院前緊急救護之遠距資訊醫療整合系統研發

給予院前心肺功能停止(out-of-hospital cardiac arrest, OHCA)患者持續地實施心肺復甦術為提升病患生存率之重點，本研究基於電動心臟按摩器之急救運行過程，施以即時且有效的心臟按摩，並整合即時生理監測系統，建構雲端網路平台，使院端即時獲得患者院前之關鍵生命訊息，爭取院前救治之時效性。本課題所發展的系統平台包含三大部分：(一)救護監測系統、(二)雲端資料庫系統與(三)網頁診斷平台。救護監測系統由訊號擷取與即時監測系統所構成，透過心電圖、光脈動體積描述圖與荷重元感測模組，將擷取得之訊號顯示於生理監測平台，同時以緊急救護平台紀錄初步評估之救護紀錄表，並經由行動無線網路更新至雲端資料庫系統之中。與此同時，網頁診斷平台即可透過網際網路獲得患者之生理參數、救護紀錄等表單內資訊，於第一時間執行診斷與評估，有效加速院端後續醫療處置的準備工作。本課題已完成即時生理監測資訊與雲端資料庫之系統整合，同時網頁診斷平台與資料庫連線顯示所有資訊。本系統之心率演算與模擬器之相關係數為0.99，血氧濃度演算與市售儀器結果之相關係數為0.9979，皆顯示出相當高之相關性。而即時視訊主要以使用者資料流通訊協定(User Datagram Protocol, UDP)進行傳輸，本課題設計即時偵測幀數建立傳輸協議切換機制，在網路涵蓋不佳的地域切換為傳輸控制協議(Transmission Control Protocol, TCP)，可提高影像接收率7%之多，有效降低影像傳輸遺失率。

關鍵字

到院前心肺功能停止；醫療資訊系統；自動心臟按摩系統；雲端資料庫系統

並列摘要

Performing cardiopulmonary resuscitation (CPR) continuously among patients with out-of-hospital cardiac arrest (OHCA) is the key point to decrease the mortality. Based on electric-based automated CPR system, the purpose of this study was to develop an integrated telemedicine system that combines bio-signal monitoring and cloud based platform to deliver critical information during CPR. The structure of this study are as follows, (1) aid monitoring system, (2) cloud based database system and (3) consultation platform. Aid monitoring system consists of bio-signal acquisition and real-time monitoring system, delivering on-site information, such as electrocardiogram (ECG), photoplethysmogram (PPG) and real-time video to off-site physician in the hospital emergency department(ED). Meanwhile, all information and patient care records (PCR) will be stored into cloud database system via 4G mobile network, so that physicians in the hospital can obtain critical data of patients on the consultation platform for diagnosis during ambulance transport and effectively accelerate the preparatory work of the follow-up medical treatment. This study successfully accomplished the integration of physiological monitoring and cloud database system, allowing physician to browse records of the same patient via cloud database connection. Compared to the simulator, the correlation coefficient of heart rate is 0.99; and the correlation coefficient of SpO_2 between home made device and oximeter sold in the market is 0.9979, which shows a high degree of similarity. The real-time video was transmitted via User Datagram Protocol(UDP), this study proposed a switching protocol UDP and TCP(Transmission Control Protocol), which improve the efficacy of video transmission in rural area about 7%.

並列關鍵字

out-of-hospital cardiac arrest ； telemedicine system ； automated CPR system ； database system

參考文獻

[1] J. M. Field, M. F. Hazinski, M. R. Sayre, L. Chameides, S. M. Schexnayder, R. Hemphill, et al., "Part 1: executive summary 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care," Circulation, vol. 122, pp. S640-S656, 2010.

[2] J. Berdowski, R. A. Berg, J. G. Tijssen, and R. W. Koster, "Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies," Resuscitation, vol. 81, pp. 1479-1487, 2010.

[4] D. J. Kereiakes, W. D. Weaver, J. L. Anderson, T. Feldman, B. Gibler, T. Aufderheide, et al., "Time delays in the diagnosis and treatment of acute myocardial infarction: A tale of eight cities Report from the Pre-hospital Study Group and the Cincinnati Heart Project," American heart journal, vol. 120, pp. 773-780, 1990.

[5] C. J. Terkelsen, J. F. Lassen, B. L. Nørgaard, J. C. Gerdes, S. H. Poulsen, K. Bendix, et al., "Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-hospital diagnosis and direct referral to primary percutanous coronary intervention," European heart journal, vol. 26, pp. 770-777, 2005.

[6] P. Montgomery, M. Godfrey, S. Mossey, M. Conlon, and P. Bailey, "Emergency department boarding times for patients admitted to intensive care unit: Patient and organizational influences," International emergency nursing, vol. 22, pp. 105-111, 2014.

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院前緊急救護之遠距資訊醫療整合系統研發

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