGraw-Hill.

Google Scholar

主題瀏覽