COVID-19初期對台灣偏鄉醫院重症醫療的影響

The Impact of Initial Stage of COVID-19 on Critical Care in a Rural Area of Taiwan

本研究旨在調查嚴重特殊傳染性肺炎初期對南投縣偏鄉重症醫療的影響。本研究資料來自南投縣偏鄉地區醫院。2019年為對照年，2020年為全球疫情年（但南投縣全年確診人數僅3人）。結果顯示加護病房總入住人次下降6.3%；男性入住比例增加4.7%；病房轉入比例下降4.9%；死亡率上升1.3%；平均住院天數下降；內科系收治比例下降。收治科別的增減趨勢：胸腔內科下降、心臟內科上升、消化內科下降、神經內科上升和腎臟內科下降；神經外科上升、一般外科上升和泌尿外科上升。嚴重特殊傳染性肺炎初期確實對偏鄉重症醫療造成影響，使得加護病房的收治人數下降但死亡率上升。其餘顯著影響包括由病房轉入比例減少、轉院減少、內科系重症減少、胸腔內科重症減少和一般外科重症增加。

The purpose of the study was to investigate the impact of the initial stage of COVID-19 on people in rural areas of critical care in Taiwan. The data were obtained from a local hospital, comparing the control year 2019 with the COVID- 19 year 2020. No COVID-19 patient was admitted to the hospital in 2020. A 6.3% decrease in total ICU admissions was observed. The proportion of male patients increased from 56.9% to 61.6%. The proportion of patients admitted via the ward decreased from 20.0% to 15.1%. Mortality increased from 2.7% to 4.0%. The rate of transfer to another hospital decreased from 14.3% to 10.4%. The average length of hospital stay decreased from 4.11 days to 3.87 days. The increasing and decreasing trends in the major admissions departments were as follows: pulmonary medicine decreased from 22.2% to 17.4%, cardiology increased from 18.9% to 19.3%, gastroenterology decreased from 12.6% to 10.6%, neurology increased from 8.5% to 10.2%, nephrology decreased from 7.2% to 7.0%, neurosurgery increased from 17.6% to 18.0%, general surgery increased from 5.8% to 8.9%, and urology increased from 2.7% to 3.5%. The initial stage of COVID-19 affected critical care in rural Taiwan. The ICU admission rate decreased, and the ICU mortality rate increased. Overall, patients admitted to the surgery system increased, as well as cardiology and neurology.