- 期刊
急性細支氣管炎嬰兒需住加護病房之危險因子
Risk Factors for Bronchiolitis-associated Intensive Care Unit Hospitalization among Infants
摘要
目的：探討在中台灣地區1歲以內嬰兒患嚴重急性細支氣管炎的相關危險因子。 方法：採個案對照研究法，自2003年4月至2004年4月以罹患急性細支氣管炎住彰化基督教醫院兒童醫院小兒加護病房之1歲以內嬰充為對象。 結果：評估之指標包括生理指標（出生病史，原始疾病或合併先天性異常等等），臨床表徵，呼吸衰竭時之X光，喘鳴相關之惡化等因子等等。本研究結果顯示患急性細支氣管炎住小兒加護病房之嬰兒共40人次，(1)35%病嬰反覆因同一疾病再入院；(2)37.5%病嬰為外籍新娘所生，其中70%為男嬰。57.5%嬰兒住院時有發紺，42.5%合併下痢。在咳嗽、呼吸急促發生之最初48至72小時是呼吸危急時段；(3)22.5%病嬰有合併先天性異常；(4)80%為呼吸道融合病毒感染。72.5%病嬰在胸腔X光月上可見肺膨脹不全；45%病嬰需接受呼吸器治療；嚴重者往往合併母親認知指數較低。 結論：影響患急性細支氣管炎嬰兒相關危險因子具有統計學上意義者包括先天性異常及病嬰為外籍新娘。咳嗽、呼吸急促發生之最初48至72小時是呼吸危急時段。此外呼吸道感染，具過敏家族史及社會經濟差異和合併症有關。
並列摘要
Objective: To evaluate the factors contribute to the morbidity of critical-care level wheezing illness in infants younger than 1 year old. Method: Forty infants younger than 1 year-old who had bronchiolitis admitted to pediatric intensive care units at Changhua Christian Hospital during April 2003 to April 2004 were enrolled retrospectively. Results: Baseline evaluations of these the infants focused on biological (demographic data, birth history, underlying diseases and associated anomalies), clinical manifestations, and radiologic findings that would potentially increase respiratory failure. Prior morbidity attributable to wheezing was assessed by medical record documentation of hospitalizations. There were forty infants younger than 1 year-old with bronchiolitis admitted to pediatric intensive care unit during April 2003 to April 2004. Thirty-five percent of infants had more than one hospitalization. Thirty seven point 5 percent infants were born to foreigner bride. Seventy percent infants were male. Fifty seven point five percent infants had lips cyanosis at admission and forty two point five percent infants also complained of diarrhea. The most compose timing for respiratory compromise was the first 48-72 hours after onset of cough and dyspnea. Twenty two point five percent infants had congenital anomalies. Eighty percent infants had RSV infection. In radiologic findings, there were seventy two point five percent infants had atelectasis over right middle lung field. Forty five percent infants received mechanical ventilation during hospitalization. In addition, greater illness severity of infants was associated with low maternal cognitive score. Conclusions: Congenital anomalies and infants born to foreigner bride were important factors in morbidity attributable to infant wheezing illness. The highest risk of respiratory compromise was during the first 48-72 hours after onset of cough and dyspnea. In addition to respiratory tract infection, both allergic processes and social variables were also associated with morbidity.