目標體溫管理應用於突發性心跳停止經心肺復甦術後恢 復自發性循環病人之成效探討

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標題:	目標體溫管理應用於突發性心跳停止經心肺復甦術後恢復自發性循環病人之成效探討 Effectiveness of Target Body Temperature Management on Recovery of Spontaneous Circulation after Cardiopulmonary Resuscitation in Sudden Cardiac Arrest Patients
作者:	林彣芷
貢獻者:	醫務管理系林為森陳珹箖
關鍵字:	突發性心跳停止恢復自發性循環低溫治療目標體溫管理 Sudden cardiac arrest Return of Spontaneous Circulation Target Temperature Management
日期:	2019
上傳時間:	2020-12-09 14:43:34 (UTC+8)
摘要:	台灣每年約有2萬人發生突發性死亡，存活率小於5%。心跳停止後，導致腦組織缺氧，5~10分鐘後即會造成永久性損傷。研究指出，儘早施行基本救命術、早期電擊、高品質的心肺復甦術以及復甦後照護等緊急醫療措施，會有70%的重新建立自發性循環的機會。目標體溫管理(Target Temperature Management, TTM)即低溫療法(Therapeutic Hypothermia, TH），可保護腦神經細胞及改善預後。本研究主要目的在分析比較心跳停止後經急救恢復心跳且意識狀態仍然呈現昏迷之病人，其執行與未執行目標體溫管理治療後之出院意識恢復狀況及存活的差異，以瞭解目標體溫管理治療成效。研究採回溯性研究設計，以方便取樣方式於台南市某醫學中心進行收案，樣本條件為2014年至2018年因突發性心跳停止經心肺復甦術後恢復自發性循環且年齡大於（含）20歲，共收案152位；收集病歷相關資料後，以SPSS軟體進行描述性及推論性統計分析。研究結果顯示，突發性心跳停止的原因以心因性居多，有76.3%患者具有過去疾病史，而初始心律可電擊可作為轉出加護病房及出院時存活及意識恢復之重要預測因子。此外發現，是否介入目標體溫管理，在轉出加護病房及出院之意識CPC狀態皆不顯著，而在轉出加護病房存活方面，有執行目標體溫管理的病人存活為57.50%，未執行目標體溫管理的病人存活為51.78%；以出院存活來看，有執行目標體溫管理的病人存活為57.50%，未執行目標體溫管理的病人存活為50.89%，雖然結果並不顯著，但發現有介入目標體溫管理治療的病患在轉出加護病房及出院時，仍有稍高的存活機會。期待本實證研究結果將助於醫護人員對突發性心跳停止經心肺復甦術後恢復自發性循環執行目標體溫管理治療之瞭解，以作為醫療院所進行醫療照護計畫之參考。 About 20,000 sudden deaths of people occurs each year in Taiwan, and the survival rate is less than 5%. The brain tissue is deprived of oxygen after 5-10 minute heartbeats stop and it will cause permanent damages. Researches pointed out that emergency medical treatments in early time such as basic life-saving surgery, electric shock, high-quality cardiopulmonary resuscitation, and post-recovery care can have 70% chance of re-establishing spontaneous circulation. Target Temperature Management (TTM) is also called Therapeutic Hypothermia (TH), which can protect brain cells and improve prognosis of medical treatment. The purposes of study is to investigate patients who recovered heartbeat after cardiac arrest and whose conscious state was still comatose and compare differences of the discharged consciousness and the survival between these patients with and without implementation of Target Temperature Management treatment. The analysis can indicate the performance of Target Temperature Management treatment. By retrospective chart review in a medical center in southern Taiwan, data recruited 152 patients who suffered cardiac arrest resumes spontaneous circulation after cardiopulmonary resuscitation and were older than 20 years in 2014-2018. Data were analyzed by descriptive statistics, Chi-Square test and Logistic Regression. Results showed sudden cardiac arrest was mostly due to heart diseases and 76.3% of patients had a disease history of illness. The initial cardiac rhythm can be used as important predictors of survival and conscious recovery when patients transferred out of intensive care unit and discharged. In addition, whether or not performing the Target Temperature Management treatment, consciousness of patients transferred out of intensive care unit and discharged were not significantly different. The survival rate of patients transferred out of intensive care unit were 57.50% with TTM compared to 51.78% without TTM. The survival rate of patients discharged were 57.50% with TTM compared to 50.89% without TTM were. Although they are not significant, patients with interventional therapy had higher survival chances whether they were transferred out of intensive care unit or hospital discharged. Results of this study can provide comprehensive understandings about effectiveness of Target Temperature Management treatment for patients with sudden cardiac arrest who resumes spontaneous circulation after cardiopulmonary resuscitation. Results can also offer information as references of healthcare plans to professionals in medical institutions.
關聯:	電子全文校內公開日期：2019-08-29;校外：2024-07-01 學年度：107，70頁
顯示於類別:	[醫務管理系(所)] 博碩士論文

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