小兒氣喘之一死亡病例報告

A Case Report of Fatal Asthma in Children

林應然(Yung-Zen Lin) ； 謝貴雄(Kue-Hsiung Hsieh) ； 丁正凱(Cheng-Kai Ting) ； 王志堯(Jiu-Yao Wang) ； 周正成(Chen-Cheng Chou)

《Acta Paediatrica Sinica》 29卷1期 (1988/02) Pp. 72-75

摘要

支氣管性氣喘(bronchial asthma)死亡病例在小兒領域內頗爲少見，在臺灣更未曾報告。本文報告一位10歲女性氣喘病人，患者自3歲起就時常有氣喘發作，尤以冬季爲烈，一直以口服theophyllin及β2-agonist治療，嚴重時並加上prednisolone使用。病人曾接受家壓減敏治療兩年，但效果不彰。兩年前開始自行使用噴霧式吸入劑β2 metered dose inhaler(MDI)，效果依然不甚理想。病人在死前一個月症狀轉劇，於住院當天清晨因呼吸困難自睡眠中醒來，自行使用β2 MDI多次，症狀不見改善，約經1小時，嘴唇發紫，經送往附近醫院，但發現呼吸及心跳均已停止，再轉臺大醫院急救，最後因多種器官功能衰竭而死亡。

並列摘要

A case of fatal childhood asthma which has never seen in literatures here in Taiwan is reported. The patient was a 10-year-old girl who was admitted to the National Taiwan University Hospital with the chief problem of cardiopulmonary failure occurred suddenly in the early morning of admission. She had bronchial asthma since 3 years of age and treated with oral bronchodilators and prednisolone in case of severe asthmatic attacks. β2-selective metered dose inhaler (MDI) was added to the treatment regimen when she was old enough to be able to use. Hyposensitization with house dust had been performed for 2 years but without evident benefit. In spite of the treatments, frequent asthmatic attacks continued to bother her. One month before admission, the symptoms became much worsened. However, she and her parents didn't seek for doctor's advices but just increased the dose of MDI. In the early morning of admission she waked up because of respiratory difficult and then inhaled an unknown number of puffs of metaproterenol aerosol. Respiratory arrest followed by cardiac standstill occurred a couple of hours later. Despite intensive treatment, she died several days after the episode. The occurrence of such kind of tragedy very poesibly may be due to delay in instituting adequate and sufficient treatment.
In the past decade, childhood asthma in Taiwan has been increasing rapidly in both incidence and severity. After reviewing the literatures, we find that the majority of fatal asthmas result from underteatment rather than overtreatment. Thus adequate and appropriate treatment should be started as soon as possible in the appearance of the earliest clue suggesting rapid worsening of bronchial asthma.

並列關鍵字

fatal asthma ； β2 metered dose inhaler ； corticosteroid