摘要
「冠狀動脈心臟病」當前主流的治療策略是以心導管手術為主，但是操作醫師及其團隊如果忽略游離輻射防護，無形中就會遭受可怕的輻射傷害。
研究目的：針對心導管治療病人，探討「醫品圈」對於減少輻射劑量暴露之影響。
研究方法: 自2016年1月開始組成一個跨部門的團隊，包括心臟介入專科醫師、皮膚科醫師、重症專科醫師、放射師、護理師等。登錄的病人來自兩家醫院心導管室，研究設計將病人區分成三組: 第一階段 (改善前, n=64) 收案時間從2016年3月到11月，第二階段 (改善中, n=42) 收案時間從2016年12月至2017年1月，第三組 (改善後, n=46) 收案時間從2017年2月至2017年5月。主要介入的研究策略是1.制定病人安全防護流程的操作指引，降低透視幀速率: 設計每秒15幀取代傳統每秒30幀；降低攝影幀速率: 設計每秒7.5幀取代傳統每秒15幀，2.創新設計涵蓋病人頭部、眼睛及甲狀腺的輻防保護套。定義p-value小於0.05, 才達到統計學上的顯著意義。
結果：三組間的基本資料並沒有統計學上的差異。心導管病人眼睛偵測輻射劑量由第一階段4.5±3.9毫西弗降至第二階段2.2±2.4毫西弗及第三階段0.8±0.6毫西弗，有明顯改善並達到統計學的顯著意義（p<0.001）；甲狀腺偵測輻射劑量由第一階段22.2±39.1毫西弗降至第二階段8.1±8.6毫西弗及第三階段4.1±3.7毫西弗，有明顯改善並達到統計學的顯著意義（p<0.001）；背部偵測輻射劑量由第一階段183.8±286.3降至第二階段39.2±49.8毫西弗及第三階段33.5±45.1毫西弗，有明顯改善並達到統計學的顯著意義(p<0.001)。
結論：本次運用「品管圈」手法，包含制定減少輻射劑量暴露的研究方案及創新設計病人輻防保護套，成功減少心導管病人眼睛、甲狀腺及背部輻射劑量，有效地提升心導管病人照護品質。

關鍵字：冠狀動脈心臟病、心導管室、醫品圈、幀速率、輻防保護套。

Abstract
The current leading therapeutic strategy for coronary heart disease is percutaneous coronary intervention. If the operators and their staffs ignore the importance of free radiation protection, the patients or operators will suffer from invisible radiation injury.

OBJECTIVE: The purpose of this study was to investigate the impact of quality control circle (QCC methods) on reducing radiation exposure during percutaneous coronary intervention.

METHODS: Since Jan, 2016, we organized a multidisciplinary team, including interventional cardiologists, dermatologists, intensivists, radiation technicians and nursing staffs. The patients, from 2 hospitals with cardiac catheterization labs, were divided into 3 groups: stage 1 (n=64) from March to November 2016, stage 2 (n=42) from December 2016 to January 2017 and stage 3 (N=46) from February to May 2017. The key interventions were: (1) utilized radiation protection guideline and reduced frame rate of fluoroscopy with 15 frames/second instead of conventional 30 frames/second, frame rate of video recording with 7.5 frames/second instead of conventional 15 frames/second. (2) Meanwhile, we designed innovative radiation protection devices over body parts: head, eyes and thyroid. A p-value less than 0.05 was considered statistically significant.

RESULTS: There is no difference among 3 study groups in baseline characteristics. The eyes radiation dose of patients reduced from 4.5±3.9 mSV in stage 1, to 2.2±2.4 mSV in stage 2 and 0.8±0.6 mSV in stage 3 (p<0.001). The thyroid radiation dose of patients reduced from 22.2±39.1 mSV in stage 1, to 8.1±8.6 mSV in stage 2 and 4.1±3.7 mSV in stage 3 (p<0.001). The back radiation dose of patients reduced from 183.8±286.3 mSV in stage 1, to 39.2±49.8 mSV in stage 2 and 33.5±45.1 mSV in stage 3 (p<0.001).

CONCLUSIONS: The QCC methods with lower radiation protocol and innovative radiation protection device are demonstrated to reduce eyes, thyroid and back radiation dose in percutaneous coronary intervention patients.

Keywords: coronary heart disease, cardiac catheterization labs, QCC, frame rate, radiation protection devices.

論文審定書 i
致謝 ii
中文摘要 iii
英文摘要 iv
圖次 vi
表次 vii
第一章 緒論 1
第一節研究背景與動機 1
第二節研究目的 2
第二章 文獻探討 3
第三章 研究方法 10
第一節 成立團隊 10
第二節 主題選定 11
第三節 活動計劃擬訂 13
第四節 現狀把握 15
第五節 問題解析 16
第六節 目標設定 22
第七節 對策擬訂 24
第八節 對策實施與檢討 26
第四章 效果確認 33
第一節 有形成果比較（主目標） 33
第二節 主目標之目標達成率 36
第三節 有形成果比較(附加效益) 36
第四節 無形成果 39
第五節 標準化 39
第五章 檢討與改進 39
第一節 活動檢討與餘留問題解決 39
第二節 結論與建議 41
參考文獻 43
附錄 45

參考文獻
中文
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英文
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