提升腦損傷病人術後目標溫控

Improving Target Temperature Management in Postoperative Patients with Brain Injury

腦損傷後發燒使顱內壓升高，導致腦血流量減少引起繼發性腦損傷，影響神經學恢復。統計2023年上半年，腦損傷併顱內壓監測術後病人共126位，發燒率高達86.5%，本專案旨在提升腦損傷併顱內壓監測衛後，病人目標溫控（體溫≦38.0°C）照護達成率。經歸納達成率低之原因為，缺乏腦損傷術後病人目標溫控治療作業規範、醫療團隊認知正確率低，及退燒設備取用不便。專案小組擬定並施行改善對策包括：設立降溫處置規範、制定腦損傷併顱內壓監測術後病人目標溫控治療流程、訂定品質管理稽核、舉辦在職教育及設立降溫百寶盒與低溫設備專區。成功提升使此類病人目標溫控治療達成率，以預防及主動處置的行動出發，減少發燒，未來建議結合醫療體系整合資料庫，分析神經學預後具體成效。

Fever following brain injury elevates intracranial pressure (ICP), reduces cerebral blood flow, and leads to secondary brain injury, ultimately affecting neurological recovery. In the first half of 2023, 126 patients with brain injury who underwent ICP monitoring surgery were recorded, with a postoperative fever rate as high as 86.5%. This quality improvement project aimed to increase the achievement rate of target temperature management (TTM; defined as body temperature :-S38.0°C) in this patient population. Root cause analysis identified three major barriers to achieving TTM: the lack of standardized TIM protocols for postoperative brain injury patients, low awareness among the healthcare team, and difficulty accessing temperature-lowering equipment. In response, the project team implemented several interventions, including the establishment of TTM treatment protocols, a stepwise care flowchart, quality audit systems, in-service education programs, and the creation of a ''Cooling Toolbox'' and a dedicated area for hypothermia devices. These actions significantly improved the achievement rate of TTM, highlighting the importance of proactive fever management in reducing postoperative complications. Future recommendations include integrating data across medical systems to evaluate the long-term neurological outcomes of TTM interventions.