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| 題 名 | Hypothermia and Sepsis: The Major Causes of Mortality in Gastroschisis=低體溫及敗血症:腹裂畸型主要死亡原因 |
|---|---|
| 作 者 | 蔡明吉; 陳曉能; | 書刊名 | 中華民國小兒科醫學會雜誌 |
| 卷 期 | 36:5 民84.09-10 |
| 頁 次 | 頁328-330+386 |
| 分類號 | 417.132 |
| 關鍵詞 | 腹裂畸型; 敗血症; 代謝性酸中毒; Gastroschisis; Sepsis; Hypothermia; Metabolic acidosis; |
| 語 文 | 英文(English) |
| 中文摘要 | 從1984年到1993年,有25位腹裂畸型患者於彰化基督教醫院治療,其中21位由院外產科出生後轉至本院治療,只有四位是院內出生。18位病患接受了primary fascial closure,另外的七位接受了silastic sac technique。有兩位病患因爲傷口愈合不良幷有發膿現象以及腸阻塞而需再一次接受手術的治療。合幷其它先天性异常的比例是16%。有17位存活8位死亡,死亡率32%。由院外出生再送至本院治療的新生兒中,有9位到醫院時有體溫過低的現象(體溫介于32.5℃到35.8℃之間),其中有三位因體溫太低引起嚴重的代謝性酸中毒最後死亡。另外有二位除了有體溫太低及代謝性酸中毒之外,又發生了敗血症而死亡。在所有的25位當中,有六位因嚴重的感染而引發敗血症,其中僅有一位能够存活下來。在我們的研究當中發現,導致死亡的主要原因是新生兒在轉送過程中未有良好的照顧,暴露於低體溫的環境下過久所造成的代謝性酸中毒,以及感染所造成敗血症。大部份病患出生之後,都是用溫的生理食監水紗布覆蓋,但是如果不能很快的轉送至後送醫院處理,體溫稍不加注意便會因散熱太快而下降,甚至嚴重至威脅生命。腹裂畸型新生兒出生後,需注意無菌操作及保溫。盡可能的防止熱能及水份的散失,幷且時常注意保溫箱溫度及體溫的變化。因此,首要的工作便是適當的保護裸露的器官以避免感染,另一方面需注意保溫以减少低體溫及代謝性酸中毒的發生。降低感染及體溫過低的發生率,便能減少不必要的傷害,進而降低腹裂畸型的死亡率。目前利用超音波及甲型胎兒球蛋白可以幫助産科醫師早期發現腹裂畸型的存在。因此我們建議,這些腹裂畸型的新生兒在出生後以及在轉送的過程中,應由具有經驗的小兒科醫師負責照顧。如果這些新生兒在出生後不能得到立即及妥善的照顧的話,最好是將孕婦轉至設血完善的醫院生産,以避免不必要的傷害。 |
| 英文摘要 | From 1984 to 1993, 25 neonates with gastroschisis were treated at Chianghua Christian Hospital (CCH). Twenty-one patients were outborn, and only four were inborn babies. Eighteen patients were treated by primary fascial closure of the abdominal wall defect and seven, by the silastic sac technique. One patient required creation of intestinal stomas for ileal atresia; Two patients received further operation because of pus formation and intestinal obstruction. Four patients (16%) had associated anomalies, including one ileal atresia, two nzalrotations and one deformity of the hand. Seven (28%) patients were small for their gestational age. Eight patients died (32%); 17 survived (68%). Nine patients (36%) were hypothermic upon arrival at the hospital, with body temperatures of 32.5℃ to 35.8℃. Among those, three died of intractable metabolic disorders related to hypothermia and two who were hypothermal and acidotic, developed sepsis and expired. Six patients (24%) developed sepsis and only one survived. Metabolic acidosis related to hypothermia and sepsis were the major causes of death in this study (P values of 0.024 and 0.01 respectively). It is no doubt that an experienced pediatrician is essential for immediate neonatal care to prevent unnecessary insults. |
本系統中英文摘要資訊取自各篇刊載內容。