臺灣博碩士論文加值系統

心臟驟停（Sudden cardia arrest，SCA）是突發、非預期的心臟功能、呼吸與意識的喪失，並且可能是心律不整或電流傳遞短路干擾的結果。而「到院前心肺功能停止」(out-of-hospital cardiac arrest, OHCA)是指病患在抵達醫院前即呈現沒有呼吸和心跳的狀態。根據統計，消防機關執行到院前緊急救護「無生命徵象者」105年20,530人、106年20,117人、107年20,201人，平均每年約有2萬300人到院前心臟驟停救護案件，如果沒有及早給予心肺復甦術（CPR）及電擊，這些患者幾乎必然死亡。
內政部消防署於106年初開始推動「DA-CPR 緊扣生命之鏈」計畫，希望提升DA-CPR之執行率，108年繼續推動DA-CPR線上指導提升品質計畫，則希望可以使DA-CPR之執行品質更上一層樓，本研究為了瞭解107年高雄市線上指導員DA-CPR的執行情況，透過文獻探討、SPSS統計分析的方式，對107年高雄市DA-CPR的執行細節項目和非創傷OHCA患者各種相關預後做一個探討。研究結果發現，大部分的指導項目對於患者到院前或者是到院後的預後都沒有統計上顯著的改善。
研究結果沒有如同預期的提升預後，除了表示高雄市政消防局在民眾對於OHCA了解和CPR的教育、線上指導員對於OHCA的辨識以及DA-CPR的指導能力等方面有更多的改進空間，另外過多記載錯誤或是資料不全的情況，對於指導完後的資料記錄，則需要更加用心。

Sudden cardia arrest (SCA) is a sudden, unintended cardiac function, loss of breathing and consciousness, and may be the result of arrhythmia or short-circuiting of current transmission. "Out-of-hospital cardiac arrest" (OHCA) means that the patient has no breathing or heartbeat before arriving at the hospital. According to statistics, the total number of first-aid missions carried out by the fire-fighting agency is 20,530 people in 2016; 20,117 people in 2017106, and 20,201 people in 2018. The average is around 2,300 cardiac arrest people annually were rescued and sent to the hospital. Without early cardiopulmonary resuscitation (CPR) and electric shock, these patients almost certainly will die.
The Fire Department of the Ministry of the Interior began to promote the " DA-CPR" program in early 2017, hoping to improve the implementation rate of DA-CPR. In year 2019, it will continue to promote“DA-CPR” quality improvement program. There is a need that the quality of CPR performed should be evaluated. This study intends to examine the implementation of DA-CPR in Kaohsiung City in year 2018. Through the literature review and SPSS statistical analysis, a variety of related prognosis in patients with traumatic OHCA is discussed. The study found that most of the mentoring programs did not significantly improve the patients prognosis before or after arriving at the hospital.
The results indicated that the Kaohsiung Municipal Fire Department has more room for improvement in the education of OHCA and CPR, the identification of OHCA by online instructors, and the ability to guide DA-CPR. In the case of errors or incomplete information, more attention needs to be paid to the data records after the guidance.

摘要 I
Abstract II
誌謝 IV
圖目錄 V
表目錄 VI
第一章 緒論 1
1.1 研究動機 1
1.2 研究目的 4
1.3 研究範圍與限制 5
1.3.1 研究範圍 5
1.3.2 研究限制 5
1.3.3 研究流程 5
第二章 文獻回顧 6
2.1緊急醫療系統和緊急救護員 6
2.2 DA-CPR執行狀況 8
2.3 DA-CPR延遲造成的影響 8
2.4 DA-CPR的政策管理 9
2.5單純按壓CPR和DA-CPR的比較 9
2.6 DA-CPR對於OHCA患者的預後影響 11
2.7其他輔助設備應用於DA-CPR的探討 12
2.8影響急救施行率的因素 13
2.9 急救品質的探討 14
2.10衛生福利部民眾版心肺復甦術參考指引摘要 14
2.11 DA-CPR 執行流程範例 18
2.12 小結 19
第三章 研究方法 20
3.1 研究假設 20
3.2 研究變數 20
3.3 研究方法 21
3.3.1 研究對象 21
3.3.2 研究工具 21
3.3.3 資料分析方法 22
第四章 資料分析 23
4.1 樣本結構分析 23
4.1.1 OHCA患者性別統計 23
4.1.2 OHCA患者年齡統計 23
4.1.3 OHCA發生地點統計 24
4.1.4旁觀者施行CPR方式統計 26
4.1.5 目擊者身分 28
4.1.6 到院前ROSC之比率統計 30
4.1.7 到院時ROSC之比率統計 30
4.1.8 到院後存活達2小時比率統計 31
4.1.9 到院後存活達24小時比率統計 31
4.1.10 出院時神經學功能預後統計 32
4.2 線上指導(DA-CPR)流程與相關成效分析 32
4.2.1 接線員是否詢問意識狀況與到院前和到院時ROSC之卡方分析 33
4.2.2 接線員是否詢問意識狀況與到院後預後之卡方分析 34
4.2.3接線員是否詢問有無正常呼吸與到院前和到院時ROSC之卡方分析 35
4.2.4接線員是否詢問有無正常呼吸與到院後之預後之卡方分析 36
4.2.5接線員是否告知需做CPR (即辨識出OHCA)與到院前和到院時ROSC之卡方分析 37
4.2.6接線員是否告知需做CPR (即辨識出OHCA)與到院後之預後之卡方分析 38
4.2.7 是否將OHCA患者移到堅硬平面與到院前和到院時ROSC之卡方分析 39
4.2.8 是否將OHCA患者移到堅硬平面與到院後之預後之卡方分析 39
第五章 結論與建議 42
5.1 結論 42
5.2 建議 42
5.3 未來研究方向 43
參考文獻 44

1.2017 8月 消防月刊
2.2017 2月 消防月刊
3.內政部消防署《107年提升DA-CPR品質對策分析報告》
4.內政部消防署《DA-CPR 線上指導及提升品質計畫》
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