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標題: | 院前施作心電圖對於心肌梗塞患者救護品質之提升與流程配套-以嘉義市為例 Operation Improvement in EMS system for Early Detection of Myocardial Infarction with Prehospital Electrocardiogram Applied-A Case Study of Chiayi City |
作者: | Hsin-Jou Lu 呂欣柔 |
指導教授: | 余峻瑜(Jun-Yu Yu) 余峻瑜(Jun-Yu Yu | jyyu@ntu.edu.tw | ), |
關鍵字: | 十二導程心電圖,STEMI,救護服務流程,服務藍圖,現場停留時間, 12-leads EKG,STEMI,Medical service process,Service blueprint,On-scene time, |
出版年 : | 2022 |
學位: | 碩士 |
摘要: | ST段上升型心肌梗塞(STEMI)的病程演進快速,時間的流逝將導致心肌受損面積及疾病死亡率的增加,因此在急救治療上刻不容緩。以往診斷是以到院後心電圖量測的波型結果作為判斷依據,如今能透過院前心電圖設備的導入及完善的救護執行流程與相關單位的合作,識別STEMI患者,提早通知急救責任醫院進行心導管室準備工作。 本文藉由訪談嘉義市消防局救護科科長與一名高級救護救官,了解設備導入後的救護服務流程及配套措施,並以服務藍圖呈現患者從報案至接受心導管治療的完整服務傳遞過程,透過前台與後台流程的劃分與呈現,除了可見患者與前線救護人員的接觸,亦可得知服務系統運行的背後,相關單位在每一個救護時間段的任務與協作。 而嘉義市消防局心電圖執行成果,從2017累計至2021年底,心電圖的執行件數為548件,當中儀器判讀為AMI的共82件,成功識別出了25名STEMI患者,立即送往急救責任醫院治療。另外,典型症狀的胸悶胸痛案件於2021年度,心電圖量測的執行率也從2020年度的38%提升至62%。 最終,本研究藉由樣本資料探究心電圖設備導入對救護時長的影響,得知有執行心電圖量測之案件(n=106),在現場停留時間(On-scene time)相較同期無量測案件(n=107)及傳統無心電圖設備時期(n=107),平均救護用時分別會增加4.4分鐘(p<0.05)及5.75分鐘(p<0.05),而完整救護時間(接獲報案至抵達醫院)平均為20.08±6.09分鐘。 The disease of ST-elevation myocardial infarction (STEMI) progresses rapidly. The duration of symptoms before reperfusion lead to the reduction in mortality and extent of myocardial salvage. Thus, time to treatment is critical. Nowadays, a pre-hospital EKG acquired by EMS providers can early detect the STEMI patients, and then the catheterization laboratory team can be activated before the patient arrival at the hospital. The study sought to understand the operational transformation in EMS system with 12-leads EKGs implemented, such as medical service process and supporting measures. Besides, this study also focuses on the impact on additional on-scene time and hospital arrival time. Based on the interviews with Division Chief of Emergency and Rescue Section and EMT-P in Chiayi City, the service blueprint shows the service delivery process from patient’s call to reperfusion therapy been conducted. The on-stage and back-stage actions and coordination are also presented. As for the results of EKG execution in Chiayi City from 2017 to 2021, a total of 548 patients received a pre-hospital EKG, and 82 patients of them are interpreted as AMI by device. Overall, 25 STEMI patients are successfully identified and transported to PCI-capable hospital. Besides, the execution rate of chest-pain cases increases from 38% in 2020 to 62% in 2021. Finally, the result shows that prehospital EKGs (n=107), compared with the cases in the same period without pre-hospital EKGs (n=108) and traditional process (n=108), were associated with a mean increase in on-scene time of 4.4 minutes and 5.75 minutes, respectively. And the mean of hospital arrival time was 20.08±6.09 minutes. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/86023 |
DOI: | 10.6342/NTU202203446 |
全文授權: | 同意授權(全球公開) |
電子全文公開日期: | 2022-09-23 |
顯示於系所單位: | 商學研究所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
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U0001-1509202216321800.pdf | 3.98 MB | Adobe PDF | 檢視/開啟 |
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