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頁籤選單縮合
題名 | Assessment of Critical Care in Children with Chronic Disease=對於有慢性疾病的兒童重症病患加護照顧的預後評估 |
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作 者 | 王玠能; 姚志達; 陳永榮; 吳俊明; | 書刊名 | 中華民國重症醫學雜誌 |
卷期 | 5:1 2003.01[民92.01] |
頁次 | 頁65-71 |
分類號 | 419.75 |
關鍵詞 | 兒童加護病房; 慢性疾病; 加護照顧; 病患預後評估; 嚴重度指數; Pediatric intensive care; Intensive care unit; Outcome assessment; Mortality prediction; Chronic disease; |
語文 | 英文(English) |
中文摘要 | 目的:具有長期慢性疾病的兒童比起一般正常的兒童常具有較高的住院機率。本研究的目的在利用PRISM III score對於罹患慢性疾病的兒科重症病患的疾病嚴重度以及預測死亡率的分析。 設計:前瞻性,觀察性研究。 病患:某南部大學醫學中心小兒科加護病房篩選其中具有慢性疾病的兒童。 方法及結果:從民國88年11月到民國89年10月,一共有248人次中的221位具有慢性疾病(116位男童及105位女童)住進小兒科加護病房,平均年齡是49.9月(範圍從4個月到18歲)。分析其中最常見的慢性疾病是先天性心臟病(27.0%)。而病童住加護病房的平均住院天數是5.54天(範圍從1天到80天)。平均疾病嚴重度指標是6.43分(範圍從0分到39分)。在死亡的33個病患當中,有10個病患是因為家屬選擇不給予積極治療。平均總體死亡率是13.64%,與預測死亡率(8.48%)兩者間具有統計上的意義差異(p值小於0.05)。但是標準加護病房住院天數比值(Standardized PICU length of stay ratio, SLOSR)是1.31,與預測加護病房住院天數比值兩者間有統計上的意義差異(p值為小於0.001)。加護病房平均總體照護效率為28.3%。 結論:由本研究結論顯示,利用PRISM III評量表來評估對於具有慢性疾病的本地兒童重症病患似乎沒有得到良好的預測性,而且實際的住院天數也遠大於預測住院天數。我們推想在不同國家的醫療環境均有差異,因此我們要利用國外的兒童死亡危險度評估表來判斷我們的加護病房住院天數或照顧效率時,仍必需考慮國内外情形的差異性。尤其對於具有慢性疾病的兒童重症病患的末期照護,不論在醫學、倫理、保險給付、家庭及社會責任上,有待將來更大規模的研究。 |
英文摘要 | Objective: Children with chronic disease have an excess rate of hospitalization compared with the general pediatric population. This study aimed an objective description of pediatric critical care for chronic ill children in Taiwan. Design: Prospective, observation study. Setting: A university hospital pediatric intensive care unit in Tainan, Taiwan. Patients: Patients with chronic condition admitted to the PICU during the period from November 1, 1999 to Qctober 31, 2000. Measurement and Main results: our PICU had 248 admissions, including 221 patients (116 boys and 105 girls) with an average age of 49.9±42.1 months (range: 4 month to 18 years). The most common underlying chronic disease for critical care was congenital heart disease (27.0%). The average duration of stay was 5.54±7.74 days (range 1 day to 80 days). The average PRISM III score was 6.43±5.68 (range 0-39). 10 of 33 patients died due to do-not-resuscitate (DNR), limitation of care, and /or withdrawal of care orders based on patients' chronic disease. The overall mortality rate in the PICU was 13.64%. The mortality rate was significantly different from the predicted rate (8.48%) (p<0.05). The efficiency of care was 28.3% and the standardized PICU length of stay ratio (SLOSR) was 1.31. The SLOSR ratio was significantly higher than the predicted rate (p value < 0.001). Conclusions: Our study suggests the results of the mortality prediction using the PRISM III scoring system are not adequate to make decisions for patients with chronic illness in Taiwan. There was also a significant variation between observed length of stay (LOS) and predicted LOS. However, a cautions approach should be taken when using the severity of illness scoring systems to predict mortality or LOS, particularly when such an assessment is carried out in contexts different from the one in which the instrument was originally developed. Further studies should address the ethical processes leading to withdrawal or no resuscitation orders, and evaluate prospectively the ways in which these decisions are made in Taiwan. |
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