近年來因種種抗生素之出現,對於細菌感染疾病之治療,已有很大的進步。雖然有些細菌對於某種抗生素可發生抗藥性,但因抗生素之不斷改進及新抗生素繼續出現,細菌感染疾病之發生率,臨床症狀及致命率,已有改善之趨勢。但白喉之發生率據日本厚生省兒童局之報告,1952~1957年間反而有增加之傾向,在本省據林等報告,1950~1960年間亦有增加之傾向。 至今傳染疾病之預防接種已有很大的進展,又因公共衛生教育之推廣及國民衛生知識之提高,致使接受預防接種者之增多及一般傳染疾病之減少,但仍有不少未經預防接種之白喉病例。 雖然抗生素及抗毒素之早期使用可以減輕白喉之臨床症狀,減少死亡例及後遺症之發生,但白喉之致命率仍高。 由以上幾點,著者等認爲對白喉仍不能勿視而且仍有再檢討之必要。因此,在最近5年間在本院小兒科住院之白喉病例分析觀察,茲報告其結果,以供參考。
Clinical observations were made on a total of 117 cases of diphtheria in children admitted to the Kaohsiung Medical College Hospital during the period of 1961-1965. The results are summarized as follows: 1. The majority of the cases or 60.7% occurred during the months of November to February. 2. The ages of the patients varied from 6 months to 11 years and 68.4% of them were under 3 years. They were 75 males (64.1%) and 42 females (35.9%). 3. Most of the patients had never been vaccinated and some of them had had inadequate immunization against diphtheria. 4. The patients were admitted to the ward on the first to 13th ill day and 80 cases (71.4%) before the 4th ill day. The lengths of hospitalization in the majority of cases (91.1%) were within 2 weeks. 5. The case-fatality rate was 15.2%; 26.8% in females and 8.5% in males and this sex difference was statistically significant (X^2=5.5l, P<0.02). Nearly half or 47.1% of the fatal cases had pharyngo-laryngeal diphtheria. Most of the fatal cases died before the 6th ill day. 6. Among the clinical symptoms, fever, cough, husky voice and dyspnea were most common. In most of the cases fever subsided on the 5th or 6th ill day and 2 to 3 days after the treatment. 7. Pseudomembranes were found in the nasal cavities, pharynx, larynx or trachea, in the majority of cases in pharynx. The pseudomembranes disappeared 2 to 10 days after the treatment. 8. Diphtheria bacilli were demonstrated in the pseudomembranes in 77 cases (77.8%). Total white blood cell counts mostly ranged from 10,000 to 25,000 per 1 cubic millimeter. Anemia was found in 16 cases (14.3%), abnormal findings in the urine in 20 cases (23.0%) and increased serum glutamic oxaloacetic transaminase in 14 cases (20.6%). 9. In the majority of cases Ilosone and Penicillin combined with 10,000 to 20,000 units of antitoxin were used for the treatment. Serum sickness appeared in 10 cases (8.9%) 5 to 20 days after the intramuscular injection of antitoxin. Tracheototomy was performed in 52 cases (46.4%).
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