嚴重急性呼吸道徵候群對第一線工作人員院內感染所導致腹瀉之探討

A Study of Diarrhea in Medical Workers with Severe Acute Respiratory Syndrome

黃瑞眞(Jui-Chen Huang) ； 方秀珍(Hsiu-Chen Fang)

《長庚護理》 16卷4期 (2005/12) Pp. 382-389

https://doi.org/10.6386/CGN.200512_16(4).0003

摘要

冠狀病毒感染會導致呼吸道或胃腸道疾病，而嚴重急性呼吸道徵候群(SARS)，所攻擊目標器官是肺部。故本研究要探討的重點，在於第一線工作醫護人員照顧嚴重急性呼吸道徵候群之病患，有可能經呼吸道傳染到冠狀病毒而引發之胃腸道病狀「腹瀉」。自民國92年5月1日6月16日，本院有十六位第一線護工作人員，被診斷爲疑似嚴重急性呼吸道徵候群(SARS)。包括醫師五位，護士八位及呼吸治療師三位，他們曾明顯地與嚴重急性急性呼吸道徵侯群(SARS)的指標病例有緊密接觸史。冠狀病毒RNA是用反錄型的聚合多鏈反應酶(RT-PCR)來檢測，共偵測喉頭檢體十六例，血清檢體二例及肛門檢體七例。腹瀉乃經由病歷上登錄爲主，另用Fisher統計方法分析。結果，男性五例、女性十一例，平均年縱k6織。第一線工作之醫護人負爲熙願嚴雲急性呼吸道故候群之病患，有可能經呼吸道傳染到冠狀病寮馮公發文胃腸道症狀，其導玫複瀉之發生率爲―良8%(3/16)，死亡率爲6.25%(1/16)。根據報告顯示，院內第一線工作之醫護人員，經呼吸道可能感染到嚴重急性呼吸道徵候群之同時，其腹瀉病症狀並不常見。醫護人員照顧嚴重急性呼吸道徵候群之病患，爲病患插管時經呼吸道感染爲主，因此，胃腸道的病毒數量較低，可見於肛門採檢反綠聚合多鏈反應酶(RT-PCR)檢查，所以檢體檢測到陽性率較低及胃腸道症狀不明顯可能有關係。第一線工作之醫護人員感染嚴重急性呼吸道徵候群合併急性腹瀉之調查，腹瀉可能與本身個體性（心理性）或體質性（生理性）之大腸急躁症有關，需要從臨床的角度來探討。

關鍵字

嚴重急性呼吸近徵候群 ； 服瀉 ； 醫護人員

並列摘要

The purpose of this study was to investigate the enteric symptoms of the medical workers who were evidently infected with SARS by means of respiratory transmission. Between May and June 16, 2003, we examined 16 medical workers who were diagnosed with the probable SARS Samples used for the detection of coronas jinx RNA by RT-PCR were collected front throat and rectal swabs during acute phase. Serum anti-SARS IgG was checked by ELISA at the convalescent phase. the incidence of watery diarrhea xx as 18.8% (3/16). The RT-PCR of coronas has v, as positive in three (18.8%) of sixteen throat swabs and in none (0%) of seven rectal swabs. Serum anti-coronavirus IgG was positive in 13 of the 15 subjects (86.7%). The mortality rate was 6.25% (1/16). In conclusion, Hospital-acquired SARS cases were infected mainly by respiratory route and less commonly presented with diarrhea. Low common diarrhea rate and low positive rate in rectal swab RT-PCR, when the virus spreaded by respiratory route, might be due to less intestinal viral load. According to the clinical observation, the psychological factor with stress could be the reason of functional gastrointestinal disorder leading to the diarrhea symptom.

並列關鍵字

severe acute respiratory syndrome ； diarrhea ； medical workers