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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
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dc.contributor.advisor | 賴美淑 | |
dc.contributor.author | Ming-Ju Hsieh | en |
dc.contributor.author | 謝明儒 | zh_TW |
dc.date.accessioned | 2021-06-16T23:08:09Z | - |
dc.date.available | 2015-09-17 | |
dc.date.copyright | 2012-09-17 | |
dc.date.issued | 2012 | |
dc.date.submitted | 2012-08-05 | |
dc.identifier.citation | 1.The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol. 1988;41:105-14.
2.Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2:43-53. 3.Hsieh FI, Lien LM, Chen ST, et al. Get With the Guidelines-Stroke performance indicators: surveillance of stroke care in the Taiwan Stroke Registry: Get With the Guidelines-Stroke in Taiwan. Circulation. 2010;122:1116-23. 4.Chien K, Sung F, Hsu H, Su T, Lin R, Lee Y. Apolipoprotein A-I and B and stroke events in a community-based cohort in Taiwan: report of the Chin-Shan Community Cardiovascular Study. Stroke. 2002;33:39-44. 5.Hu HH, Chu FL, Chiang BN, et al. Prevalence of stroke in Taiwan. Stroke. 1989;20:858-63. 6.Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med. 1995;333:1581-7. 7.Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J. 1957;2:200-15. 8.Farrell B, Godwin J, Richards S, Warlow C. The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatry. 1991;54:1044-54. 9.Jauch EC, Cucchiara B, Adeoye O, et al. Part 11: adult stroke: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S818-28. 10.Goldstein L, Bertels C, Davis J. Interrater reliability of the NIH stroke scale. Arch Neurol. 1989;46:660-2. 11.高雄長庚紀念醫院NIHSS教學系統. http://www1.cgmh.org.tw/strokeshk/NIHSS/cai/page04.htm [cited 2012 May 8]. 12.台灣腦中風防治指引2008. http://www.stroke.org.tw/guideline/guideline_new.asp2008 [cited 2012 May 8]. 13.Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA. 1995;274:1017-25. 14.Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet. 1998;352:1245-51. 15.Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset:The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA. 1999;282:2019-26. 16.Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet. 2004;363:768-74. 17.Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317-29. 18.Lansberg MG, Bluhmki E, Thijs VN. Efficacy and safety of tissue plasminogen activator 3 to 4.5 hours after acute ischemic stroke: a metaanalysis. Stroke. 2009;40:2438-41. 19.Lees KR, Bluhmki E, Kummer Rv, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010;375:1695–703. 20.Fonarow GC, Smith EE, Saver JL, et al. Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke: patient characteristics, hospital factors, and outcomes associated with door-to-needle times within 60 minutes. Circulation. 2011;123:750-8. 21.Wester P, Rådberg J, Lundgren B, Peltonen M. Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA: a prospective, multicenter study.Seek- Medical-Attention-in-Time Study Group. Stroke. 1999;30:40-8. 22.Johnston F, Wardlaw J, Dennis M, et al. Delays in stroke referrals. Lancet. 1999;354:47-8. 23.Charleston A, Barber P, Bennett P, Spriggs D, Harris R, Anderson N. Management of stroke in Auckland Hospital in 1996. N Z Med J. 1999;112:71-4. 24.Hoegerl C, Goldstein F, Sartorius J. Implementation of a stroke alert protocol in the emergency department: a pilot study. J Am Osteopath Assoc. 2011;111:21-7. 25.Lindsberg P, Häppölä O, Kallela M, Valanne L, Kuisma M, Kaste M. Door to thrombolysis: ER reorganization and reduced delays to acute stroke treatment. Neurology. 2006;67:334-6. 26.Tilley B, Lyden P, Brott T, Lu M, Levine S, Welch K. Total quality improvement method for reduction of delays between emergency department admission and treatment of acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Arch Neurol. 1997;54:1466-74. 27.Heo JH, Kim YD, Nam HS, et al. A computerized in-hospital alert system for thrombolysis in acute stroke. Stroke. 2010;41:1978-83. 28.Hamidon BB, Dewey HM. Impact of acute stroke team emergency calls on in-hospital delays in acute stroke care. J Clin Neurosci. 2007;14:831-4. 29.Nazir FS, Petre I, Dewey HM. Introduction of an acute stroke team: an effective approach to hasten assessment and management of stroke in the emergency department. J Clin Neurosci. 2009;16:21-5. 30.Fonarow GC, Smith EE, Saver JL, et al. Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association's Target: Stroke initiative. Stroke. 2011;42:2983-9. 31.Sattin JA, Olson SE, Liu L, Raman R, Lyden PD. An expedited code stroke protocol is feasible and safe. Stroke. 2006;37:2935-9. 32.Tai YJ, Weir L, Hand P, Davis S, Yan B. Does a 'Code Stroke' rapid access protocol decrease door-to-needle time for thrombolysis? Intern Med J. 2011 Dec 29. doi: 10.1111/j.1445-5994.2011.02709.x. [Epub ahead of print] 33.Batmanian J, Lam M, Matthews C, et al. A protocol-driven model for the rapid initiation of stroke thrombolysis in the emergency department. Med J Aust. 2007;187:567-70. 34.Gregg C. Fonarow, Eric E. Smith, Jeffrey L. Saver, et al. Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association's Target: Stroke initiative. Stroke. 2011;42:2983-9. 35.de la Ossa NP, J. Sanchez-Ojanguren J, Palomeras E, et al. Influence of the stroke code activation source on the outcome of acute ischemic stroke patients. Neurology. 2008;70:1238-43. 36.Bae HJ, Kim DH, Yoo NT, et al. Prehospital notification from the emergency medical service reduces the transfer and intra-hospital processing times for acute stroke patients. J Clin Neurol. 2010;6:138-42. 37.Puolakka T, Vayrynen T, Happola O, Soinne L, Kuisma M, Lindsberg PJ. Sequential analysis of pretreatment delays in stroke thrombolysis. Acad Emerg Med. 2010;17:965-9. 38.Pines JM, Localio AR, Hollander JE, et al. The impact of emergency department crowding measures on time to antibiotics for patients with community-acquired pneumonia. Ann Emerg Med. 2007;50:510-6. 39.Mills AM, Shofer FS, Chen EH, Hollander JE, Pines JM. The association between emergency department crowding and analgesia administration in acute abdominal pain patients. Acad Emerg Med. 2009;16:603-8. 40.Pines J, Hollander J. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med. 2008;51:1-5. 41.Solberg L, Asplin B, Weinick R, Magid D. Emergency department crowding: consensus development of potential measures. Ann Emerg Med. 2003;42:824-34. 42.Wang Y, Liao X, Zhao X, et al. Using recombinant tissue plasminogen activator to treat acute ischemic stroke in China: analysis of the results from the Chinese National Stroke Registry (CNSR). Stroke. 2011;42:1658-64. 43.陳志弘。中風治療品質:談急性中風靜脈血栓溶解治療之比例。腦中風學會會訊. 2010;17:2-4. 44.George M, Tong X, McGruder H, et al. Paul Coverdell National Acute Stroke Registry Surveillance - four states, 2005-2007. MMWR Surveill Summ. 2009;58:1-23. 45.van den Berg JS, de Jong G. Why ischemic stroke patients do not receive thrombolytic treatment: results from a general hospital. Acta Neurol Scand. 2009;120:157-60. 46.Garcia-Monco JC, Pinedo A, Escalza I, et al. Analysis of the reasons for exclusion from tPA therapy after early arrival in acute stroke patients. Clin Neurol Neurosurg. 2007;109:50-3. 47.江俊宜, 賴呈樺, 熊光華等。整合到院前及到院後急性缺血性腦中風溶栓照護:以北臺灣為例:前趨研究。Journal of Taiwan College of Emergency Physician. 2010;2:74-82. 48.Yip P, Jeng J, Lu C. Hospital arrival time after onset of different types of stroke in greater Taipei. J Formos Med Assoc. 2000;99:532-7. 49.Williams J, Rosamond W, Morris D. Stroke symptom attribution and time to emergency department arrival: the delay in accessing stroke healthcare study. Acad Emerg Med. 2000;7:93-6. 50.Geffner D, Soriano C, Perez T, Vilar C, Rodriguez D. Delay in seeking treatment by patients with stroke: who decides, where they go, and how long it takes. Clin Neurol Neurosurg. 2012;114:21-5. 51.Clark JM, Renier SA. A community stroke study: factors influencing stroke awareness and hospital arrival time. J Stroke Cerebrovasc Dis. 2001;10:274-8. 52.Jones SP, Jenkinson AJ, Leathley MJ, Watkins CL. Stroke knowledge and awareness: an integrative review of the evidence. Age Ageing. 2010;39:11-22. 53.Lin CS, Tsai J, Woo P, Chang H. Prehospital delay and emergency department management of ischemic stroke patients in taiwan, r.o.c. Prehosp Emerg Care. 1999;3:194-200. 54.Barber P, Zhang J, Demchuk A, Hill M, Buchan A. Why are stroke patients excluded from TPA therapy? An analysis of patient eligibility. Neurology. 2001;56:1015-20. 55.Mikulik R, Goldemund D, Reif M, et al. Calling 911 in response to stroke: no change following a four-year educational campaign. Cerebrovasc Dis. 2011;32:342-8. 56.Luepker R, Raczynski J, Osganian S, et al. Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: The Rapid Early Action for Coronary Treatment (REACT) Trial. JAMA. 2000;284:60-7. 57.Bett J, Tonkin A, Thompson P, Aroney C. Failure of current public educational campaigns to impact on the initial response of patients with possible heart attack. Intern Med J. 2005;35:279-82. 58.Mikulik R, Bunt L, Hrdlicka D, Dusek L, Vaclavik D, Kryza J. Calling 911 in response to stroke: a nationwide study assessing definitive individual behavior. Stroke. 2008;39:1844-9. 59.Mosley I, Nicol M, Donnan G, Patrick I, Dewey H. Stroke symptoms and the decision to call for an ambulance. Stroke. 2007;38:361-6. 60.Kothari R, Pancioli A, Liu T, Brott T, Broderick J. Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ann Emerg Med. 1999;33:373-8. 61.Smith W, Isaacs M, Corry M. Accuracy of paramedic identification of stroke and transient ischemic attack in the field. Prehosp Emerg Care. 1998;2:170-5. 62.Kidwell C, Starkman S, Eckstein M, Weems K, Saver J. Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS). Stroke. 2000;31:71-6. 63.Morgenstern L, Staub L, Chan W, et al. Improving delivery of acute stroke therapy: The TLL Temple Foundation Stroke Project. Stroke. 2002;33:160-6. 64.Jeng J, Tang S, Deng I, Tsai L, Yeh S, Yip P. Stroke center characteristics which influence the administration of thrombolytic therapy for acute ischemic stroke: a national survey of stroke centers in Taiwan. J Neurol Sci. 2009;281:24-7. 65.Evenson K, Foraker R, Morris D, Rosamond W. A comprehensive review of prehospital and in-hospital delay times in acute stroke care. Int J Stroke. 2009;4:187-99. 66.Bray J, Martin J, Cooper G, Barger B, Bernard S, Bladin C. An interventional study to improve paramedic diagnosis of stroke. Prehosp Emerg Care. 2005;9:297-302. 67.Schmitz C, Parsons B. Everything you wanted to know about logic models but were afraid to ask. http://www.insites.org/documents/logmod.htm1999 [cited 2012 May 10]. 68.Foundation WKK. Logic model development guide. http://www.wkkf.org/knowledge-center/resources/2006/02/WK-Kellogg-Foundation-Logic-Model-Development-Guide.aspx; 1998 [cited 2012 May 10]. 69.Kleindorfer D, Broderick J, Khoury J, et al. The unchanging incidence and case-fatality of stroke in the 1990s: a population-based study. Stroke. 2006;37:2473-8. 70.Reeves MJ, Arora S, Broderick JP, et al. Acute stroke care in the US: results from 4 pilot prototypes of the Paul Coverdell National Acute Stroke Registry. Stroke. 2005;36:1232-40. 71.Heuschmann PU, Berger K, Misselwitz B, et al. Frequency of thrombolytic therapy in patients with acute ischemic stroke and the risk of in-hospital mortality: the German Stroke Registers Study Group. Stroke. 2003;34:1106-13. 72.Reed S, Cramer S, Blough D, Meyer K, Jarvik J. Treatment with tissue plasminogen activator and inpatient mortality rates for patients with ischemic stroke treated in community hospitals. Stroke. 2001;32:1832-40. 73.Grotta J, Burgin W, El-Mitwalli A, et al. Intravenous tissue-type plasminogen activator therapy for ischemic stroke: Houston experience 1996 to 2000. Arch Neurol. 2001;58:2009-13. 74.Mikulik R, Kadlecova P, Czlonkowska A, et al. Factors influencing in-hospital delay in treatment with intravenous thrombolysis. Stroke. 2012;43:1578-83. 75.Bluhmki E, Chamorro A, Dávalos A, et al. Stroke treatment with alteplase given 3.0-4.5 h after onset of acute ischaemic stroke (ECASS III): additional outcomes and subgroup analysis of a randomised controlled trial. Lancet Neurol. 2009;8:1095-102. 76.Generalized efficacy of t-PA for acute stroke. Subgroup analysis of the NINDS t-PA Stroke Trial. Stroke. 1997;28:2119-25. 77.Ferrari J, Knoflach M, Kiechl S, et al. Stroke thrombolysis: having more time translates into delayed therapy: data from the Austrian Stroke Unit Registry. Stroke. 2010;41:2001-4. 78.Lecouturier J, Rodgers H, Murtagh M, White M, Ford G, Thomson R. Systematic review of mass media interventions designed to improve public recognition of stroke symptoms, emergency response and early treatment. BMC Public Health. 2010;10:784. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/64921 | - |
dc.description.abstract | 背景
近年來,腦中風為台灣十大死因的第三位,而缺血性腦中風約占所有腦中風的七成左右。血栓溶解劑被證明可改善急性缺血性腦中風病患的功能性預後,且中風症狀發生後越早施打血栓溶解劑效果越好。縮短病患到達急診後至接受血栓溶解治療的時間不僅可增加血栓溶解治療的效果,也可減少血栓溶解治療併發症產生的機會。某醫院已進行急性腦中風急診病患縮短血栓溶解治療時間之介入方案且進入成熟期。該介入方案自2010年8月1日開始進行分階段導入。本研究主要目的在評估該醫院之介入方案結果。另外亦尋求影響血栓溶解治療時間的影響因子。 材料與方法 本評估研究比較2010年1月1日至2010年7月31日之介入方案前期間及2011年3月1日至7月31日之介入方案後評估期間之變化。評估指標包括病患到達急診至開始接受血栓溶解劑的時間、到達急診至完成電腦斷層時間與接受血栓溶解治療的病患占急性缺血性腦中風病患的比例。研究個案之納入條件為:(1)研究期間內經急診到院,且到達急診離症狀發作時間≦3小時;(2)經影像檢查或神經科醫師診斷為急性缺血性腦中風的病患。排除條件為:(1)在醫院內發生的缺血性中風; (2)在其他醫院經由影像學檢查與醫師診斷為急性缺血性腦中風,為了接受血栓溶解治療而轉診前來本院。經訓練的中風登錄員以病歷回顧方式,回溯性地收集於該醫院急診部之腦中風及短暫缺血性中風病患的人口統計學資料與相關中風資訊,同時收集研究期間病患到院前救護資料。利用醫院之醫療資訊系統抓取於研究期間內,執行電腦斷層完成後,第一張電腦斷層片上傳電腦的時間與急診擁塞指標。 結果 在介入方案前期間和介入方案後評估期間分別有607位及554位於症狀發作10天內經急診入院的腦中風及短暫缺血性腦中風病患。在排除了腦內出血、蜘蛛膜下腔出血、短暫缺血性腦中風病患、在醫院內發生中風的病患、到達急診距離症狀發作時間超過3小時的病患,以及從外院轉來接受施打血栓溶解劑的病患後,介入方案前期間和介入方案後評估期間分別有106位及90位病患成為研究族群,而其中有57位病患接受血栓溶解劑。18位於介入方案前期間接受血栓溶解劑治療,而其他39位則於介入方案後評估時期接受血栓溶解劑治療。經由比較兩期間病患到達急診至開始接受血栓溶解治療的時間中發現,該時間間隔的中位數由原本的66.5分鐘縮減到53分鐘且有統計學上的意義﹙P=0.03﹚。到達急診至完成電腦斷層時間從介入方案前期間的42.5分鐘下降為11.6分鐘﹙P<0.01﹚。接受血栓溶解劑病患占所有缺血性腦中風病患比例從原本之4.19%上升到9.95%﹙P<0.01﹚。介入方案為唯一影響到達急診至開始接受血栓溶解劑的時間≦60分鐘目標的影響因子﹙P=0.03﹚,而年齡與到院前救護人員處置時間並無影響。 結論 本評估研究發現該介入方案可使病患到達急診至完成電腦斷層時間及開始接受血栓溶解治療的時間都顯著地縮短,達到美國心臟醫學會準則建議的目標;接受血栓溶解劑治療病患占急性缺血性腦中風病患的比例亦顯著增加。介入方案實行後,到院前救護處置時間長短卻無顯著改變。上述評估研究結果顯示此介入方案有效改善了急性腦中風病患的醫療照護品質。 | zh_TW |
dc.description.abstract | Background
Recently, stroke is the third leading cause of death in Taiwan. About 70% of stroke is ischemic stroke. Thrombolytic therapy has been proved to improve the functional outcome of the patients with acute ischemic stroke. In addition, It also has been shown that the sooner the stroke patients receiving thrombolytic therapy, the better the functional outcome. Door-to-needle time is defined as the time duration from patients arriving at emergency department (ED) to patients starting to receive thrombolytic therapy. Shortening the door-to-needle time not only increases the effects of thrombolytic therapy but also lowers the risk of complications induced by the therapy. One intervention program on shortening the door-to-needle times in ED patients with acute stroke has performed in the hospital and is under the period of maturity. The intervention program was launched step by step since August 1, 2010. The aim of our study is to evaluate the intervention program. We also want to search the factors affecting the door-to-needle time. Material and Methods Our study compared the condition of the evaluation period from March 1, 2011 to July 31, 2011 with those of the pre-intervention period from January 1, 2010 to July 31, 2010. The evaluation measures included the door-to-needle time, the time duration from patients arriving at ED to computed tomography being finished (door-to-CT time) and the percentage of patients with thrombolytic therapy among ischemic stroke patients. The inclusion criteria were as follows: (1) patients arriving at ED within 3 hours after symptoms onset (2) ischemic stroke patients diagnosed by neurologists or neuroimaging results. Patients with in-hospital stroke, or patients transferred from other hospitals for thrombolytic therapy were excluded. The trained stroke registrar collected the demographics and the in-hospital stroke data of the study group retrospectively. The pre-hospital data was collected at the same time. We also acquired the time of finishing computed tomography (CT) and ED overcrowding variables from the medical information system of the hospital. Results A total of 607 patients during the pre-intervention period and 554 patients during the evaluation period diagnosed as stroke and transient ischemic stroke visited ED within 10 days after symptoms onset. After excluding patients with intra-cerebral hemorrhage, subarachnoid hemorrhage, transient ischemic stroke, in-hospital stroke, patients arriving at ED more than 3 hours after stroke onset and patients transferred from other hospitals for thrombolytic therapy, there were 106 patients during the pre-intervention period and 90 patients during the evaluation period into our study group. Fifty-seven patients of our study group received thrombolytic therapy with 18 patients during the pre-intervention period. The median of door-to-needle time decreased from 66.5 minutes to 53 minutes significantly after intervention program was performed (p=0.03). The door-to-CT time decreased from 42.5 minutes to 11.6 minutes significantly (p<0.01). The percentage of patients with thrombolytic therapy among ischemic stroke patients increased from 4.19% to 9.95% (p<0.01). Intervention program was the only factor affecting the door-to-needle time≦60 minutes (p=0.03). No association was noted between age and the door-to-needle time≦60 minutes. The pre-hospital operation period was not different significantly (22.5 minutes vs. 24 minutes, p=0.43). Conclusion Our study revealed that the intervention program shortened the door-to-CT time and the door-to-needle time significantly. The intervention program achieved the goals of management time recommended by the American Heart Association guideline. In addition, the percentage of patients with thrombolytic therapy among ischemic stroke patients also increased significantly after intervention program was implemented. Nevertheless, the duration of pre-hospital operation period did not change. Our study showed that the intervention program effectively improved the quality of care in patients with acute stroke. | en |
dc.description.provenance | Made available in DSpace on 2021-06-16T23:08:09Z (GMT). No. of bitstreams: 1 ntu-101-R99849015-1.pdf: 657897 bytes, checksum: e6468e566bdefb5b687ae67f176b59c0 (MD5) Previous issue date: 2012 | en |
dc.description.tableofcontents | 口試委員會審定書 i
誌謝 ii 中文摘要 iii 英文摘要 v 第一章 背景 1 第二章 文獻回顧 2 第一節 腦中風的治療 2 第二節 國內外縮短血栓溶解治療時間的介入方案 4 第三節 國內外增加血栓溶解劑施打比例的介入方案 10 第四節 介入方案之評估 14 第五節 於台灣之血栓溶解劑治療相關研究 15 第六節 血栓溶解劑治療的行動方案模式 16 第七節 介入方案之描述 17 第三章 目的 26 第四章 材料與方法 27 第一節 研究方法 27 第二節 研究個案資料收集 29 第三節 研究變項 31 第四節 樣本估計 34 第五節 統計方法 34 第六節 評估研究族群之選擇過程 35 第五章 結果 40 第一節 介入方案前後時期評估指標之比較 40 第二節 到達急診至接受血栓溶解劑時間之影響因子 42 第三節 介入方案前後時期到院前救護處置時間之比較 42 第六章 討論 47 第一節 縮短血栓溶解治療時間介入方案的選擇 47 第二節 選擇評估指標之理由 47 第三節 血栓溶解治療時間與完成電腦斷層時間探討 48 第四節 缺血性腦中風病患接受血栓溶解劑的比例探討 50 第五節 介入方案對於症狀性腦出血與院內死亡率之影響 51 第六節 影響血栓溶解治療時間的因子分析探討 52 第七節 到院前救護處置時間之探討 54 第八節 急診擁塞指標之影響 55 第九節 研究限制與未來研究之建議 55 第十節 未來政策實施之建議 56 第七章 結論 59 參考文獻 60 | |
dc.language.iso | zh-TW | |
dc.title | 急性腦中風急診病患縮短血栓溶解治療時間介入方案的評估研究 | zh_TW |
dc.title | Evaluation of Intervention Program on Shortening the Door-to-needle Times in Emergency Department Patients with Acute Stroke | en |
dc.type | Thesis | |
dc.date.schoolyear | 100-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 馬惠明,林寬佳,賴超倫,邵文逸 | |
dc.subject.keyword | 中風,栓溶治療,組織與行政,品質, | zh_TW |
dc.subject.keyword | stroke,thrombolytic therapy,organization and administration,quality, | en |
dc.relation.page | 65 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2012-08-06 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 流行病學與預防醫學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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