中華民國兒童胸腔醫學會雜誌
台灣兒童胸腔暨重症醫學會,停刊
選擇卷期
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Objective: To study the short-term influence of teaching self-management principles and skills on the control of asthma in children. Material and methods: Children aged from six to eighteen years with all classes of asthma severity were enrolled in the study at our outpatient clinic from December 2001 to June 2002. all patients were taught the concept of avoidance of environmental allergens at the first visit and were instructed in the use of home peak expiratory flow rate (PEFR) monitoring twice a day. They recorded the PEFR and symptoms in a diary and were followed weekly for 6 weeks. Analysis included changes in the PEFR, PEFR variability, and symptom and physical finding scores. Results: A total of 107 children were studied, 66 boys and 41 girls, with a mean age of 9.7±1.9 (mean ± SD, range: 6 to 18 years). They represented all classes of asthma severity. The PEFR, PEFR variability, physical findings and symptom scores all showed significant improvement at 6 weeks compared with the baseline. (P＜0.05) Significant improvement was seen in all variables in each subgroup according to severity, with the exception of the average PEFR and symptom scores in the mild intermittent group (274.4 to 282.5; 0.740 to 0.481, respectively, P＞0.05). Conclusion: Asthma in children is better controlled when the patients or their parents develop the skills to manage the disease themselves.
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自發性氣縱膈是一種罕見的兒童疾病，當病童因性胸痛而至小兒診就醫時，這個疾病常被忽略而不考慮在診斷之中。為了能了解及評估兒童自發性氣縱膈的臨床表現，本研究採回溯性分析自1994年6月至2003年6月之中，19位18歲以下在彰化基督教醫院診斷為自發性氣縱膈之病童，探討其病因，臨床表徵，住院過程以及預後。診斷工具則以胸部X光為主。在本研究的結果中，分析出與自發性氣縱膈最為相關的病因為呼吸道感染症（42%），其後為氣喘（21%）及不明因素（21%）；此外，最常見的臨床狀為胸痛（58%），其次為呼吸困難（53%）；而最常見的特殊理學檢查發現為皮下氣腫（79%），其次為Hamman’s sign。 本研究所有的病童都安排住院治療，其中有六位病童（32%）因嚴重的呼吸窘迫症狀而須入加護病房觀察及治療，所有病童平均住院天數為4.5±2.6天，而範圍則從2至11天，每位病童於出院前的胸部X光則都已完全或接近完全改善，並且，在本研究期間皆無復發的情況出現。因此本研究的結論：自發性氣縱膈對兒童而言是一種罕見而良性的病症，當病童如果出現有因胸痛，呼吸困難或頸部疼痛不適的症狀而被送至小兒急診室就醫時，特別是本身有呼吸道感染或氣喘的病童，自發氣縱膈的診斷應該要考慮到，同時，胸部X光也應安排檢查。我們也建議對於自發性氣縱膈的病童要安排短期住院觀察並且治療可能引起呼不適的併發症，例如伴隨而至的氣胸。
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In Taiwan, asthma is one of the most common allergic diseases because Taiwan is an island and located in the subtropical area with optimal humidity and temperature for the growth of house dust mites and cockroaches. The inhalant allergens of house dust mites and cockroaches become the most important triggers of childhood asthma. To evaluate the correlation between cockroach and mite sensitive asthmatic children with or without atopic dermatitis, 75 asthmatic children with positive house dust mites skin reaction were enrolled for skin prick test using the extracts from both American and German cockroach extracts, respectively. 26.7%(20/75) mite sensitive asthmatic children had at least one specific IgE antibodies against American, German or Oriental cockroaches, and the sensitized rates of American, German and Oriental cockroaches were 20.0%(15/75), 14.7%(11/75) and 22.7%(17/75), respectively. There was no statistical significant difference to cockroach hypersensitivity between mite sensitive asthmatic children with and without atopic dermatitis (p＞0.05). In Taiwan, Oriental cockroach may also play an important role in triggering childhood asthmatic symptoms in addition to American and German cockroaches. WE will underestimate the status of cockroach allergy in mite sensitive asthmatic children only by using allergy skin test with German cockroach extracts or specific IgE antibody against German cockroach by Pharmacia CAP system.
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呼吸融合病毒（RSV）是造成嬰幼兒細支氣管炎的最主要的原因，而幼兒時期的細支氣管似乎又與兒童時期反覆喘鳴甚或是氣喘有關。許多臨床研究都顯示RSV細支氣管炎是兒童氣喘或者異位體質的一個重要的危險因子。而此危險性甚而會持續至13歲之前。其機轉雖仍未知，但已有許多動物及體外實驗提供了許多可能之研究方向。本文將從臨床開始並進入有關之基礎研究，介紹近年之進展。
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咳血常是一種令人驚恐的症狀。引起咳血的原因，包括有感染，心臟血管疾病，腫瘤，以及血管炎等。大量咳血則需要立即地保護呼吸道，及早診斷，以及防止更進一步的出血。 我們報告一個肺結核病例咳血為其最開始症狀。肺部高解析度電腦斷層發現在右上肺葉的後肺小葉有許多節結狀浸潤，且有厚壁空洞狀的病灶。在結多抗結核菌的藥物治療後，病患咳血自動緩解。在此篇文章中，我們也有回顧兒童咳血的原因與治療。
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肺炎如大家所熟知的是兒童腹痛的原因之一，而且引起腹痛的肺炎多半位於右下肺葉。但是，我們所要提出的這位肺炎雙球菌性肺炎的患者的初始症狀為發燒、腹痛、非常輕微的咳嗽（一天只咳3-5聲）。理學檢查並沒有發現囉音或乾囉音，但其大葉性肺炎的位置是在右上肺葉。很快地，這個患者也惡化到瀕臨敗血性休克及瀰漫性血管內凝血的階段。但她終究仍幸運地在高劑量盤尼西林的治療下順利出院。