(3.80.6.131) 您好!臺灣時間:2021/05/14 03:48
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:董家檥
研究生(外文):Chia-Yi Tung
論文名稱:住院病人心臟驟停與早期預警徵象和心肺復甦成效之探討
論文名稱(外文):Improving outcome in cardiopulmonary resuscitation for hospital inpatients: systems to prevent cardiac arrests through recognition of early warning signs and timely intervention
指導教授:許玫琪許玫琪引用關係
指導教授(外文):Mei-Chi Hsu
學位類別:碩士
校院名稱:義守大學
系所名稱:管理碩博士班
學門:商業及管理學門
學類:企業管理學類
論文種類:學術論文
論文出版年:2016
畢業學年度:104
語文別:中文
論文頁數:48
中文關鍵詞:院內心跳停止心肺復甦早期預警徵象
外文關鍵詞:in-hospital cardiac arrestcardiopulmonary resuscitationearly warning signs
相關次數:
  • 被引用被引用:0
  • 點閱點閱:242
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
院內或院外急救在病人危急時是非常重要,然而往往忽視了在院內的心肺停止發生前的危險因子,本研究目的為探討高雄市某區域教學醫院院內住院病人心臟驟停與早期預警徵象和心肺復甦成效之探討。
採病歷回溯性研究,於西元2013年1月1日至西元2014年12月31日分析發生院內心跳停止施行心肺復甦的病患資料,問卷回收後,進行資料編碼及登錄,以SAS 9.4版本之統計軟體來進行資料分析。
本研究共查閱310本病歷,研究結果顯示病人基本資料,例如:年齡與性別與急救成功並無統計學上顯著差異;內科發生心臟驟停居多,但依然沒有達到統計上的顯著差異;病人的過去疾病史,例如:心衰竭、呼吸衰竭、癌症等也無顯著差異。在急救處置上、發生急救之初始呼吸變化與急救成效達到統計上的差異。心臟驟停前預警徵象、包含體溫、心跳次數、呼吸次數、脈搏次數、收縮壓、舒張壓、血氧濃度、疼痛分數會隨著時間達到顯著性的變化,從分析中發現,(1)前一小時的預警徵象變化中呼吸次數(P =0.01)、血氧濃度(P =0.01)及疼痛分數有顯著差異(P =0.002);(2).前二小時預警徵象統計在體溫(P=0.008)、呼吸次數(P =0.001)、脈搏次數(P =0.03)、血氧濃度(P =0.01)有顯著差異;(3)前三小時預警徵象在血氧濃度(P =0.03)有顯著差異(4)前四小時預警徵象中呼吸次數(P=0.03)有顯著差異;(5)前五小時預警徵象心跳次數(P =0.036)、呼吸次數(P =0.013) 、脈搏(P =0.029)、收縮壓(P=0.005)均達到統計上的顯著差異。
初始心律為心室纖維性顫動 (ventricular flutter,VF)與無脈搏心室心搏過速(ventricular tachycardia,VT)共266人次,即時執行去顫術人次為26人次(9.8%),發生心室顫動(VF)/無脈搏頻脈(VT)至執行去顫術時間≤3分鐘為3人次(1.1%),發現心臟驟停時為VF/VT心律存活出院為31人次(11.7%)。
急救無脈搏心跳死亡病人269人次中,有簽署拒絕心肺復甦術(Do not resuscitate,DNR)宣告或撤除維生設備只有39人次(14.5%);停止CPR原因包含無救治希望89人次(28.7%),死亡50人次(16.1%),急救後家屬要求簽屬DNR同意書39人(12.6%),家屬要求停止急救17人次(5.5%),和急救後回復自發性循環Return of Spontaneous Circulation 149人次(41.6%)。本研究結果也發現心肺復甦前預警徵象和第一時間電擊對存活率有正面的影響。
期待本研究結果能協助醫院改善病人心臟驟停與早期預警徵象的評估,讓住院病人心臟驟停的發生率降低、且提升心肺復甦之成功率和存活率,減少心臟驟停後所引發的身心傷害與住院天數延長。

It is often ignored to recognize early signs of sudden cardiac arrest and risk factors of clinical deterioration, when rapid assessment and resuscitation of critical conditions in in-hospital or out-of-hospital may need to be carried out. The study aim was to investigate the relationship and outcomes of cardiac arrest, early warning signs and cardiopulmonary resuscitation in hospital inpatients.
The is a retrospective chart review study by reviewing clinical data of patients who experienced sudden cardiac arrest and cardiopulmonary resuscitation. The patients’ medical records in hospital data bank dated from January 2013 to December 2014 were collected from a large mental hospital in southern Taiwan. The data were analyzed by applying SAS 9.4 full version.
A total of 310 patients met entry criteria. Results showed that demographic variables such as age and sex were not significantly correlated with success in first aid management. Internal Medicine had more cases of cardiac arrest, although it did not reach statistically significant difference. The past history of diseases such as heart failure, respiratory failure and cancers was shown to be non- statistically significant correlated for first aid management. Initial respiration changes when emergency occurs and success in first aid management were statistically significant correlated. Early warning signs such as temperature, heart rates, pulse rates, systolic pressure, diastolic pressure, blood oxygen saturation and pain scores showed significant differences over time. A number of results were found: (1). patients had significant changes in respiratory rates (P =0.01), blood oxygen saturation (P =0.01) and pain scores (P =0.002) within first monitored one hour of the warning signs. (2). Significant changes in temperature (P=0.008), respiratory rates (P =0.001), pulse rates (P =0.03) and blood oxygen saturation (P =0.01) in the monitored second hour of the warning signs. (3). Significant changes in blood oxygen saturation (P =0.03) in the monitored third hour of the warning signs. (4). Significant changes in respiratory rates (P =0.03) in the monitored fourth hour of the warning signs. (5). Changes of heart rates (P =0.036), respiratory rates (P =0.013), pulse rates (P =0.029), and systolic pressure (P=0.005) were all reached statistical significance in the monitored fifth hour of the warning signs.
A total of 266 inpatients showed first monitored rhythm as ventricular flutter (VF) and pulseless ventricular tachycardia (VT). Twenty-six patients (9.8%) received prompt defibrillation. Three inpatients’ defibrillation (1.1%) after the appearance of VT/VF is within three minutes. A rate of survival from cardiac arrest was associated with VT and VF to 31 inpatients (11.7%)
There are a total of 39 inpatients (14.5%) who signed do not resuscitate (DNR) or removed life support system in 269 pulseless and no heartbeat deaths after first aid management. Reasons of cessation of CPR include patients with a hopeless prognosis (N=89, 28.7%), death (N=50, 16.1%), family signed DNR after first aid management (N=39, 12.6%), requests from family to end CPR (N=17, 5.5%), and return of spontaneous circulation after first aid management (N=149, 41.6%). The study also found that early warning signs and prompt defibrillation is beneficial to rate of survival.
Hopefully, this study could help to improve the assessments of in-hospital cardiac arrest and early warning signs in order to decrease the incidences of cardiac arrest of inpatients, increase the success of cardiopulmonary resuscitation and inpatients’ survival rates, and decrease the physiological and psychological impacts and admission days.

致謝 i
中文摘要 ii
英文摘要 iv
目錄 vi
表目錄 viii
圖目錄 ix
第一章 緒論 1
第一節 研究背景與動機 1
第二節 問題陳述與研究問題 2
第三節 研究重要性 3
第二章 文獻查證 6
第一節 心肺復甦背景 6
第二節 心肺復甦相關研究 7
第三節 早期預警系統及其相關研究 9
第三章 研究方法 11
第一節 研究設計 11
第二節 研究情境場所 11
第三節 資料蒐集 12
第四節 研究工具與信效度測量 12
第五節 研究倫理 13
第六節 資料統計及分析方法 13
第四章 統計分析結果 15
第一節 病人基本資料之分布情形 15
第二節 早期預警徵象資料 18
第三節 急救成效與相關因子之迴歸分析 25
第五章 討論與結論 29
第一節 心臟驟停與早期預警徵象和心肺復甦之成效 29
第二節 研究限制 30
第三節 後續建議 31
參考資料 32
中文部分 32
英文部分 32

中文部分
財團法人醫院評鑑暨醫療品質策進會(2007).台灣病人安全通報系統.取自http://www.tpr.org.tw/index03.php?getid=year
胡勝川(2001) .心肺復甦的演變.慈濟醫學,13(3),143-149。

英文部分
Appleton, G. O., Cummins, R. O., & Larson, M. P. (1995). CPR and the single rescuer: at what age should you "call first" rather than "call fast"? Annals of Emergency Medicine, 25, 492-494.
Aune, S., Herlitz, J. & Bang, A. (2005). Characteristics of patients who die in-hospital with no attempt at resuscitation. Resuscitation, 65, 291-299.
Buist, M., Bernard, S., Nguyen, T. V., et al., (2004). Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation, 62,137–41.
Bookman, A., Harrington, M., Pass, L., & Reisner, E. (2007). Family Caregiver Handbook. Cambridge, MA: Massachusetts Institute of Technology. Brown, A., & Co, J. (1994). Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. The Criteria Committee of the New York Heart Association (9th ed., pp. 253-256).
Brymer, C., Gangbar, E., Orourke, K., & Naglie, G. (1995). Age as a determinant of cardiopulmonary resuscitation outcome in the coronary care unit. Canadian Journal of Emergency Medicine, 4316, 634-637.
Burns, R., Graney, M. J.&Nichols, L. O. (1989). Prediction of in-hospital cardiopulmonary arrest outcome. Archives of Internal Medicine, 149 (6), 1318-1321.
Chao, C. S. (2002). Physician’s Attitudes toward DNR of terminally ill cancer patients in Taiwan. Nurse Researcher, 10, 161-167.
Chen, F. C., Su, C. M., Li, C. J., Le, W. H., & Kung, C. T. (2009). The use of Charlson comorbidity index for patients receiving inhospital unexpected resuscitation by a cardiac arrest team: clinical outcome and - 55 - implications. Journal of the Taiwan Emergency Medicine, 11, 35-42.
Cooper, S, Janghorbani M, & Cooper G. (2006) A decade of in-hospital resuscitation: outcomes and prediction of survival? Resuscitation, 68, 231–237.
Cummins, R. O., Chamberlain, D., & Hazinski, M. F. (1997). Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital ''Utstein style''. Circulation, 95, 2213-2239.
Danciu, S. C., Klein, L. M., & Hosseini, M. (2004). A predictive model for survival after in-hospital cardiopulmonary arrest. Resuscitation 62, 35-42.
DeBard, M. L. (1981). Cardiopulmonary resuscitation: analysis of six year experience and review of the literature. Academic Emergency Medicine, 10, 408-416.
Doing, C. J., Paul, J. E., & James, D. S. (2000). A 2 years prospective cohort study of cardiac resuscitation in a major Canadian hospital. Journal of Clinical Investigation, 23(2), 132-143.
Dumot, J. A., Burval, D. J., Sprung, J., Waters, J. H., Mraovic, B., Karafa, M. T., Mascha, E. J., & Bourke, D. L. (2001). Outcome of adult cardiopulmonary resuscitations at a tertiary referral center including results of “limited” resuscitations. Archives of Internal Medicine 161, 1751–1758.
Eisenberg, M. S.,&Mengert, T. J. (2001). Primary Care: Cardiac resuscitation. The New England Journal of Medicine, 344, 1304-1313.
Emmanuel, U., & Joseph V. (2010). The Medical Emergency Team and prevention of sudden cardiac death :where is data? Critical Care & Shock, 13, 73-74.
Enohuman, KO., Moerer O., Kirmse C., Bahr j, Neumann P., & Quintel M. (2006). Outcome of cardiopulmonary resuscitation in intensive care units in a university hospital. Resuscitation, 71, 161-170.
Ewanchuk, M., & Brindley, P. G. (2006). Perioperative do-not-resuscitate orders--doing ''nothing'' when ''something'' can be done. Critical Care, 10, 219.
Geroge, A. L., & Crecelius, P. L. (1989). Pre-arrest morbidity and other correlates of survival after in-hospital cardiopulmonary arrest. American Journal of Medicine, 87, 28-34.
Herlitz, J., Bang, A., Alsen, B., & Aune, S. (2002). Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours. Resuscitation, 53, 127–133.
Herlitz, J., Bang, S., Aune, G., Ekstrom, L., Lundstrom, L., & Holmberg, S. (2001). Characteristics and outcome among patients suffering in-hospital cardiac arrest in monitored area. Resuscitation, 48(1), 125-135.
Herlitz, J., Rundqvist, A., Bang, S., Aune, G., Lundstrom, L., Ekstrom, L., & Lindkvist J. (2001). Is there a difference between women and men in characteristics and outcome after in hospital cardiac arrest? Resuscitation, 49, 15-23.
Hodgetts, T. J., Kenward, G., Vlackonikolis, I., Payne, S., Castle, N., Crouch, R…. Shaikh, L. (2002). Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. Resuscitation, 54, 115–123.
Hu, S. C. (2001). The evolution of cardiopulmonary resuscitation. Tzu Chi Medicine Journal, 13, 143-149.
Huang, C. H., Chen, W. J., Ma, H. M., Chang, W. T., Lai, C. L., & Lee, Y. T. (2002). Factors influencing the outcomes after in-hospital resuscitation in Taiwan. Resuscitation, 53( 3), 265-270.
Huang, Y. H., Huang, S. J., & Ko, W. J. (2010). Survey of Do-not-resuscitate order in surgical intensive care units. Journal of the Formosan Medical Association, 109(3), 201-208.
Huang, C. H., Hu, W. Y., &Chiu, T. Y., (2008). The practicalities of terminally ill patients signing their own DNR orders- a study in Taiwan. Journal of Medicine Ethics, 34, 336-340.
Jerng, J. S., Ko, W. J., Lu, F. L., Chen, Y. S., Huang, S. F., Yu, C. J., Wang, M. J. & Lin, F. Y. (2008). Incidence and Significance of Clinically Abnormal Events in a Tertiary Referral Medical Center: Implementation of the Clinical Alert System (CAS). Journal of the Formosan Medical Association, 107(5), 396-403.
Jolande, E. B., & Anne, B. G. (2007). In-hospital resuscitation of the elderly: Characteristics and outcome. Resuscitation, 75(2), 372-376.
Kause, J., Smith, G., Prytherch, D., Parr, M., Flabouris, A., Hillman, K.…Australian and New Zealand Intensive Care Society Clinical Trials Group. (2004). A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand and the United Kingdom the Academia study. Resuscitation, 62:275–82.
Jerng., Ko., Lu., Chen.,Huang., Yu., Wang., Lin., (2007). Incidence and significance of clinically abnormal events in a tertiary referral medical center: implementation of the clinical alert system (CAS). Journal of the Formosan Medical Association, 107(5), 396-403.
Junod, P. N., Morabia, A., & De Torrente, A. (2002). Evaluation of do not resuscitate order in a Swiss community hospital. Journal of Medicine Ethics, 28, 364-367.
Landry, F. J., Parker, J. M., & Phillips, Y. Y. (1992). Outcome of cardiopulmonary resuscitation in the intensive care setting. Annals Internal Medicine, 152(11), 2305-2308.
Lesley, B., &Kevin, S. (1999). Predicting unsuccessful cardiopulmonary resuscitation (CPR) a comparison of three morbidity scores. Resuscitation, 40, 89-95.
Liu, H.L., Lai, S.C., Li, C.J., Liu, T.A., Wu, Y.F., &Chou, C.C. (2009). determining the clinical outcome in patients suffering cardiac or non-cardiac out-of-hospital cardiac arrest, who have achieved sustained ROSC in the emergency department. Journal of the Taiwan Emergency Medicine, 11, 77-85.
Liu, J. M., Lin, W. C., Chen, Y. M., & Chen, C. Y. (1999). The status of the do-not resuscitate order in Chinese clinical trial patient in a cancer center. Journal of Medicine Ethics, 25, 309-314.
Mary, A. P., Joseph, P. O., & Larkin, G. L. (2008). Survival from in-hospital cardiac arrest during nights and weekends. Journal of the American Medicine Association, 299(7), 785-792.
McGrath, R. B. (1987). In-house cardiopulmonary resuscitation after a quarter of a century. Annals Internal Medicine, 16, 1365-1368.
Miller, R. D. (2009). Miller’s Anesthesia: Anesthesia for cardiac surgical procedures. (pp. 1889-1975). New York: Elsevier Science.
Peterson, M. W., Geist, L. J., Schwartz, D. A., Konicek, S., &Moseley, P. L. (1991). Outcome after cardiopulmonary resuscitation in a medical intensive care unit. Chest, 100 (1), 168-174.
Peberdy, M. A., Kaye, W., Ornato, J. P., Larkin, G. L., Nadkarni, V., Mancini, M. E…. Lane-Trultt T (2003) Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation, 58.297–308.
Plaisance, P., Lurie, K. G., & Vicaut. E. (1999). A comparison of standard cardiopulmonary resuscitation and active comparison-decompression resuscitation for out-of hospital cardiac arrest. New England Journal of Medicine, 341, 569-575.
Rien, D. V., Rudolph, W. K., Rob, J., Hans, O., Poll, A. & Angela, J. (1999). Prearrest morbidity and outcome. Annals Internal Medicine, 159, 845-850.
Roberts, D., Landolfo, K., Light, R. B., & Dobson, K. (1990). Early predictors of mortality for hospitalized patients suffering cardiopulmonary arrest. Chest, 97 (2), 413-419.
Sandroni, C., Nolan, J., Cavallaro, F., & Antonelli, M. (2007). In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Medicine, 33(2), 237-245.
Sahm, S., Will, R., & Hommel, G. (2005). Attitudes towards and barrier to writing advance directives amongst cancer patients, healthy controls, and medical staff. Journal of Medicine Ethics, 31(8), 437-440.
Schein, R., Hazday, N., Pena, M., Ruben, B., & Sprung, C. L. (1990). Clinical antecedents to in hospital cardiopulmonary arrest. Chest, 98(6), 1388-1392.
Shiha, C. L., Lu, T. C., Jerng, J. S., Liu, Y. P., Chen, W. J., & Lin, F. Y. (2007). A web-based Utstein Style registry system of in-hospital cardiopulmonary resuscitation in Taiwan. Resuscitation, 72( 3) 394-403.
Skogvoll., E., Isern, E., Sangolt, G. K., & Gisvold, S. E. (1999). In-hospital cardiopulmonary resuscitation. Acta Anaesthesiology, 43, 177-184.
Skrifrars, M. B., Rosenberg, P. H., & Finne P. (2003). Evaluation of the in-hospital Utstein template in cardiopulmonary resuscitation in secondary hospitals. Resuscitation, 56, 275-282.
Stiell, I. G., Wells, G. A., Field, B. J., Spaite, D. W., De Maio, V. J., Ward, R., … Dagnone, E. (1999). Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. Ontario Prehospital Advanced Life Support. Journal of the American Medical Association, 281, 1175–1181.
Thorevska, N., Tilluckdharry, L., Tickoo, S., Havasi, A., Amoateng-Adjepong, Y., & Manthous, C. A. (2005). Patients understanding of advance directives and cardiopulmonary resuscitation. Critical Care, 20(1), 26-34.
Tokuda, Y., Nakazato, N., & Tamaki, K. (2004). Evaluation of end of life care in cancer patients at a teaching hospital in Japan. Journal of Medicine Ethics, 30, 264-267.
Van Walraven, C., Forster, A. J., & Stiell, I. G. (1999). Derivation of a clinical decision rule for the discontinuation of in-hospital cardiac arrest resuscitation. Annals Internal Medicine, 159, 129-134.

QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
系統版面圖檔 系統版面圖檔