中文摘要
本研究係以宜蘭地區到院前心跳停止病患(OHCA)為對象，瞭解不同背景變項之到院前心跳停止病患，在到院前及到院後急救因子之差異情形；並探討其到院前、到院後急救因子與急救預後成效之間是否有關聯性。
本文採用回溯性研究，並依據Utstein統一報告格式，蒐集宜蘭某區域教學醫院2007年至2009年到院前心跳停止所有創傷及非創傷病患284例 (有效樣本282例) ，採用描述性統計、獨立樣本t 考驗、卡方檢定分析後，獲致以下結論：
一、本研究有效樣本282人，能恢復自體循環者57人 ( 20.2 % )，平均自第14.77分鐘起恢復自體循環，能存活住院者33人 ( 11.7 % )，平均存活住院15.36天，而能存活出院者共有6人 ( 2.1 % )。
二、內科疾病為到院前心跳停止最常見之病因，過去病史中，以心臟病、高血壓、糖尿病為主要。而65歲以上之為主要年齡族群，占 67.7% 。
三、在到院前急救因子中，發生地點、是否有現場目擊者、現場處理時間、總反應時間、是否使用自動體外電擊器、現場民眾是否進行CPR等向度，與急診預後成效有相關。
四、在到院後急救因子中，初始心律、體溫、瞳孔大小、強心劑數量、是否使用電擊、急診急救時間、醫療費用等向度，與急診預後成效有相關。
五、本研究恢復自體循環比率及存活率，均較過去台北市及台大醫院所進行之研究結果為低。究其原因，可能與城鄉差距、緊急醫療救護系統完善程度及人員訓練有關。
六、今後除改進緊急救護持續監測系統外，亦應加強EMT相關訓練，積極教育民眾瞭解並學習CPR，使宜蘭地區之救護體系臻於完備，期以有效提昇急救成功率。
關鍵詞：到院前心跳停止、心肺復甦術、恢復自體循環、U

The Analysis of Ilan’s Out-of-Hospital Cardiac Arrest (OHCA) Patients
Abstract
The study uses Ilan’s out-of-hospital cardiac arrest (OHCA) patients as the research object to understand the variable backgrounds of OHCA patients how they are affected by first aid factors between the period of pre-hospital and post-hospital admission. The study also discusses whether there is a correlation between first aid factors and first aid prognosis among those OHCA patients during pre-hospital and post-hospital admission periods.
The study is retrospective and based on the Utstein style format. It collects 284 out-of-hospital cardiac arrest (OHCA) patient cases with trauma and non-trauma (282 effective samples) in an example of a regional teaching hospital in Ilan from 2007 to 2009. It uses descriptive statistics, independent sample t test, and Chi-Square test as the statistical analysis to obtain the following conclusions:
1. There are 282 effective sample patients in the study. There are 57 patients ( 20.2 %) who were return of spontaneous circulation (ROSC) after cardiac arrest approximately 14.77 minutes on average. There are 33 patients (11.7 % ) who survived to be hospitalized for 15.36 days on average, and there are 6 patients ( 2.1 % ) who were discharged from the hospital.
2. Internal medicine disease is the major causative factor of out-of-hospital cardiac arrest. Among those internal medicine disease cases, the history showed hypertension, diabetes mellitus, and heart diseases are the main causes of out-of-hospital cardiac arrest. Patients who are older than 65 years old are the main age groups, accounting for 67.7% of these cases.
3. The pre-hospital admission factors which affect the prognosis after the Emergency Department (ED) are the place of the accident, whether there are witnesses, scene process time , total reaction time , whether automatic external defibrillation was used, and whether people at the scene used CPR.
4. The post-hospital admission factors which affect the prognosis after the ED are initial cardiac rhythm, body temperature, pupil size , dose of epinephrine, whether defibrillation was used, the time of applying emergency first-aid, and medical expense.
5. The percentages of return of spontaneous circulation and survival rates in the study are lower than those of past studies of Taipei City and National Taiwan University Hospital. The possible factors are probably related to differences between rural and urban areas in the quality of emergency medical service systems (EMSS), and healthcare training.
6. From now on, in addition to improving the first-aid continuous monitoring system, we should also enhance EMT related training, and actively educate people to understand and learn CPR, so that comprehensive first-aid systems are available everywhere to effectively increase the success rate of first-aid.
Keywords：Out-of-hospital cardiac arrest (OHCA), Cardiopulmonary resuscitation

目 錄
審定書….……………………………………………………………………..………i
致謝詞………………………………..……………………………………………….ii
中文摘要….…………………………………………………………………..………iii
英文摘要……………………………..……………………………………………….iv
目錄...……..………………………………………………………………………… vi
表目錄…………………………………………………………..…………………..viii
圖目錄……………………………………………………………………..……….....x
第一章 緒論 ………………………………………………………………………1
第一節 研究動機與目的….…………………………………………………….. 1
第二節 研究方法與範圍…………………………………………………………5
第三節 研究流程….…………………………………………………………….. 6
第四節 重要名詞解釋….……………………………………………………….. 7
第二章 文獻探討…..………………………………………………………………10
第一節 猝死及到院前心跳停止之流行病學.………………………………… 10
第二節 心肺復甦術與生存之鏈………………………………………………. 12
第三節 到院前心跳停止病患之急救成效……………………………………. 14
第四節 到院前心跳停止病患之急救預後因子………………………………. 17
第三章 研究方法 ………………………………………………………………. 19
第一節 研究架構與假設………………………………………………………. 19
第二節 各研究變項之操作性定義……………………………………………. 21
第三節 資料蒐集與彙整………………………………………………………. 24
第四節 統計分析方法…………………………………………………………. 25
第四章 研究結果分析與討論……………………………………………………. 28
第一節 研究樣本基本資料分析………………………………………………..28
第二節 病患到院前及到院後急救情形之分析與討論………………………..35
第三節 病患急救預後成效之分析與討論……………………………………..43
第四節 病患到院前、到院後急救因子與急救預後成效相關情形之分析與討論
..…………………………………………………………………………48
第五章 結論與建議………………………………………………………………..63
第一節 結論……………………………………………………………………..63
第二節 建議……………………………………………………………………..69
第三節 研究限制………………………………………………………………..71
參考文獻 …………………………………………………………………………..72
附錄 背景變項與有差異表現向度之交叉表……………………………………..75
















表目錄
表1-1 救護能力相關指標一覽表 …………………..…………………………. 3
表2-1 台灣地區歷年來到院前心跳停止病患流行病學資料及急救成效 …….15
表4-1 有效研究樣本資料分析表………………………………………………..29
表4-2 有效研究樣本連續變數描述統計表……………………………………..32
表4-3 病患背景資料與急救預後成效交叉分析結果…………………………..34
表4-4 不同性別心跳停止病患在到院前及到院後急救因子(類別變項)各向度之差異比較表……………………………………………………………..36
表4-5 不同性別心跳停止病患在到院前及到院後急救因子(連續變項)各向度之差異比較表……………………………………………………………..38
表4-6 不同年齡心跳停止病患在到院前及到院後急救因子(類別變項)各向度之差異比較表……………………………………………………………..39
表4-7 不同年齡心跳停止病患在到院前及到院後急救因子(連續變項)各向度之差異比較表……………………………………………………………..41
表4-8 不同背景變項心跳停止病患在「到院前急救因子」及「到院後急救因子」之差異情形………………………………………………………………..42
表4-9 不同性別心跳停止病患在急救預後成效(類別變項)各向度之差異比較表…………………………………………………………………………..44
表4-10 不同性別心跳停止病患在急救預後成效(連續變項)各向度之差異比較表…………………………………………………………………………..45
表4-11 不同年齡心跳停止病患在急救預後成效(類別變項)各向度之差異比較表…………………………………………………………………………..46
表4-12 不同年齡心跳停止病患在急救預後成效(連續變項)各向度之差異比較表…………………………………………………………………………..46
表4-13 不同背景變項心跳停止病患在「急救預後成效」之差異情形……….47
表4-14 「到院前急救因子」與「急救預後成效」之相關分析(p值)………….49
表4-15 「到院前急救因子」與「急救預後成效」之相關程度表…….……….49
表4-16 「到院後急救因子」與「急救預後成效」之相關分析(p值)………….52
表4-17 「到院後急救因子」與「急救預後成效」之相關程度表….………….53
表4-18 「到院前急救因子」、「到院後急救因子」與「急救預後成效」相關情形…………………………………………………………………………..56
表4-19 病患背景資料與急救預後成效交叉分析結果…………........…………..57
表4-20 病患到院前急救因子與急救預後成效交叉分析結果…………………..59
表4-21 病患到院後急救因子與急救預後成效交叉分析結果…………………..61
表5-1 到院前心跳停止病患有效樣本與存活出院者差異比較………………..66
表5-2 本研究結果與台灣地區歷年來到院前心跳停止病患流行病學資料及急救成效對照表……………………………………………………………..68












圖目錄
圖1-1 1999-2001年台北市到院前心跳停止病患經急救復甦後的存活趨勢…. 2
圖1-2 研究流程 ….……………………………………………………………… 7
圖2-1 1997至2000年台大醫院到院前心跳停止病患經急救復甦後存活趨勢 .....………………………………………………………....…….........16
圖3-1 研究架構 ………………………………………………………….…… 20
圖3-2 參考Utstein統一報告格式登錄並分析資料之樹狀圖 ………………. 25

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蔡朝義，2006，到院無心跳呼吸病患之急救結果與醫療資源利用之分析─以南部某區域教學醫院為例，高雄醫學大學健康科學院醫務管理學研究所碩士論文。
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