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題 名 | 鉤端螺旋體引起呼吸衰竭之呼吸照護經驗=Clinical Experience of Respiratory Patient with Leptospirosis Induse Respiratory Failure |
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作 者 | 周卉羚; 蔡坤龍; 吳青佩; 林曉瑛; 蕭慧英; 周紹庭; | 書刊名 | 呼吸治療雜誌 |
卷 期 | 12:2 2013.07[民102.07] |
頁 次 | 頁107-121 |
分類號 | 415.415 |
關鍵詞 | 鉤端螺旋體病; 急性肺出血; 急性呼吸窘迫症; 多重器官衰竭; Leptospirosis; Acute pulmonary hemorrhage; Acute respiratory distress syndrome; Multiple organ failure; |
語 文 | 中文(Chinese) |
中文摘要 | 鉤端螺旋體病(Leptospirosis)是一種「新興及再浮現傳染病」,為廿年來新出現的傳染病,同時也是世界上最普遍的人畜共通傳染病之一。鼠類雖為終身保菌宿主,但犬、貓類因與人類接觸密集,更易造成人類感染該疾病。感染鉤端螺旋體後,常會造成腎臟慢性感染,並經由尿液大量排菌,且經由黏膜、皮膚傷口等直接或間接接觸鉤端螺旋體病原菌而感染。在臨床上症狀多樣化且複雜,從不明顯的病徵到高死亡率的嚴重多器官衰竭,但大部份以不顯性感染為主。本文敘述照護一位鉤端螺旋體引起呼吸衰竭之照護過程,住入加護病房期間,詳細記錄脫離呼吸器數值與病情變化,其中個案呼吸照護問題有三項:一、病情惡化造成急性呼吸窘迫症候群(acute respiratory distress syndrome, ARDS)合併急性肺出血(acute pulmonary hemorrhage)二、多重器官衰竭困難脫離呼吸器問題三、院內感染合併急性腎衰竭、心衰竭等多重器官衰竭影響氧合的問題。使用壓力控制型通氣(pressure control ventilation, PCV)模式及高吐氣末正壓並採肺保護策略之呼吸器設定來輔助個案提供病人適當氧合並且協助病人成功脫離呼吸器之經驗分享。 |
英文摘要 | Leptospirosis is an emerging and re-emerging infectious disease. Not only has Leptospirosis been one of the new infectious disease that emerge in the past 20 years, but also among the world's most common disease transmitted to human from animals. Rats and mice are the important primary hosts; however since dogs and cats live more closely with human, they are most likely to transmit the disease as secondary hosts. Once infected with Leptospirosis, symptoms can include chronic liver infection and excretion of large amount of bacteria from urine. The infection is commonly transmitted to humans by direct or indirect contact through mucous membrane and unhealed skin with the pathogenic bacteria. In clinical practice, the symptoms are more diverse and complex. It can go from no apparent symptoms to high death rate of multiple organs failure, but most of the cases have no apparent symptoms. This paper discusses and a detailed record of the course of a leptospirosis patient who developed respiratory distress and was put under the intensive-care unit and the process of weaning from the ventilator. Two problems had arise during the course of this period. Due to the worsening condition of the patient; the patient developed acute respiratory distress syndrome (ARDS) and acute pulmonary hemorrhage which damage the function of respiratory tract to clean and obstructed the air passage. The other problem was dealing with hospital-acquired infection, acute renal failure, heart failure, and multiple organ failure and providing oxygenation and limited medical facilities to assist the patient for successfully weaning from the ventilator. |
本系統中英文摘要資訊取自各篇刊載內容。