https://scholars.lib.ntu.edu.tw/handle/123456789/188368
標題: | 台灣地區「嚴重性呼吸道症候群」之臨床研究─(子計畫二)長期追蹤嚴重急性呼吸道症候群病患之肺部機能後遺症 | 作者: | 余忠仁 | 關鍵字: | 嚴重急呼吸道症候群;急性呼吸窘迫症候群;高解像力電腦斷層檢查;肺功能檢查;一氧化碳瀰漫量;severe acute respiratory syndrome;acute respiratory distress syndrome;high-resolution computed tomography;pulmonary function test;diffusion capacity | 公開日期: | 2004 | 出版社: | 臺北市:國立臺灣大學醫學院內科 | 摘要: | 在2003 年2 月至8 月間,全球共有8096 位嚴重急呼吸道症候群(SARS )病患,774 位死 亡,死亡率為9.6%。在台灣,346 位病患中,37 位死於SARS ,大多數因發生急性呼吸窘 迫症候群(ARDS )而呼吸衰竭。研究顯示,ARDS 的存活者,由於經歷了嚴重的疾病過程, 產生了長期在軀體上與神經心理上的後遺症,造成肺部與肺外之病態。本研究計畫以定期 之肺功能檢查與高解像力電腦斷層檢查SARS 病患之肺部變化。由於吾人對於SARS 的臨 床經驗仍在累積中,精確的評估SARS 的長期肺部機能之變化有助於臨床醫師對於治療此 一疾病之思考。 本計畫自92 年4 月執行至93 年7 月,本院共照顧76 位嚴重呼吸道症候群之可能病患,15 位死亡。40 位於發病後51.8 ±20.2 天接受第一次高解像力電腦斷層檢查,37 位接受肺功能 檢查;發病後140.7 ±26.7 天,19 位接受第二次高解像力電腦斷層檢查,22 位接受第二次肺 功能檢查。第一次高解像力電腦斷層檢查顯示多數病例肺部影像仍有明顯變化(air trapping ,92.5%;ground-glass opacity ,90%;reticulation ,70%;parenchymal band ,55%; bronchiectasis ,17.5%; consolidation ,10%;honeycombing ,7.5%)。 發生ARDS 之SARS 病患其肺部變化明顯較嚴重,尤其是ground-glass opacity (GGO )的嚴重度。肺功能檢查 有12 位(37%)病患有囿限性通氣病變,其餘之肺功能檢查為正常。發生ARDS 之SARS 病 患其肺功能明顯較差。接受第二次檢查之病患,高解像力電腦斷層檢查與肺功能檢查均呈 現明顯進步,包括電腦斷層影像之GGO 嚴重度由8.68 ±6.96 分降至4.42 ±5.14, (p < 0.0001 ) 與纖維化嚴重度由5.79 ±6.13 降至3.05 ±5.80 ,(p < 0.0001 ),肺功能檢查FVC (%預測值) 由 71.3 ± 23.4 上升至 98.1 ± 19.6%,(p = 0.004 ),而 FEV1 (%預測值) 由73.9 ± 21.0 上升至 96.5 ± 17.9%,(p = 0.005 )。即使是發生ARDS 之SARS 病患其第二次電腦斷層檢查與肺功 能檢查也都有明顯進步,但仍有50%仍有囿限性通氣病變。肺部之一氧化碳瀰漫量(DLco ) 變化與電腦斷層檢查之纖維化嚴重度成明顯負向相關。本觀察研究顯示嚴重急性呼吸道症 候群之肺部傷害之預後可能較原先預期為良好,而肺功能檢查之DLco 值可作為肺部纖維 化嚴重度之參考。 Between Feb to August, 2003, in more than 29 countries, 8096 cases and causing more 774 deaths (fatality rate 9.6%). In Taiwan, 37 out of 346 SARS victims died, most of deaths were attributed to severe acute respiratory distress syndrome (ARDS). Pulmonary sequelae is especially anticipated in patients developing severe pulmonary infection or acute lung injury. Survivors of the acute respiratory distress syndrome have persistent functional disability one year after discharge from the intensive care unit. As the clinical experience of dealing with SARS is accumulating, studies prospectively evaluating physiological, functional, and morphological measures during the year after diagnosis of SARS will provide valuable information for clinicians to handle patients with this new disease. From April, 2003 till now, 76 patients with documented SARS were admitted to our hospital,15 died of the disease. Forty of the survivors received first HRCT examination at 51.8 ±20.2 days after symptom onset, 37 received pulmonary function examination ;140.7 ±26.7 after symptom onset,19 received a second HRCT examination ,22 had a second pulmonary function examinations 。HRCT of lung parenchymal change revealed air trapping (92.5%), ground-glass opacity (90%), reticulation (70%), parenchymal band (55%), bronchiectasis (17.5%), consolidation (10%), and honeycombing (7.5%) in the first follow-up study. SARS patients who experienced ARDS (n=16) had significantly higher scores than those without ARDS (n=24) in ground-glass opacity. Twelve of the 37 patients (37%) showed variable degrees of restrictive ventilatory defects in first PFT examiantion and 11 of them had been complicated by ARDS. On the first PFT patients without ARDS had better test results than those complicated by ARDS. Comparison between the first and second follow-up HRCT of 19 cases revealed significant improvement in ground glass opacity (CT scores 8.68 ±6.96 vs. 4.42 ±5.14, p < 0.0001) and fibrosis (CT scores 5.79 ±6.13 vs. 3.05 ±5.80, p < 0.0001). All these impairments in PFT improved 2 months later. The FVC (% predicted) values improved from 71.3 ± 23.4 to 98.1 ± 19.6% (p = 0.004) and the FEV1 (% predicted) increased from 73.9 ± 21.0 to 96.5 ± 17.9% (p = 0.005). Most HRCT and PFT parameters in patients with SARS-ARDS significantly improved on the second examinations, but a restrictive defect was still present in 5 of the 10 patients (50%), probably because of residual pulmonary fibrosis. The DLco (% predicted) was inversely correlated with the total fibrotic scores on the high-resolution computed tomography (HRCT) of the chest. Our observation study revealed that lung damage in SARS patients usually resolve over time. The DLco may be a useful marker to follow-up fibrosis sequelae. |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/23673 | 其他識別: | 923112B002042 | Rights: | 國立臺灣大學醫學院內科 |
顯示於: | 醫學系 |
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