臺灣博碩士論文加值系統

中文摘要
研究背景：一歲以前嬰兒泌尿道感染發生率為6.72%，無發燒來源的泌尿道感染的機率更可達7%~13.2%，因此針對好發率高及結構異常高的嬰兒族群中，如何增加對疾病的敏感度，早期發現確定診斷，早期接受適當處置，及提供發展完整的照護計畫，進而降低疾病造成腎臟傷害很重要。
研究目的：1. 嬰兒泌尿道感染就醫比例、復發率及各基本資料之分析.2.嬰兒泌尿道感染復發的嬰兒及照顧者基本資料分析.3.嬰兒泌尿道感染情形與各變項之相關性.4.嬰兒泌尿道感染復發與各變項之相關性。
研究方法及對象：以台灣中部某醫學中心，回溯2008.01.01 ~ 2010.12.31期間，28天以上1歲以下（包括1歲）之兒科門診、小兒中重度病房及兒科病房，初次診斷為泌尿道感染之病歷，總病歷數共178264位，符合本研究之有效樣本共324位。使用自擬嬰兒泌尿道感染之相關因素調查表（附件一）為分析調查工具，收集並分析病歷資料中的人口學變項、臨床表徵及其他相關因素之分佈情形，研究結果運用SPSS 15.0版統計軟體，進行資料統計分析，以p＜.05為顯著臨界值，進行各資料屬性及研究假設檢定。
研究架構：依研究目的，收集28天以上一歲以下之罹患泌尿道感染之嬰兒病歷資料，整理分析出「嬰兒基本資料」、「照顧者基本資料」、「先天泌尿道結構異常」、「排便型態」，以及「哺餵方式」五大部分，及其個別細項之分佈比例，並進一步探討「嬰兒泌尿道感染與月年齡、性別、先天泌尿結構異常及排便型態之相關性」，以及「嬰兒泌尿道感染復發情形與嬰兒年齡、性別、先天結構異常、排便型態等變項間之相關性」，而整理出本研究之研究架構圖，如圖一。
研究結果：嬰兒泌尿道感染的就醫比率為0.18%，就醫症狀以發燒（99.1%）最多，臨床上多以尿袋（70.7％）方式收集檢體。尿液檢驗結果以大腸桿菌（E. col.）居多（62.5％）。治療上，細菌培養前會給與兩種經驗性抗生素，之後再依培養結果給予單一敏感性抗生素。在泌尿道感染中有18.5%結構異常，以膀胱輸尿管逆流16.67%居多，臨床上也都會給予腎臟超音波（Renal Echo）+膀胱排尿攝影（VCUG）+腎臟皮質掃描（DMSA）三種方式進行檢查（88％），以評估有無結構異常。
在25%（81/324）復發率中，一個月內的復發率為8.3%（53/81），年齡越小復發機率越高，復發情形與嬰兒性別及照顧者教育程度無關。有先天泌尿結構異常容易復發，但復發卻不一定是由先天泌尿結構異常造。便秘不一定會造成泌尿道感染復發，但有泌尿道感染復發現象者，通常合併有便秘情形。
研究結論：期望藉由此研究報告，了解嬰兒泌尿道感染之相關因素，如與嬰兒的性別、年齡、先天泌尿道結構異常與不同解便型態，藉此增加對此疾病危險因子的敏感度，並提供臨床訂定相關預防措施、照護依據，減少嬰兒泌尿道感染發生及腎臟損傷。
關鍵字：嬰兒、泌尿道感染、復發

Abstract
Background: The prevalence of urinary tract infection in infants is 6.72% and reaches up to 7%-13.2% in asymptomatic infants. It is essential to identify the significance of disease recognition, early diagnosis and intervention and provide an extensive caring plan for infants who are prone to urinary tract infection in order to reduce the incidence rate and to prevent complications.
Objective: 1 The proportion of medical treatment, the relapse rate and the basic data analysis of the infants with urinary tract infection. 2. The basic data analysis of the infants with recurrent urinary tract infection and their caregivers. 3. The correlation of variables of the infants with urinary tract infection. 4 The correlation of variables of the infants with recurrent urinary tract infection.
Methods and materials: Infants aged between >28 days to ≤1 year old were included in this retrospective study. Data was collected from a medical center located in central Taiwan and included infants who either visited the pediatric outpatient department or who was admitted to the intermediate care unit or pediatric ward during the period between and January 1, 2008 to December 31, 2010. The infants included in this study were all diagnosed with urinary tract infection for the first time. A total of 178,264 patients were included in this study and only 324 patients met the inclusion criteria. Questionnaires were handed out to caregivers for basic information records that were relevant to infantile urinary tract infection. The statistics of this study was obtained via analysis using SPSS version 15.0 software and p value < 0.05 was considered significant.
Research framework: Analysis of the data collected from infants who met the inclusion criteria was performed and data were analyzed according to five different categories: 「General data of infants」、「Caregiver’s basic information」、「Congenital urogenitalia anomalies」、「Defecation characteristics and feeding methods」. Further discussion was conducted into identifying the association between infantile urinary tract infection with age, gender, congenital urogenitalia anomaly and defecation patterns. Moreover, association between the recurrence rate of infantile urinary tract infection with age, gender, congenital urogenitalia anomaly and defecation patterns were compared. (See Table 1.)
Results: The doctor rate of infantile urinary tract infection was 0.18% and fever was the most frequent presented symptom (99.1%). Most of the urine samples were collected using urine collection bags (70.7%). The most frequent cultured pathogen from urine samples was Escherichia coli (62.5%). A combination of two empiric antibiotics was administered initially and then was subsequently switched to one susceptible antibiotic according to the results of urine culture. In this study, 18.5% of infants diagnosed with urinary tract infection showed urogenitalia anomalies and the most common anomaly encountered was vesicoureteral reflux (16.67%). Three diagnostic tools including renal ultrasound, voiding cystourethrogram (VCUG) and dimercaptosuccinic acid scan (DMSA) were used to confirm urogenitalia anomalies.
The recurrence rate of urinary tract infection was 25% and the recurrence rate within one month of the initial diagnosis was 8.3%. The recurrence of urinary tract infection was not associated with gender or caregiver’s education level but instead, was related to congenital urogenitalia anomaly and age. The rate of recurrence was indirectly proportional to age with younger children being more susceptible to recurrent urinary tract infection. On the other hand, urogenitalia anomaly was directly proportional to the recurrence of urinary tract infection. However, recurrent urinary tract infection was not only observed in infants with congenital urogenitalia anomaly. Infants with recurrent urinary tract infection present with higher risk for constipation but not all patients with constipation result in urinary tract infection.
Conclusion: The incidence of urinary tract infection may be associated with gender, age, urogenitalia anomalies and defecation patterns. With the identification of these associated risk factors, management of urinary tract infection through disease recognition, patient care and preventive measures may avoid possible complications that result in kidney damage.
Keywords: Infant, Urinary Tract Infection, Recurrence

目 錄

致 謝………………………………………………………………………I
中文摘要…………………………………………………………………II
英文摘要…………………………………………………………………IV
目 錄……………………………………………………………………VII
表目錄……………………………………………………………………IX
圖目錄……………………………………………………………………XI
第一章 緒論………………………………………………………………………1
第一節 研究背景與動機……………………………………………………..1
第二節 研究的重要性…………………………………………………………..3
第三節 研究目的………………………………………………………………..4
第二章 文獻查證…………………………………………………………………5
第一節 嬰兒泌尿系統…………………………………………………………..5
第二節 嬰兒泌尿道感染之定義、病因、症狀與機轉 ………………………8
第三節 嬰兒泌尿道感染之影響………………………………………………14
第四節 嬰兒泌尿道感染之檢驗與處置………………………………………16
第五節 影響嬰兒泌尿道感染之相關因素……………………………………26
第六節 嬰兒泌尿道感染照護…………………………………………………36
第三章 研究方法……………………………………………………………..41
第一節 名詞定義………………………………………………………………41
第二節 研究架構………………………………………………………………42
第三節 研究設計………………………………………………………………43
第四節 研究假設………………………………………………………………45
第五節 選樣方法及收案場所…………………………………………………47
第六節 研究工具………………………………………………………………48
第七節 資料收集過程……………………………………………………....50
第八節 倫理考量……………………………………………………………..50
第九節 資料分析方法………………………………………………………..50
第四章 研究結果………………………………………………………………53
第一節 嬰兒泌尿道感染就醫人數、復發率及各基本資料之分析………..53
第二節 復發嬰兒泌尿道感染的嬰兒及照顧者基本資料分析……………..59
第三節 嬰兒泌尿道感染情形與各變項間之相關性………………………..64
第四節 嬰兒泌尿道感染復發情形與各變項間之相關性…………………..72
第五章 討論……………………………………………………………….…81
第一節 研究結果之討論……………………………………………………..81
第二節 研究方法的討論……………………………………………………..89
第三節 臨床實務反思…..……………………………………………………90
第四節 專科護理師臨床上照顧嬰兒泌尿道感染的角色與功能…………..91
第六章 結論與建議……………………………………………………………95
第一節 結論………………………………………………………………95
第二節 建議……………………………………………………………...96
第三節 研究限制與未來研究方向………………………………………97
參考文獻 ………………………………………………………………………..99
中文部份…………………………………………………………………..99
英文部份…………………………………………………………………102
附 錄………………………………………………………………………….123 附錄一 嬰兒泌尿道感染之相關因素調查表………………………………..124
附錄二 嬰兒泌尿道感染照護指引……………………………………129

表目錄

表4-1-1 2008年~2010年就醫總人數及嬰兒泌尿道感染人數………………53
表4-1-2 324位嬰兒泌尿道感染中男嬰、女嬰之發生…………………………54
表4-1-3 2008年~2010年嬰兒泌尿道感染的復發……………………………54
表4-1-4 81位復發嬰兒泌尿道感染中男嬰與女嬰復發率……………………54
表4-1-5 嬰兒基本資料分析…………………………………………………55
表4-1-6 照顧者基本資料分析………………………………………………59
表4-2-1 復發泌尿道感染嬰兒基本資料分析………………………………60
表4-2-2 復發泌尿道感染的照顧者基本資料分析…………………………64
表4-3-1 嬰兒先天泌尿道結構異常與嬰兒性別、年齡之相關性…………66
表4-3-2 嬰兒先天泌尿道結構異常之類別與嬰兒、性別年齡之相關性……68
表4-3-3 嬰兒先天泌尿道結構異常之類別與嬰兒、性別年齡之相關性…68
表4-3-4 嬰兒泌尿道感染之性別與培養菌種之相關性……………………69
表4-3-5 嬰兒泌尿道感染之便秘與目前哺餵狀態之相關性………………70
表4-3-6 嬰兒泌尿道感染之便秘與是否曾母乳哺餵………………………70
表4-3-7 嬰兒泌尿道感染之便秘與初次母乳哺餵時間之相關性…………71
表4-3-8 嬰兒泌尿道感染之便秘與主要母乳哺餵時間之相關性…………71
表4-3-9 嬰兒泌尿道感染之便秘與混合母乳哺餵時間之相關性…………71
表4-3-10嬰兒泌尿道感染之便秘與完全配方奶哺餵時間之相關性………72
表4- 4-1 嬰兒泌尿道感染之復發情形與嬰兒性別、年齡之相關性……73
表4-4-2 嬰兒泌尿道感染復發情形與先天泌尿道結構異常之相關性……74
表4-4-3 嬰兒泌尿道感染復發情形之性別與先天泌尿道結構異常之相關性75
表4-4-4 嬰兒泌尿道感染復發情形與不同解便型態之相關性……………75
表4-4-5 嬰兒泌尿道感染復發與便秘之相關性……………………………76
表4-4-6 復發嬰兒泌尿道感染之便秘與目前哺餵狀態之相關性…………76
表4-4-7 復發嬰兒泌尿道感染之便秘與是否曾母乳哺餵之相關性………77
表4-4-8 復發嬰兒泌尿道感染便秘與初次母乳哺餵時間之相關性………77
表4-4-9 復發嬰兒泌尿道感染便秘與混合母乳哺餵時間之相關性………77
表4-4-10復發嬰兒泌尿道感染便秘與完全配方奶哺餵時間之相關性……78
表4-4-11嬰兒泌尿道感染之復發與照顧者教育狀態之相關性….…………78
表4-4-12嬰兒泌尿道感染復發之性別與培養菌種之相關性………………79
表5-1-1 研究假設檢定之結果………………………………………………88


圖目錄

圖一 研究架構……………………………………………………………………44

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