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題 名 | The Feasibility of Short-Term Emergency Intensive Care Model for Critically Ill Patients in Emergency Department=針對危急病人急診加護病房提供短期加護照顧模式 |
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作 者 | 蘇柏樺; 陳美英; 劉秀薇; 羅鴻彰; 顏鴻章; 蔡明哲; 黃睦舜; 黃俊一; 李建賢; | 書刊名 | 中華民國急救加護醫學會雜誌 |
卷 期 | 22:4 2011.12[民100.12] |
頁 次 | 頁147-157 |
分類號 | 419.73 |
關鍵詞 | 加護病房; 急診部; 臺灣檢傷分類標準; 急性生理及慢性健康評估分數Ⅱ; Intensive care unit; Emergency department; Taiwan triage and acuity scale; Acute physiological and chronic health evaluation Ⅱ score; |
語 文 | 英文(English) |
中文摘要 | 背景:急診部門設置急診加護病房提供危急病人的持續性照顧模式相關之資訊尚缺乏。本研究的目的乃探討於急診部門內,針對危急病人提供短期加護照顧具有明確診治療效。 研究方法:以前瞻性收集所有至急診就診後需要後續加護病房照顧的所有危急病人,收集期間自 2010年1月至 12月大於 18歲以上收住急診加護病房之成年病人進行回顧性分析。記錄所有研究病人的臨床特徵,包括人口學資料、檢傷分級、主要診斷、急診加護病房收住時間、停留時間、收住後轉科處置及預後。多重邏輯式回歸統計模式分析所有與病人住院死亡預後相關臨床因子。 結果:總共入住 2,253病人,平均年齡為 72.9±17.0 (標準差 )歲,男性占 70.4%。屬於台灣五級檢傷分類第 1至3級病人占 94%。平均住急診加護病房時間為 38.1±37.0小時。急性生理及慢性健康評估分數 II系統由進住時的 19.7±9.1至轉出時的 18.4±9.1 (p < 0.001);以疾病分類時,敗血症病人是降低最多者為1.7 (95%信賴區間差異 1.1 to 2.2),腎臟疾病相關者居次,降低 1.6 (95%信賴區間差異 0.6 to 2.5),急性呼吸衰竭者降低 1.5 (95%信賴區間差異 1.1 to 1.9)。所有研究病人的整體住院後死亡率為 30.8%,進一步分析1412位病人未拒絕急救簽署者,死亡率降低至 11.8%。預後分析顯示收住時段是白天、小夜或大夜、假日或非假日,與收住院後死亡率無明顯統計差異。在回歸統計分析發現:男性、較嚴重的檢傷等級、急診加護病房進住時或轉出時的急性生理及慢性健康評估分數 II、醫院住院總天數等因子,是與住院後死亡率有明顯統計意義。 結論:根據所有進住急診加護病房病人的特徵、與住院死亡相關數個危險因子之確認、及預後的分析結果顯示:本急診加護病房結合急診專科醫師及其他專科醫師的運作模式,能具有及時性、有效、及有效率提供多種的臨床照顧的優勢,建議此照顧模式可應用在未來的健康照顧體系。 |
英文摘要 | Background: Little is known about the specific operative model of intensive care unit located in the emergency department (ED). The aim of this study was to demonstrate the short-term emergency and intensive care model can provide clinical benefits for acute critically ill patients in ED. Methods and Material: We prospectively enrolled all consecutive patients visiting our ED in anuniversity-affiliated medical center at northern Taiwan from January 1st to Dec 31th in 2010. Patients with age more than 18 years, who were admitted to emergency intensive care unit (EICU), were recruitedfor retrospective analysis after ED visits. Patients’ demographic data, triage category, time of EICU admission, major diagnosis, length of EICU stay, dispositions, and outcomes were analyzed. Multivariatelogistic regression analysis was applied for risk predictors for mortality. Results: A total of 2,253 patients, with a mean age 72.9 ± 17.0 (SD) years and male predominant(70.4%). Ninety-four percent of patients belonged to Taiwan Triage and Acuity Scale (TTAS) level 1 to 3. An average of EICU stay was 38.1 ± 37.0 hours. The acute physiological and chronic health evaluation(APACHE) II score in admission decreased from 19.7 ± 9.1 to 18.4 ± 9.1 (p < 0.001), and sepsis patients by largest reduction 1.7 (95% CI, 1.1 to 2.2), followed by renal-related disease 1.6 (95% CI, 0.6 to 2.5)and acute respiratory failure 1.5 (95% CI, 1.1 to 1.9), respectively. The overall hospital mortality rate in all study patients was 30.8%, which can varied to 11.8% among 1412 patients without signing Do-Not-Resuscitate order. In outcomes assessment, neither were time of day and day of the week admissions to our EICU associated with significant differences in hospital mortality. In regression analyses, male, higheracuity TTAS level, APACHE II score at admission and on transfer, hospital length of stay were risk factors associated with hospital mortality. Conclusion: Several risk factors associated with mortality were identified in our EICU patients, and this study demonstrated that our timely, efficiently, and effectively operative model, combination withemergency physician and other subspecialists, provide clinical advantages and be suggested to apply in health care system. |
本系統中英文摘要資訊取自各篇刊載內容。