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題 名 | Comparison of Intensive Care of Injured Children between Pediatric-based and Non-pediatric-based Intensive Care Units in a University Hospital in Taiwan=兒童急性創傷後的加護照顧在小兒科加護病房以及非小兒科加護病房之比較 |
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作 者 | 王玠能; 吳俊明; 邱元佑; 羅傳堯; | 書刊名 | 臺灣兒科醫學會雜誌 |
卷 期 | 40:6 民88.11-12 |
頁 次 | 頁400-405+463 |
分類號 | 419.75 |
關鍵詞 | 急性創傷; 重症醫療; 兒童加護照顧; 小兒科加護病房; 外科加護病房; Injuried children; Pediatric intensive care unit; Surgical intensive care unit; Intensive care; |
語 文 | 英文(English) |
中文摘要 | 重症兒童的加護照顧需要在以兒童病患為主體的小兒科加護病房,多方面的團隊 合作,細心的處理,才會有良好的預後。但是目前在臺灣,絕大多數的重症創傷的兒童病患 ,大多是由外科醫師在外科加護病房照顧。但這些外科加護病房的設備及人員訓練並不是專 為兒童設計。本研究的目的在於探討比較小兒科加護病房以及非小兒科加護病房 (外科加護 病房 ) 對於急性創傷的兒童病患照顧的預後結果。 從民國 78 年 1 月到民國 84 年 8 月 ,以病歷回溯研究, 一共有 118 位兒童 (68 位男童及 50 位女童 ) 因為嚴重創傷住進外 科加護病房; 平均年齡是 9.19 歲 (範圍從 3 個月到 16 歲 )。 同時期一共有 65 位兒童 (42 位男童及 23 位女童 ) 住進小兒科加護病房; 平均年齡 5.04 歲 (範圍從 2 個月到 16 歲 )。決定住進那一個加護病房由外科急診醫師視當時床位空缺而定。 住院後這些病患 則是由外科主治醫師負責。兒童死亡危險度評估表 (PRISMscore) 則用作為評估兒童嚴重度 指標。分析最常住進加護病房的原因都是車禍事故。而病童在外科加護病房的平均住院天數 是 4.06 天 (範圍從 1 天到 23 天 )。 而小兒科加護病房的平均住院天數則是 3.34 天 ( 範圍從 1 天到 17 天 )。平均兒童嚴重度指標在外科加護病房是 7.87 分 (範圍從 0 分到 41 分 )。而小兒科加護病房的平均兒童嚴重度指標則是 6.48 分 (範圍從 0 分到 35 分 ) 。 關於死亡率的比較在外科加護病房是 12.7%,而小兒科加護病房是 7.7%。統計上顯示兩 個加護病房病患的平均年齡及接受開刀手術的比例上有統計上的差異,其餘在平均住院天數 ,嚴重度指標及死亡率方面,並無統計上的意義差異。利用迴歸分析法來進一步討論危險因 子發現: 不同的加護病房,病患年齡或住院天數並不會影響預後; 但是兒童死亡危險度評估 表 (PRISMscore) 每增加一分則有一點五倍的不良預後危險。但是開刀手術具有降低不良預 後危險的機會。由本研究結論。創傷分佈種類及嚴重度指標在兩個加護病房相似,而且沒有 統計上有意義的差異。兒童死亡危險度評估表 (PRISMscore) 則可以作為預測重症兒童預後 指標。雖然小兒科加護病房的平均住院天數較短及死亡率較低,但是兩個加護病房照顧的預 後結果,在統計上沒有明顯的差異,有待將來對於重症兒童的加護照顧更大規模研究。 |
英文摘要 | Intensive care management of the injured child requires a multidisciplinary approach and meticulous attention to detail. However, the overwhelming majority of injured children are cared for by surgeons in surgical intensive care units (ICU) that see both adult and pediatric patients. There have been no previous reports of studies comparing the outcome in surgical ICUs (SfCU) dealing with patients of all ages versus the outcome in pediatric ICUs (PICU). This study sought to determine differences in the outcome of pediatric intensive care between the SICU and PICU of our hospital. From Jan. 1989 to Aug. 1995, I!8 children (68 boys and 50 girls), with an average age of 9.19 years (range: 3 months to 16 years), were admitted to our SICU. During the same period, 65 children (42 boys and 23 girls), with an average age of 5.04 years (range: 2 months lo!6 years), were admitted to our PICU. Most of these patients received surgical intervention and were exclusively under surgeons' management. The decision to admit patient to the SICU or PICU was made by surgeon based on the availability of ICU beds. Pediatric risk of mortality (PRISM) score was used as a scoring system to assess disease severity in children. The most common cause for admission in both ICUs was traffic accidents. The average hospitaUwtion duration in the SICU was 4.06 days (range 1 day to 23 days) and 3.34 days (range ] dav to 17 days) in the PICU. The average PRISM score was 7.87 (range 0-41) in the SICU and 6.48 (range 0-35) in the PICU. The overall mortality rate in the SICU was 12.7% (15/118) and 7.7% (5/65) in the PICU. There was a significant difference in patients' age and operative status but no significant difference in admission duration, PRISM score, and mortality rate between the SICU and PICU groups. The regression coefficients of the selected predictor variables and the impact on outcome showed one more score of PRISM would increase 1.5 fold of risk to become poor outcome while operation had lower risk (O.1 fold) to develop poor outcome. In conclusion, disease diversity and severity were similar among PICU and pediatric SICU patients in this study. The outcome was better in PICU patients although the difference was not statistically significant. The PRISM score is a useful measure to predict poor outcome in ICU patients after adjustment with confounders. |
本系統中英文摘要資訊取自各篇刊載內容。