- 期刊
Shock in the Pediatric Emergency Service: Five Years' Experience
小兒急診之休克病人：五年回顧
摘要
休克是小兒死亡的重要原因之一。本研究之目的爲回溯性分析小兒急診之非受創性休克病人的病因及預後因素。研究對象爲自1992年10月1日至1997年9月30日止，於本院小兒急診就醫之非受創性休克病人。共22名病人爲研究對象，包括11名敗血性休克(50%)，7名低血容積性休克(32%)及4名心因性休克(18%)病人。病人年齡分巾從2個月至19歲。這22名病人中，14名病人(64%)有潛在性之疾病。革蘭氏陰性敗血症(6/11，55%)，急性腸胃炎(7/7，100%)，及擴張性心肌病變(2/4，50%)分別爲敗血性休克，低血容積性休克，及心因症性休克之最常見原因。總共12名病(55%)死亡。死亡率以敗轎性休克(9/11，82%)及心因性休克(3/4，75%)病人爲高。低血容積性休克病人則無人死亡。影響病人預後的危險因子包括血小板低下及凝血時間(prothrombin time, partial thromboplastin time)處長。而如果病人小於兩歲叵有白轎球低下及較高之C-反應蛋白(C-reactive protein)值之情況，則伴有較高死亡率之傾向。
並列摘要
We undertook a retrospective study of the risk factors determining outcome of nontraumatic patients with shock in the pediatric emergency service. From October 1992 through Septemper 1997, 22 patients with the diagnosis of shock were identified, including 11 with septic shock (50%), 7 with hypovolemic shock (32%) and 4 with cardiogenic shock (18%). Their age ranged from 2 months to 19 years old. Among the cases, 14 patients (64%) had other underlying diseases. Gram-negative bacterial sepsis (6/11, 55%), dilated cardiomyopathy (2/4, 50%) and acute gastroenteritis (7/7, 100%) were the most frequent causes of septic, cardiogenic and hypovolemic shock, respectively. In total, 12 patients (55%) died. The mortality rate was high in septic shock (9/11, 82%) and cardiogenic shock patients (3/4, 75%), but low in hypovolemic shock patients (0/7, 0%). The risk factors of poor outcome in patients with shock included thrombocytopenia, prolonged prothrombin time and partial thromboplastin time. Patients with leukopenia, a higher level of C-reactive protein, or under 2 years of age tended to have poor outcome.