- 期刊
SARS的影像學和鑑別診斷：其防疫角色
Imaging Findings and Differential Diagnosis of Severe Acute Respiratory Syndrome: Its Role in Containing Outbreak
摘要
嚴重急性呼吸道症候群（Severe Acute Respiratory Syndrome,SARS），是一種由全新的冠狀病毒（coronavirus）所引起的高傳染力、高死亡率的非典型肺炎。台灣為全球第三位受危害疫區，一度造成恐慌，人人聞之色變。由於院內感染為其主要擴散模式（clusters of nosocomial transmission），因此如何儘早正確診斷SARS為迫切的課題。而胸部放射學影像的變化為早期診斷SARS病例及追蹤病情進展的重要依據。此疾病之早期影像表現多為周邊型，分布於下肺葉之air-space浸潤性陰影，呈現毛玻璃影像（ground-glass）或肺泡實質化（consolidation），一般沒有肋膜積水、開洞（cavitation）或淋巴結病變。約四分之三的患者在發燒初期就可以發現異常胸部X光變化，而其餘四分之一初期X光為正常患者，平均三天後亦會出現X光或高解像度電腦斷層檢查（High-resolution Computed Tomography, HRCT）的典型變化。此外，HRCT會比X光檢查提早二天顯示異常變化。
並列摘要
A novel coronavirus, the causative agent of SARS, affected healthy persons with atypical pneumonia, which is highly infectious and fatal. Taiwan has experienced the third largest outbreak on record, where every case of atypical pneumonia has the potential to arouse suspicion and spark a panic. The major disease outbreak is by way of nosocomial transmission, there fore early case detection, patient isolation and contact tracing are the keys to break the chain of transmission. Chest image is the central step to the early diagnosis and the care of the patients, so health care workers or medical students should be aware of the radiographic appearance of this disease to prevent its transmission. Initial chest images were abnormal in three fourths of patients and showed ground-glass shadow or air-space consolidation, but the rest of the subjects with an initial normal chest radiograph, showed evidence of air-space opacities on subsequent follow-up chest radiographs or HRCT after an average of three-day intervals. Peripheral lung and low lung zones were more commonly involved. No cavitation, lymphadenopathy, or pleural effusion was demonstrated. Beside, the radiographic abnormalities developed an average of two days after CT scanning.
延伸閱讀
- 黃月嬌、張瑛瑛、丁秀子、莊寶玉、陳美玉（2003）。由醫院臨床的觀點談SARS的防治－以某醫學中心為例。護理雜誌，50(3)，11-17。https://doi.org/10.6224/JN.50.3.11
- 蘇勳璧、邱詩惠、林美嫻、王明琴、周振英（2003）。電子顯微鏡下的SARS病毒。疫情報導，19(10)，540-545。https://doi.org/10.6524/EB.200310_19(10).0002
- 陳美芳、楊惠如、黃淑宜（2003）。從感染控制觀點談SARS病患之檢傷、醫院及居家隔離。長庚護理，14(4)，403-409。https://doi.org/10.6386/CGN.200312_14(4).0008
- Kao, H. W., Hsu, H. H., Hsu, G. C., Cheng, W. T., & Chen, C. Y. (2004). Severe Acute Respiratory Syndrome: Radiographic Features of 36 Probable Cases. 中華放射線醫學雜誌, 29(1), 1-6. https://www.airitilibrary.com/Article/Detail?DocID=10188940-200402-29-1-1-6-a
- Jiang, J. S., Jang, T. N., Huang, C. S., & Kao, S. J. (2003). Prone Position Ventilation in a Spontaneous Breathing Patient with Severe Acute Respiratory Syndrome: A Case Report. 中華民國急救加護醫學會雜誌, 14(4), 169-173. https://doi.org/10.30018/JECCM.200312.0006