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題名：基於病人初步的生命跡象預測經由動脈栓塞治療骨盆腔骨折出血的成功率
作者：董政城
作者(外文)：Tung, Cheng-Cheng
校院名稱：亞洲大學
系所名稱：健康產業管理學系健康管理組
指導教授：藍守仁
學位類別：博士
出版日期：2018
主題關鍵詞：初步生命跡象；動脈栓塞治療；骨盆腔骨折出血；initial presentation；trans-arterial embolization；pelvic fracture bleeding
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背景和目的:
骨盆腔骨折出血通常會導致出血性休克。經由動脈栓塞被認為是最有效之治療。然而，病人最初生命跡象會影響經由動脈栓塞治療骨盆腔骨折出血之成效。 這是一個回朔性研究，其目的是探討是否可以基於病人初步生命跡象，預測經由動脈栓塞治療骨盆腔骨折出血之成功率。
研究資料與研究方法:
總共回收集二十七個骨盆腔骨折出血，且接受經由動脈栓塞治療病例。所謂治療失敗定義是：病人在接受經由動脈栓塞治療骨盆腔骨折出血後，因為無法有效止血，病人需立即接受剖腹探查手術，或是病人死亡。對於這些接受經由動脈栓塞治療骨盆腔骨折出血病人，我們分析病人初步人口學資料與生命跡象狀態，包括年齡、性別、收縮血壓、心率、體溫、呼吸率,格拉斯哥昏迷指數（GCS），外傷嚴重分數（ISS），與合併其他器官系統損傷。我們使用皮爾遜相關性（Pearson’s correlation）和獨立t 檢定（Independent t-test）的統計方法。最後再使用勝算比（Odds ratio）找出病人最佳之初步生命跡象狀態，以提升接受經由動脈栓塞治療骨盆腔骨折出血之成功率。
研究結果:
病人接受經由動脈栓塞治療骨盆腔骨折出血之成功率與年齡和性別無關。病人生命跡象狀態，包括年齡、性別、收縮血壓、心率、體溫、呼吸率、格拉斯哥昏迷指數（GCS）、外傷嚴重分數（ISS），與合併其他器官系統損傷，皆與病人接受經由動脈栓塞治療骨盆腔骨折出血之成功率有統計學意義的相關。且在勝算比的統計上，也達到統計上顯著之差異（p < 0.05）。
研究結論:
要提昇病人接受經由動脈栓塞治療骨盆腔骨折出血的成功率，病人必須預防低體溫，體溫需在攝氏三十六度以上；應少於二個合併其他器官系統的損傷；維持呼吸速率於每分鐘二十二下；維持收縮血壓於九十釐米汞柱（mmHg）；維持心跳速率於一百下；維持格拉斯哥昏迷指數（GCS）於十三分以上；維持外傷嚴重分數（ISS）於二十分以下。
Background and Aim：
Pelvic fracture bleeding generally leads to hemorrhagic shock. Trans-arterial embolization (TAE) is regarded as the most useful treatment; however, the initial presentation of the patient can impact the effectiveness of TAE for pelvic fracture bleeding. The aim of this retrospective study is to explore whether the patient initial presentations can predict the success of TAE for pelvic fracture bleeding.
Materials and Methods：
Twenty-seven charts were retrospectively reviewed. TAE failure was defined as any patient who eventually received an exigent laparotomy or who died due to uncontrolled bleeding after TAE. For patients who received TAE, we analyzed factors recorded at the initial presentation, including age, gender, systolic blood pressure, heart rate, respiratory rate, body temperature, Glasgow coma scale (GCS) score, injury severity score (ISS) and associated injuries, using Pearson’s correlation and independent t-tests. The odds ratio was used to determine the cut-off values for the patient presentation findings related to successful TAE and thus was used to assess the congruity.
Results:
Successful TAE was not correlated with age or gender. The hierarchical order of statistically significant associations between successful TAE and initial presentation data was as follows: the patient’s body temperature, associated injury, respiratory rate, systolic blood pressure, GCS score, and ISS. The odds ratios for all statistically significant initial presentation factors were within a ninety-five percent confidence interval.
Conclusion:
The findings upon initial presentation of a patient with pelvic fracture bleeding that were related to the predictability of successful TAE include the following: hypothermia prevention with maintenance of the body temperature above thirty-six degrees Celsius, associated injuries limited to two organ systems, maintenance of the respiratory rate at approximately twenty-two breaths per minute, a sustained systolic blood pressure of approximately ninety mmHg, maintenance of a heart rate of approximately one hundred beats per minute, a minor head injury with a GCS score greater than thirteen and a moderate ISS of less than twenty.
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