台灣離島地區腦中風病患空中轉診之流行病學研究

Epidemiologic study of stroke patients transported by emergency air medical services (EAMS) in Taiwan

葉俊廷(Chun-Ting Yeh)

指導教授 ： 蔡行瀚

臺北醫學大學/公共衛生暨營養學院/傷害防治學研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00156

摘要

前言：急性腦中風是一個真正的醫療急症。病患出現腦中風症狀時，應立即給予正確的診斷及治療。不論是梗塞性腦中風或出血性腦中風，近幾年都有逐漸年輕化的趨勢。台灣離島因醫療資源不足，居民若發生急性腦中風時，必須經由空中緊急醫療轉送至台灣本島治療。
目地：本論文分析台灣離島地區出現急性腦中風症狀並經由空中緊急醫療轉送返台就醫病患的流行病學分布，並探討各離島地區急性腦中風病患轉診數是否有逐年上升、年齡層是否有逐年下降的趨勢。
方法：這是一個回溯性敘述分析研究，作者檢閱行政院衛生署空中轉診審核中心於民國九十二年一月一日至民國九十九年十二月三十一日間，台灣離島地區，包括澎湖、金門、馬祖、蘭嶼、綠島、琉球及東沙，出現急性腦中風症狀並申請空中緊急醫療轉送返台就醫病患的電腦檔案及紙本紀錄，並進行分析研究。
結果：於八年研究期間，行政院衛生署空中轉診審核中心接獲台灣離島地區申請空中緊急醫療轉送的病患共計2,386位，通過審核共2,150位，其中因急性腦中風症狀經由空中緊急醫療轉送返台就醫的病患共計326位。民國九十二年至民國九十九年每年度轉診人數分別為26人、47人、58人、21人、33人、42人、56人、43人。各離島轉診人數分別為澎湖134人、金門112人、馬祖34人、蘭嶼24人、綠島20人、琉球1人、東沙1人。這326位病患平均年齡61.64±15.13歲，年齡最小12歲、年齡最大95歲；男性212位、女性114位；發作症狀以意識改變最常見(n=154)；轉診申請時間以上午八點到中午十二點最多(n=79)；病患就醫時平均意識狀態(GCS)分數為10.84±3.70分；梗塞性腦中風有120位、出血性腦中風有206位；轉診後住普通病房有90位、住加護病房有236位。研究期間每年度離島急性腦中風轉診病患的平均年齡分別為61.62±11.96歲、60.13±13.20歲、62.72±15.02歲、65.05±12.89歲、58.39±16.77歲、61.74±15.11歲、63.16±16.43歲、60.64±17.27歲 (P=0.770)。
結論：研究結果發現 : (一)台灣離島地區經空中緊急醫療轉送的急性腦中風病患人數從民國九十五年有增加之趨勢，推論應與行政院衛生署實施的全國性醫院緊急醫療能力評核及腦中風臨床治療準則有關。(二)離島地區急性腦中風空中轉診病患的平均年齡並沒有年輕化的趨勢，可能導因於離島地區人口老化，年齡層偏高。(三)金門地區神經專科醫師進駐使空中緊急醫療轉診急性腦中風人數有明顯下降，顯示增加離島地區醫療資源可以有效減少空中緊急醫療轉診的頻率，如何提升離島地區醫療服務品質，仍是刻不容緩的議題。

關鍵字

腦中風轉診 ； 空中轉診審核中心 ； 空中緊急醫療轉送

並列摘要

Introduction: Acute Stroke is a real medical emergency. Patients who appear to have stroke symptoms should be given the correct diagnosis and treatment immediately. Both ischemic stroke and hemorrhagic stroke in recent years had appeared on younger patients than they used to be. Because of the lack of medical resources in remote islands, local residents who get diagnosed with an acute stroke must be transferred immediately to the main island of Taiwan by Emergency air medical services(EAMS).
Objective: This thesis is mainly focusing on analyzing the epidemiological distribution of acute stroked patients transferred via EAMS from remote islands of Taiwan back to the mainland, and studying trends of transferred patients’ numbers and average ages.
Methods : This is a retrospective descriptive analysis study. We reviewed and analyzed both the digitized files and records in paper from National Aeromedical Approval Center, showing the acute stroked patients transferred via EAMS from January 1, 2003 to December 31, 2010 in many remote islands of Taiwan including Penghu, Kinmen, Lienchiang, Lanyu, Lyudao, Liouciou, and Dongsha Islands.
Results: During the eight years of assessment period, a total number of 2,386 applied for EAMS in remote islands of Taiwan and 2,150 of them were approved for their transportations. 326 out of those transferred patients appeared to have symptoms of acute stroke. The annual numbers of those in the past eight years were 26, 47, 58, 21, 33, 42, 56, 43. The total numbers of transferred patients for each island were 134 in Penghu, 112 in Kinmen, 34 in Lienchiang, 24 in Lanyu, 20 in Lyudao, 1 in Liouciou, and 1 in Dongsha Islands. The average age of total 326 patients was 61.64±15.13 years old, ranged from the youngest in 12 years old and the oldest in 95 years old. There were 212 men and 114 women. Change of consciousness level was the most common symptom of presentation (n=154). 8AM to 12PM was the most common time interval in applying for the transfer via EAMS. The average Glasgow Coma Scale score of the 326 patients in emergency department was 10.84±3.70. There were 120 ischemic stroked patients and 206 hemorrhagic stroked patients. 90 of transferred patients were admitted to the regular floors and 236 were cared in intensive care units after the transportation. The average ages of stroked patients transferred in remote Taiwan in each of the 8 assessment years were 61.62±11.96, 60.13±13.20, 62.72±15.02, 65.05±12.89, 58.39±16.77, 61.74 ±15.11, 63.16±16.4, and 60.64±17.27 years old. (P=0.770).
Conclusion: (1) The increased amount of acute stroked patients transferred via EAMS in remote islands of Taiwan from 2006 may be correlated to the national assessment done by “Department of Health, Executive Yuan” to all hospitals in their capabilities of handling the urgent care and to the clinical guidelines for acute stroke management. (2) The average age of these stroked patients transferred during the 8 years assessment period didn’t go down annually. This could be explained by the overall aging of the general population in remote areas. (3) After dispatching a neurologic specialist in Kinmen, we had seen the decreased amount of transferred patients via EAMS. This practice revealed that the frequency of EAMS employment could be reduced by providing sufficient medical resources and improving the quality of the care in the remote areas.

並列關鍵字

Stroke transfer ； National Aeromedical Approval Center ； Emergency air medical services

參考文獻

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