- 學位論文
到院無心跳呼吸病患之急救結果與醫療資源利用之分析-以南部某區域教學醫院為例
Outcomes of resuscitation of death on arrival and medical expense: example of regional teaching hospital at southern Taiwan
摘要
中文摘要 研究背景：國內有關於DOA的研究 相當少，以實證醫學的動機來看，本研究可以用不同的藥物以及劑量求取不同的結果，所以成為了能引起我興趣，進而選擇這個題目作為我的研究論文。 研究目的：本研究擬探討DOA(到院已無心跳呼吸)的病患至急診室時之醫療處置以及相關醫療費用的利用情形.主要目的也要探討有無新的急救方式在實證醫學之論據下.提供更為有力之急救觀念和方法來促進DOA病患急救成功率。 研究方法：以南部某區域教學醫院於2004年1月至12月從急診室進入共有272例的到院無心跳呼吸的病患為研究對象,收集心肺復甦單(CPCR),收集病例記錄,以及健保申報電腦檔原始資料,急診護理工作人員的問卷調查,使用spss統計軟體進行分析。 研究結果： 研究樣本平均年齡為62歲，性別以男性居多，占60.89%，合併慢性病高血壓22.98%糖尿病23.78％心臟病21.17％氣喘6.45%以及創傷佔4.4%。以二至三月是發生高峰期而以九月最低DOA發生地點:以發生於家裡最高佔78％戶外佔14.7%院際轉進佔4.4%護理之家佔1.5%.有作預作CPR比率佔52.8%。DOA急救成功(ROSC)平均時間花費為14.33分，272例 DOA有41例急救成功(ROSC)佔15.07％有作預作CPR比率佔52.8%.醫療費用平均為9233元。會影響費用之因子有發生地點及使用腎上腺素注射次數；會影響急救成功與否之預測因子為高血壓與腎上腺素注射次數。 結 論： 1. 醫療費用：戶外發生之DOA病患之醫療費用比一般病人高出2,094元。腎上腺注射次數，每增一次醫療費用提高390元。醫療費用之影響因子戶外發生之DOA病患(P=0.005)腎上腺注射次數(P=0.000)。 2. 醫療結果：影響急救結果之預測因子為高血壓(P=0.000)與腎上腺素注射次數(P=0.040)。
並列摘要
ABSTRACT Purpose : Research this plan patient to probe into DOA (get institute have heartbeat breathe yet ) to emergency ward medical treatment handle and relevant use situation of hospitalization cost at. Whether probe into the new first aid way under the argument of medical science of the real example too. Offer stronger first aid idea and method to promote DOA patient's first aid success rate . : Enter the patient who there is no heartbeat to breathe from the emergency ward to the institute with 272 examples as the research object in 2004.1 to 2005.1 with one regional teaching hospital in the south, collect the heart and lungs and recover single (cpcr )ly , collect the case to write down , and is strong in protecting and declaring the shelf firsthand information of the computer, the emergency call attends to the questionnaire investigation of staff members, use spss to count the software to analyse. Results : DOA easy to take place on will it be backward 2 month such as U.S.A. one month. Happen most in the family. Take medicine for being most in the the above-mentioned opportunity lavatory . Emergency call succeeds more to women. It is not obvious to the successful group of first aid to shock by electricity. The hospitalization cost is 9233 yuan on average . It is secondly the technological fee of first aid to spend and use highest with the instrument mainly. The medicine occupies the end. Use medicine if adrenaline have obvious success rate with many dosage. A doctor is used to using pitressin its result to be astonishing too in addition. First aid succeeded time was 8.15.11 minute was the latest to be 49 minutes. First aid hospitalization cost shocked by electricity to have drop on 12000 yuan. Have 2 example pediatrics patient difference 1253 and 31700 all from groups of value. Whether expect it influences success rate too that the heart and lungs recover (stand by CPR ). Research this is it answer 42 to rescue of 272 DOA The rate is that 15.7% is excellent. Discussions : The DOA time to usually send the emergency ward exceeds 4 until 6 minutes prime time . It is lower and lower to shock by electricity the chance: Can only use heart massage at this moment. Go on for medicines finally hard . The use of the medicine becomes the exquisite focus . It is astonishing that one doctor of this research has been using Pitressin to rescue 5 of 12 all the time . It is obvious with much dosage too that the adrenaline is used. Do not dare to carry on the experiment of contrasting the group that machinery pigeonholes the chest hastily on the basis of this research of medical ethics . But not already have it is many DOA via (Thumper) Machinery type pigeonholed the chest device and rescued back massage. The advanced heart will save someone's life in skill America and Europe and already reach common understanding as the backbone with incessant CPR in 2005. Will shock by electricity the number of times to reduce. It is identical that on one hand even improve some results of location steps of pitressin and this research. A lot of DOA happens while going to toilet. So if if the lavatory also should improve vigilance to the serious disease patient in the emergency ward. This is that a patient is safe and apt to ignore the place . Organ transplant may become a hot ring of medical science afterwards. First aid comes back even if the DOA patient whose brain dies can offer and donate the important source of organ . Certainly sign and give up the first aid book for the example at the end in cancer. It is selecting while communicating with relatives of first-aid personnel too. This research examines and understands with questionnaire investigation on the basis of follow-up study the nursing staff uses psychology and cognition to do the preparation of the next research to thumper. DOA patient rescued back but the nerve has been already unable to resume. This often makes people disheartened and unwilling to do the best because the prognosis is to make people depressed . But the new method is appearing constantly if the low-temperature treatment (Hypothermia ) encourages medical treatment to continue putting into the Unknown virgin land .