縮短急性心肌梗塞ST節段上升型病人於急診停留時間之專案

The Project of Reducing Time Delays in Emergency Room for Patients with Acute STEMI Treatment via Primary PCI

10.29494/LN.201906_20(2).0009

簡榎岑(Chia-Tsen Chien)；傅玉招(Yuh-Jan Fuh)

急性心肌梗塞 ； 血管再灌流時間 ； 急診 ； Acute myocardial infarction ； Door to balloon time ； Emergency department

領導護理

20卷2期（2019 / 06 / 01）

111 - 128

繁體中文

美國心臟協會公布的治療準則中，經皮冠狀動脈介入治療術是治療心肌梗塞的方法，並建議90分鐘內於心導管室完成。依據本院2016年統計數據發現病人從入急診室檢傷到接受心導管完成冠狀動脈再灌流平均時間為76分鐘，及格率為77.8%，但仍有22.2％之病人未能在時間內完成，嚴重影響病人接受治療的黃金時間，欲提升door to balloon time（D to B）小於90分鐘之比率，以更精進本院心臟照護品質，經查閱2016年1月1日到6月30日之相關紀錄及數據進行分析，及相關文獻及研究，執行改善措施。成果顯示，病人從進入急診室開始到做完心導管介入治療打通血管，由改善前76分鐘經由改善後縮短為67分鐘；D to B小於90分鐘之達成率由改善前77.8%，改善後提升至88.9%；急診停留時間，由改善前約54分鐘，經由改善後縮短到約47分鐘。

According to the guidelines issued by the American Heart Association, percutaneous coronary intervention (PCI) is a preferred method for treating myocardial infarction and is recommend to be completed within 90 minutes. The 2016 annual statistical data of this hospital shows record of a patient, from accepting triage to receive a coronary catheter and hence coronary reperfusion, was within the average time of 76 minutes. Even with a success rate of 77.8%, there are still 22.2% of the patients who cannot make it during the golden time for treatment. In order to improve our hospital's heart caring standard, we analyzed our data and records from January 1 to June 30, 2016 and researched relevant records and data for assessment. We conducted enhanced mechanism longing to enhance the odds of door to balloon time (D to B) to less than 90 minutes. The results shown the time for a patient entering the emergency room to the completion of a catheterization treatment in order to open blood vessels was shortened from 76 minutes to 67 minutes. The success rate of D to B in less than 90 minutes was improved from 77.8% to 88.9%. The duration of stay in our emergency was reduced from the original average time of 54 minutes to 47 minutes after the improvement.

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