到院前心肺功能停止病患恢復自發性循環之到院前相關因素探討-以嘉義某區域教學醫院為例

Prehospital Factors Associated with Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest Patients of One Chiayi's Regional Teaching Hospital

張惠娟(Hui-Chuan Chang)

指導教授 ： 黃偉堯

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2016年)

摘要

背景：針對突然心臟停止的病患有4分鐘的黃金搶救時間，每過一分鐘存活率將減少10-12%。為了成功救活病患，了解那些是有效的急救處置是必要的。
目的：探討嘉義地區到院前心肺功能停止病患(Out-of-Hospital Cardiac Arrest, OHCA)之來院方式與到院前處置是否影響恢復自發性循環(Return of Spontaneous Circulation, ROSC)。
方法：本研究為次級資料分析，資料來源為2009年1月~2014年12月嘉義某區域教學醫院急診室20歲以上OHCA病患相關醫療資料。OHCA病患共636人，在排除已簽立不施行心肺復甦術、創傷、溺水、中毒、燒傷、ROSC立即轉院後，本研究研究對象計435人。以ROSC為依變項，來院方式及到院前處置，包括自動體外去顫器、喉頭面罩呼吸道、旁觀者心肺復甦術、到院前電擊為自變項。擷取到院前急救處置、到院後急救處置、來院方式、存活情形、病人基本資料等變項進行描述性統計、卡方檢定、獨立樣本t檢定、及羅吉斯迴歸進行分析。
結果：到院前心肺功能停止病患之平均年齡為72歲；由具醫療背景陪同送醫者居多，有380人(87.3%)；到院前處置包括喉頭面罩呼吸道使用有27人(6.2%)、旁觀者心肺復甦術34人(7.8%)、到院前電擊27人(6.2%)。各變項與ROSC的卡方檢定為性別(p=0.147)、年齡(p=0.015)、慢性病(p=0.572)、自動體外去顫器(p=0.682)、喉頭面罩呼吸道(p=0.836)、旁觀者心肺復甦術(p=0.263)、到院前電擊(p=0.430)、來院方式(p=0.305)、到院時心律(p=1.000)、到院後電擊(p=0.004)、施打Epinephrine次數(p=0.059)、專責救護隊(p=0.778)。到院前心肺功能停止病患到院前處置、專責救護隊與恢復自發性循環經羅吉斯迴歸檢定後無顯著差異。
結論：在嘉義地區某區域教學醫院的到院前處置，包括由醫療人員陪同送入、使用自動體外去顫器、使用喉頭面罩呼吸道、由專責救護隊送入、可電擊之心律對恢復自發性循環並未有顯著性的影響。

關鍵字

到院前心肺功能停止 ； 恢復自發性循環 ； 專責救護隊 ； 到院前處置

並列摘要

Background：A 4-minute prime time to rescue sudden cardiac arrest patients, every minute survival rate will be reduced by 10-12%. In order to successfully save the patient, we have to understand what is effective emergency treatment is necessary.
Objective：The hospital transport and pre-hospital emergency treatment of out-of-hospital cardiac arrest (OHCA) patients affect return of spontaneous circulation (ROSC) in Chiayi region.
Methods：The secondary data analysis is adopted as the basis of this study, the related medical data from January 2009 to December 2014 were collected in a regional teaching hospital emergency room OHCA patients over 20 years old situating in Chiayi region. OHCA patients were 636 people have been executed in the exclusion of non-implementation of cardiopulmonary resuscitation, trauma, drowning, poisoning, burns, ROSC transferred immediately, this study were 435 people. The ROSC as the dependent variable, hospital transport and pre-hospital emergency treatment, including automated external defibrillator, laryngeal mask airway, bystander CPR, pre-hospital shock as independent variables. Capture the pre-hospital emergency treatment, the hospital emergency treatment, hospital transport, survival situation, basic patient information as variables to do Descriptive statistics, Chi-square test, independent samples t-test, and logistic regression analysis.
Results：The pre-hospital cardiopulmonary function stopping patients with an average age of 72 years old, Most accompanied by people with medical background were 380 people (87.3%), the pre-hospital emergency treatment, including using the laryngeal mask airway were 27 people(6.2%), bystander cardiopulmonary resuscitation were 34 people(7.8%), and pre-hospital electric shock were 27 people(6.2%). The chi-square test between every independent variable and ROSC show that gender (p=0.147), age(p=0.015), chronic diseases (p=0.572), automated external defibrillator(p=0.682), laryngeal mask airway(p=0.836), bystander cardiopulmonary resuscitation(p=0.263), the pre-hospital electric shock(p=0.430), transport(p=0.305), heart rhythm is shockable in hospital(p=1.000), electric shock in hospital (p=0.004), injection Epinephrine times(p=0.059), designated ambulance crew(p=0.778). The pre-hospital stopping cardiopulmonary function patients in pre-hospital emergency treatment, designated ambulance crew, and ROSC were no significant differences by logistic regression test.
Conclusion：The pre-hospital emergency treatment, including patients accompanied by people with medical background to the emergency, using automated external defibrillators, using laryngeal mask airway, sent by designated ambulance crew, and shockable heart rhythm were no significant effect on ROSC in this regional teaching hospital of Chiayi.

並列關鍵字

Out-of-Hospital Cardiac Arrest(OHCA) ； Return of Spontaneous Circulation(ROSC) ； designated ambulance crew ； pre-hospital emergency treatment

參考文獻

吳榮平、余岐育(2011)·消防機關執行 OHCA 患者到院前緊急救護之調查研究·危機管理學刊，8(1)，9-18。

李文輝、廖訓禎、陳日昌、卜樂得(1996)·急重症病患使用緊急醫療救護系統送醫之意願調查·中華民國急救加護醫學會雜誌，7(2)，61-68。

李建璋(2006)·到院前呼吸心跳停止的流行病學與預後·當代醫學(391)，394-399。

李建璋、馬惠明、陳文鍾(2008)·心肺復甦後存活患者腦神經預後之預測因子·當代醫學，35(1)，23-27。

林俊農、林增記、郭美娟、周俊仁、林靖國、蔡米山(2002)·急診非創傷院前死亡病人急救成功之因子分析·Kaohsiung J Med Sci，18，84-90。