臺灣博碩士論文加值系統

本研究主要目的為瞭解嚴重急性呼吸道症候群（SARS）的臨床特徵為何，並探討影響SARS病患死亡之相關因子。
本研究採回溯性（Retrospective）研究設計，於2003年8月至2004年2月以某南、北醫學中心SARS可能病例為收案來源，個案數共78人。利用SARS結構性問卷收集資料。以SPSS 10.0 for Windows統計套裝軟體，應用描述性及推論性統計進行資料分析。
研究主要結果發現為（1）78位個案（平均年齡＝44歲；標準差＝18歲；年齡範圍＝13-84歲），男性24人（30.8％），女性54人（69.2％）。感染的原因以院內感染居多（56.4％）。（2）最早出現的生理症狀前五項分別為發燒（98.7％）、咳嗽（48.7％）、全身酸痛（24.4％）、呼吸短促（21.8％）、寒顫僵硬及全身虛弱（20.5％）。（3）實驗室檢查包括，白血球減少（入院時，23.4％；住院期間，50％），白血球增加（入院時，16.9％；住院期間，53.1％），血小板減少（入院時，35.1％；住院期間，56％），segment增加（入院時，58.4％；住院期間，84.4％），淋巴球減少（入院時，68.8％；住院期間，84.4％）， CPK異常升高（入院時，27.0％；住院期間，36.4％），LDH異常升高（入院時，28.4％；住院期間，57.9％）， GOT異常升高（入院時，35.3％；住院期間，100％），GPT異常升高（入院時，21.2％；住院期間，71.4％），CRP異常升高（入院時，77.8％；住院期間，91.2％）。（4）個案胸部X光呈現病變（入院時，71.8％；住院期間，97.4％）於入院後7.1天（SD＝6.6）變嚴重。（5）47位（60.3％）個案從檢體中分析出SARS-CoV病毒。（6）在78位可能病例中有24位個案死亡，死亡率高達30.8％。（7）在單變量分析中，年齡（t＝-4.9,p＜0.001）、婚姻（χ2＝10.819,p＝0.004）、教育程度（χ2＝13.200,p＝0.040）、是否為醫護相關人員（p＝0.004）、過去是否患有癌症（p＝0.003）、過去是否患有肺部疾病（p＝0.002）及有無插管（p＜0.001）、入院第一週與第二週第一次白血球、segment值及第二週第一次淋巴球值（t=2.998,p=0.004）、入院第二週（t=-4.393,p＜0.001）及第三週（t=-2.796,p=0.008）的胸部X光與死亡是呈顯著意義。（8）邏輯迴歸（Logistic Regression）分析則顯示有插管者（OR＝115,p＜0.001）是死亡之預測因子。

The purpose of this study was to understand the clinical manifestations and death related factors in patients with severe acute respiratory syndrome (SARS).
Between August 2003 and February 2004, 78 patients with probable SARS seen at some South, North Medical center included in this retrospective study. Utilize SARS structural questionnaire to collect the data. Data were analyzed using descriptive and inferential Statistics with the SPSS software package, version 10.0 for Windows.
The main findings are as follows: (1) Of the 78 patients with probable SARS (Mean ages, 44 years; SD, 18 years; range, 13-84 years), 24 were male (30.8%) and 54 were female (69.2%). Nosomical infection (56.4%) is the major cause for SARS. (2)The earliest symptoms appearing as follows: fever (98.7%), cough (48.7%), myalgia (24.4%), short of breath(21.8%), chillness and weakness (20.5%). (3)The laboratory findings included leucopenia (on hospital admission, 23.4%; during hospitalization, 50%), leukocytosis (on hospital admission, 16.9%; during hospitalization, 53.1%), thrombocytopenia (on hospital admission, 35.1%; during hospitalization, 56%), elevated segment (on hospital admission, 58.4%; during hospitalization, 84.4%), lymphopenia (on hospital admission, 68.8%; during hospitalization, 84.4%), elevated CPK (on hospital admission, 27%; during hospitalization, 36.4%), LDH (on hospital admission, 28.4%; during hospitalization, 57.9%), GOT (on hospital admission, 35.3%; during hospitalization, 100%), GPT (on hospital admission, 21.2%; during hospitalization, 71.4%), CRP (on hospital admission, 77.8%; during hospitalization, 91.2%). (4)The patients had abnormal findings on chest radiographs (on hospital admission, 71.8%; during hospitalization, 97.4%) became serious at a mean time of 7.1± 6.6 days after hospitalized. (5)The sample for SARS-CoV was positive in 47 of the 78 patients (60.3%) in whom the test was performed. (6)Mortality was 24 of the 78 patients (30.8% ). (7)Age (t=-4.9,p<0.001), married (χ2=10.819,p=0.004), education background (χ2=13.200,p=0.040), the medical relevant personnel (p=0.004), the past history of cancer (p=0.003), the past history of pulmonary disease (p=0.002) , intubations (p<0.001), the first time of leukocyte and segment on the first week and second week , the first time of lymphocyte on the second week (t=2.998,p=0.004) during hospitalization, the second week (t=-4.393, p<0.001) and the third week(t=-2.796,p=0.008) on chest radiograph during hospitalization were associated with death. (8) Logistic regression analysis showed that intubations was the only significant predictor of death (OR=115,p＜0.001).

目錄
指導教授推薦書……………………………………………………
論文口試委員會審定書……………………………………………
國家圖書館授權書 ………………………………………………… iii
長庚大學授權書 …………………………………………………… iv
致謝 ………………………………………………………………… v
中文摘要 …………………………………………………………… vii
英文摘要 …………………………………………………………… ix
第一章 緒論 ……………………………………………………… 1
第一節 研究動機與重要性 …………………………………… 1
第二節 研究目的與研究問題 ……………………………… 3
第三節 名詞解釋 …………………………………………… 3
第二章 文獻查證 ………………………………………………… 5
第一節 SARS之簡述 ………………………………………… 5
第二節 心理衝擊 …………………………………………… 17
第三節 文獻總結 …………………………………………… 20
第三章 研究方法 ………………………………………………… 21
第一節 研究架構 ……………………………………………… 21
第二節 研究設計 ……………………………………………… 22
第三節 研究場所及研究對象 ………………………………… 22
第四節 研究工具 ……………………………………………… 22
第五節 研究信效度檢定 ……………………………………… 23
第六節 倫理考量 ……………………………………………… 23
第七節 資料收集過程 ………………………………………… 23
第八節 資料統計與分析方法 ………………………………… 24
第四章 研究結果 ……………………………………………………26
第一節 SARS可能病例之人口學特徵 …………………………26
第二節 SARS可能病例之臨床症狀 ……………………………29
第三節 SARS可能病例住院期間血液學之變化 ………………39
第四節 SARS可能病例住院期間生化學之變化 ………………42
第五節 SARS可能病例住院期間胸部X光之特徵 …………… 45
第六節 影響SARS可能病例死亡之相關因子 …………………50
第五章 討論 …………………………………………………………57
第一節 SARS可能病例之基本屬性 ……………………………57
第二節 SARS可能病例之臨床症狀 ……………………………58
第三節 SARS可能病例之實驗室檢查 …………………………61
第四節 SARS可能病例之胸部X光 …………………………… 65
第五節 SARS可能病例與死亡之相關因子 ……………………67
第六章 結論與建議 …………………………………………………69
第一節 結論 …………………………………………………… 69
第二節 臨床實務的應用 ……………………………………… 72
第三節 未來學術研究上的建議 ……………………………… 73
第四節 研究長處與限制 ……………………………………… 75
參考資料……………………………………………………………… 76
中文部份 ……………………………………………………… 76
英文部份 ……………………………………………………… 76
附錄…………………………………………………………………… 85


表目錄
表3-1 統計分析法 …………………………………………… 24
表4-1 SARS可能病例之人口學特徵 ………………………… 27
表4-2.1 所有個案所呈現的生理症狀 ………………………… 31
表4-2.2 所有個案所呈現的心理症狀 ………………………… 32
表4-2.3 無插管個案所呈現的生理症狀………………………… 34
表4-2.4 無插管個案所呈現的心理症狀………………………… 35
表4-2.5 有插管個案所呈現的生理症狀………………………… 37
表4-2.6 有插管個案所呈現的心理症狀………………………… 38
表4-3 血液學檢查異常發生率………………………………… 40
表4-4 生化學檢查異常發生率………………………………… 43
表4-5.1 SARS可能病例入院之初之胸部X光型態……………… 46
表4-5.2 SARS可能病例入院期間胸部X光型態及預後………… 46
表4-5.3 SARS可能病例入院期間之胸部X光分佈……………… 47
表4-5.4 SARS可能病例入院期間之胸部X光型態……………… 47
表4-5.5 SARS可能病例胸部X光片合併之疾病………………… 48
表4-5.6 SARS可能病例每週胸部X光片嚴重度之平均分數…… 49
表4-6.1 比較SARS可能病例有無死亡之人口學情形……………51
表4-6.2 第一週第一次血液生化檢驗值與死亡與否之分析…… 54
表4-6.3 第二週第一次血液生化檢驗值與死亡與否之分析…… 54
表4-6.4 胸部X光與死亡與否之分析 …………………………… 55
表4-6.5 胸部X光之合併疾病與死亡與否之分析 ……………… 55
表4-6.6 有無插管與死亡與否之邏輯迴歸分析………………… 56


圖目錄
圖3-1 研究架構圖…………………………………………………… 21
圖4-3.1 血液（WBC、platelate）異常發生率線性圖 ……………41
圖4-3.2 血液（WBC、segment、lymphocyte）異常發生率線性圖41
圖4-4.1 生化（CPK、GOT、CRP）異常發生率線性圖 …………… 44
圖4-4.2 生化(LDH、GPT)異常發生率線性圖……………………… 44
圖 4-5 胸部X光嚴重度線性圖 ………………………………………50

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