余忠仁2006-08-312018-07-112006-08-312018-07-112004http://ntur.lib.ntu.edu.tw//handle/246246/29790至今年7 月31 日止，全世界共有8,098 確定SARS 病例，774 （9.6%）例死亡。大約 10-20%之SARS 患者發生呼吸衰竭需要呼吸器與重症醫療。死亡主要與年齡有關。 對於持續惡化的病人，及早在瀕臨呼吸衰竭前插管並給予合乎標準的呼吸照護被認 為是目前最有效的治療。由先前的觀察大致可以歸納出會發生疾病惡化之危險因 子，包括高齡、中性白血球偏高、高LDH 、嚴重的淋巴球缺乏、延遲給予類固醇與 Ribavirin 合併治療及慢性B 型肝炎感染。然而，除了年齡之外，並沒有一個簡易的 疾病標誌可供辨認哪位病患會發生呼吸衰竭以及死亡。每天重複監測各項實驗室檢 查數據是唯一辨識這些高危險群的方法。胸部影像檢查也可以提供重要的預後資 訊，但是，也必須每天重複檢查胸部影像。有時候，病情發展太快，胸部影像檢查 一日數變，增加照護上的困難。雖然SARS 治療指引上也明確規範在危險病患早期 插管，但有時確然難以辨識誰為危險病患。而一但為緊急插管，常會導致不佳的後 果。台大醫院在上一波SARS 盛行期間共收治76 位確認SARS 病患，其中27 位發 生急性呼吸衰竭，15 位死亡，多數死亡均因併發急性呼吸窘迫症候群或多器官衰竭。 本計畫中，我們希望利用這76 位確認SARS 病患之臨床資訊，包括症狀、理學檢查 與一系列之實驗室檢查之資料，利用Oracle Clinic 與Classification and Regression Tree analysis (CART)分析方式，建立一預測系統，以早期辨識會發生呼吸衰竭之高危險群 病患，可幫助醫護人員對於這些病患提供更密切的監測，以降低死亡率。Severe Acute Respiratory Syndrome (SARS) is an acute respiratory illness caused by infection with a new coronavirus, SARS-CoV, identified in March, 2003. The disease is characterized by high contagious, may progress rapidly to respiratory failure and is potentially lethal in severe cases. As of June 5, 8,402 cases of SARS had been reported in the world, and 772 (9.2%) died of the disease. About 10-20% of SARS patients developed respiratory failure requiring intensive care and mechanical ventilation. Mortality majorly depends on the age group affected, with an overall estimate of 14% to 15%. For patients with progressive deterioration, early intubation for impending respiratory failure and providing best supportive and respiratory care are considered to be of primary importance. Risk factors that have been reported to be associated with a progressive disease are: older age, high neutrophil count, high LDH peak; severe lymphopenia, impaired ALT, delayed starting of ribavirin and steroids; chronic Hepatitis B infection. However, besides age, no single early markers or clinical parameters have been identified to predict the progression to respiratory failure or fatal outcome. Tedious daily laboratory monitoring is necessary to figure out who will develop progression of the disease. Chest radiographs offer important prognostic clues for disease progression. However, serial chest films are necessary, and sometimes the clinical deterioration is too rapid that a regular chest film may not be useful, dramatic change may appear within one single day. Although a guideline had been proposed for caring SARS patients, which advised elective and early intubation for SARS patients with impending respiratory failure, clinical prediction of high risk patient is sometimes not possible. Emergent intubation or the need of resuscitation seems related to the fatal outcome. In this study, we plan to establish a prediction system by using the clinical parameters early in the disease course to identify patients with high risk for acute respiratory failure, which will help doctors to provide a more intensive monitoring of high-risk patients.application/pdf102356 bytesapplication/pdfzh-TW國立臺灣大學醫學院內科嚴重急性呼吸道症候群急性呼吸衰竭Severe acute respiratory syndromeacute respiratory failure[SDGs]SDG3reporthttp://ntur.lib.ntu.edu.tw/bitstream/246246/29790/1/922751B002016Y.pdf