- 學位論文
積極退燒與不積極退燒兒童之退燒成效探討-以急性咽喉炎為例
Investigation of effectiveness in aggressive antipyretic therapy and non-aggressive antipyretic therapy in febrile children – Based on children with a diagnosis of acute pharyngitis
摘要
研究目的：發燒是兒科常見的症狀，臨床上，孩童發燒通常都是良性的病毒性疾病的表徵。對於健康的孩童，發燒的益處通常大於風險，適度發燒是有益的。而發燒症狀的處理應以增加舒適為主，非以降低體溫為目標，過度積極退燒藥物的使用有可能增加感染，了解兒童發燒的處置重要性和適切性，故本研究探討積極使用退燒藥物與不積極使用退燒藥物對兒童之退燒成效與影響。 研究方法及資料：本研究為回溯性研究，研究對象為中部某醫學中心小兒科病房住院病童，以病歷回顧方式進行研究分析，以多元線性回歸分析，分析病童基本屬性，積極使用退燒藥物和非積極使用退燒物兩組病童，探討此發燒處置方法，有無差異性。 研究結果：本研究共收案162位病童，積極退燒組21位，未積極退燒組141位。結果發現主要影響因子為是否積極退燒者（p<0.001），有相關性為積極退燒者的發燒時數會比未積極退燒者多67.93小時（=2.83天）。 結論與建議：發燒是人體面對感染的一種防護機轉，一種訊號，而發燒其實是疾病的症狀表現，因此退燒的考量，是以增進發燒病童的舒適度為主要，如果病童無特殊疾患且處於發燒時，沒有任何不適的情況，對於發燒的情形就不用過於積極的處理，只需要持續監測，給予補充營養、熱量、水分與電解質，比只提供退燒處置來抑制發燒情形更有意義，也可以促進免疫功能；本研究退燒藥物處理方面相關性的結果，積極退燒者的發燒時數會比未積極退燒者多67.93小時(=2.83天)。建議未來可以擴大收案年份及多個診斷疾病的病童，可以擴大樣本數以及不同區域的住院病童做病歷回顧分析。
並列摘要
Objective：Fever is a common symptom in children, which is usually benign and is also a benefit to clinical course when the fever is adequate. The treatment of fever should increase comfortable for febrile children rather than only reduce body temperature. However, excessive and aggressive antipyretic therapy may increase secondary infection. Therefore, we need to realize the treatment principle of fever and to investigate the influence and effectiveness of aggressive and non-aggressive antipyretic therapy on febrile children. Methods and Materials：This study was a retrospective and chart review study. It was conducted at the ward of Department of Pediatrics, at a medical center in Mid-Taiwan. Clinical and laboratory data were collected by chart review and then divided into aggressive and non-aggressive antipyretic therapy groups. Multiple linear regression was applied to evaluate effectiveness of aggressive and non-aggressive antipyretic therapy in febrile children. Results：This study enrolled 162 cases of febrile children with acute pharyngitis, including 21 in the aggressive antipyretic therapy group and 141 in the non-aggressive group. We found that the fever duration of aggressive antipyretic therapy group was significantly longer than the non-aggressive group (p <0.001). The aggressive antipyretic therapy group had longer febrile hours (67.93 hours, equal to 2.83 days) when compared to the non-aggressive antipyretic therapy group. Multiple linear regression analysis showed that the aggressive antipyretic therapy was a risk factor for the influence of fever duration on hospitalized febrile children. Conclusion and Suggestion：Fever is a protective mechanism of immune system, also is one kind of infection signals and symptom of the diseases. Therefore, the treatment of fever should be comfortable to febrile children who have no other severe symptoms, and aggressive antipyretic therapy was not recommended. Moreover, continuously monitoring body temperature and supplement nutrition, energy, water and electrolytes were more meaningful rather than only giving antipyretic agents in febrile children. Our study revealed that the aggressive antipyretic therapy treated children had more longer febrile hours (67.93 hours, equal to 2.83 days) than the non-aggressive antipyretic therapy treated children. However, we may need larger, longer, multiple areas and extended studies to draw a firm conclusion.