臺灣博碩士論文加值系統

發生院前心跳停止的緊急急救患者，大部份預後不如預期。分析患者急救經過，可找出危險因子，並建立風險模型作為到院前救護決策指標。
本文回顧新北市2010年至2011年OHCA Registry Data之患者，並蒐集其案例，分析患者到院前的狀況，將資料以國際烏特斯坦式標準進行資料萃取。繼以回歸探索分析，瞭解變因與OHCA兩小存活率之間的關係及萃取OHCA建模的風險因子(Risk Factor)，暨找出OHCA風險因子係數。用Apriori分析OHCA患者慢性病關聯規則，採用決策樹分類演算法建構OHCA風險決策模型。
OHCA之發生與兩小時的存活率風險因子分析發現，罹患慢性病與否顯著相關（P-value=0.001）；用Apriori法分析慢性病的相關性，關聯規則多數與心臟病、糖尿病、高血壓高度相關；病患年齡65歲以上死亡風險高；將病患送到第三級緊急責任醫院的存活率是送到非緊急責任醫院的15.75倍，一級緊急責任醫院的2.4倍，二級緊急責任醫院的1.3倍；使用AED的初始心律編碼電擊去顫（VT/VF）比沒有使用風險高；OHAC的外科病患比內科死亡風險高；派遣EMT-P比一般EMT的存活率高。
OHCA的決策樹模型依據將病患分成三組並加入罹患慢性病相關規則，這有助於緊急救護派遣員（Emergency Medical Dispatche, EMD），在OHCA病患在到院前醫療資源分配，這個模型可為救護單位提供實用的的工具，並有助於臨床質量評估，協助研究人員分析不同OHCA病患的醫療策略。

Background：In many emergency cases, patients had cardiac arrest before reaching the hospital and the prognosis are not as well as what medical perspective has expected. This study has analyzed the first aid process used on these emergency patients, to identify the risk factors and established a risk model as pre-hospital decision indicators to increase the patient’s opportunities of survival.
Methods：This study has several segments: reviewing and collecting the OHCA patients with Registry Data of New Taipei city from 2010 to 2011: analyzing and applying International Utestein formula standards for data extraction; using regression analysis to search for the relationship between the variations and OHCA two hour survival rate; applying OHCA modeling to identify risk factors coefficient; using Apriori to analyze the association rules, and adapting decision tree to create a Risk Decision Model.
Results: The correlation chronic diseases: Heart Disease, Diabetes Disease, and Hypertensive Disease have a significant correction on OHCA two hour survival risk factors. Meanwhile, senior citizens have had high risk could not be revive form standard emergency measure.
Conclusions： OHCA Decision tree model helped EMD and rescue units to allocate pre-hospital medical resources and contributes to an accurate clinical quality assessments to assist to analyze medical policy for different OHCA patients.

Acknowledgement I
Abstract II
Table of content III
List of Tables V
List of Figures VI
CHAPTER 1 INTRODUCTION 1
1.1 Background and Motivation 1
1.2 Purpose of the Study 5
1.3 Research Critireas 6
CHAPTER 2 LITERATURE REVIEW 8
2.1 Common causes of OHCA 8
2.2 Success rate of OHCA patients 14
2.3 Prognosis factors of OHCA paitient 16
CHAPTER 3 METHODOLOGY 19
3.1 Utstein Style 19
3.2 OHCA Patients of the Risk Factors 20
3.3 Patients and Study Area 21
3.4 Data Processing 23

CHAPTER 4 RESULT AND DISCUSSIONS 24
4.1 Statistical Analysis 24
4.2 Linear Regression Analysis 24
4.3 Logistic Regression Analysis 25
4.4 Apriori Analysis 25
4.5 Classification and Regression Tree 26
4.6 Results 27
CHAPTER 5 Summary of the Study 32
5.1 Discussion 32
5.2 Conclusions 39
5.3 Suggestions for Future Studies 40
References 43

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