2-4 肆臨床表徵及併發症 (90-100%) 37 (26-90%) (50-80%) (5-65%) (20-40%) 33-75% 30% (HIV ) 3.3% 5,6 伍治療方式 ( ) 一人工呼吸道的建立, 有下列症狀的病人會建

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1 臨床藥物治療學急性會厭炎的臨床處理臺大醫院新竹分院藥劑部藥師張玉慧壽偉瑾摘要 acute epiglottitis symptom treatment 壹前言 3 (acute epiglottitis) 1,2 貳病理病因學 aryepiglottic fold (AE fold) ( ) Hib (Haemophilus influenzae type B B ) 3%-14% Pseudomonas aeuginosa Candida species ( ) 1,2 參流行病學 50% THE JOURNAL OF TAIWAN PHARMACY Vol.29 No.3 Sep

fold (AE fold) ( ) Hib (Haemophilus influenzae type B B ) 3%-14% Pseudomonas aeuginosa

2 2-4 肆臨床表徵及併發症 (90-100%) 37 (26-90%) (50-80%) (5-65%) (20-40%) 33-75% 30% (HIV ) 3.3% 5,6 伍治療方式 ( ) 一人工呼吸道的建立, 有下列症狀的病人會建議立即建立人工呼吸道 ( ) ( ) ( ) ( ) > 50% ( ) 3 圖一急性會厭炎的處理流程 (endotraceal intubation) (tracheostomy) 5% 2-3 5,6 二投予適當的抗生素 ( ) Haemophilius influenzae type B Penicillin-resistant streptococcus pneumoniae Staphylococcus aureus (MRSA) strains cephalosporin ( ceftriaxone 29 3 Sep 藥學雜誌第 116 冊 69

厭炎的處理流程 (endotraceal intubation) (tracheostomy) 5% 2-3 5,6 二投予適當的抗生素 ( ) Haemophilius influenzae type B

3 臨床藥物治療學 cefotaxime) Antistaphylococcal ( ) MRSA ( vancomycin) MRSA ceftriaxone cefotaxime c e f e p i m e c e f u r o x i m e a m p i c i l l i n - sulbactam ( ) vancomycin (meningitis) cephalosporin G(-) 3. β-lactam vancomycin quinolone ( ) ( ) 7-10 ( ) 2-3 ( ) ( ) 3 三其他藥物的輔助治療 ( 一 ) 類固醇藥品 20-83% ( 二 ) 支氣管擴張劑 epinephrine ( 三 ) 鎮靜劑的使用 benzodiazepine 陸案例報告 48 A (WBC:14740/µL) ( ) X ( ) ( ) ( ) ( ) A B C ( 70 THE JOURNAL OF TAIWAN PHARMACY Vol.29 No.3 Sep

β-lactam vancomycin quinolone ( ) ( ) 7-10 ( ) 2-3 ( ) ( ) 3 三其他藥物的輔助治療 ( 一 ) 類固醇藥品 20-83% ( 二 ) 支氣管擴張劑

4 ) B Haemophilus influenza 10 表一病人 A 於加護病房之生命徵狀 Date 2/19 2/20 2/21 2/22 2/23 2/24 2/25 2/26 Respiratory rate ( / ) Pulse ( / ) Temperature ( ) Blood pressure (mmhg) 136/66 133/34 128/55 150/90 145/84 155/91 143/92 140/84 Intake (ml/day) Output (ml/day) I/O (ml/day) 表二病人 A 住院用藥一覽表 Medicine 2/19 2/20 2/21 2/22 2/23 2/24 2/25 Amoxicillin/Clavulanic acid 1.2 g/vial, IV q8h Methylprednisolone 40 mg/vail IV q12h Estazolam 2 mg/tab po hs Gentamcin 80 mg/vial, IV q8h Potassium Chloride 40 meq IV qd Magnesium oxide 250 mg po tid Acetaminophen 500 mg po qid Sucralfate 500 mg po t id 表三三位病人的基本資料及入院時的臨床狀況及檢測結果 Patient A Patient B Patient C Sex male male male Age LMD ( ) before 3 days before 2 days before 7 days Symptoms sorethroat, swallow disturbance, fever, stridor Culture S/C (-) sorethroat, SOB, dysphagia S/C (Haemophilius influenzae) odynophagia (1week), laryngeal edema S/C (-) Temp. ( ) Pulse (/min) Respiratory rate (/min) B. P. (mmhg) 135/78 133/75 92/62 WBC (/µl) BUN (mg/dl) Cr (mg/dl) Sep 藥學雜誌第 116 冊 71

6 36.6 Blood pressure (mmhg) 136/66 133/34 128/55 150/90 145/84 155/91 143/92 140/84 Intake (ml/day) 2910 3400 3410 3175 2420 Output (ml/day) 1150 2040 2670 3380 3260 I/O (ml/day) 1760 1360 740-205

5 臨床藥物治療學圖二病人A治療前鼻咽喉鏡檢圖 (會厭部圖三位腫脹) 位回復正常) 參考資料病人A治療後鼻咽喉鏡檢圖 (會厭部 4. Charles R Woods. Epiglottitis (supraglottitis): Clinical feature and diagnosis UpToDate L-A G, Lynne D, Becker BC. Acute epiglottitis: epidermiology, clinical presentation, management and outcome. The J. of Laryngology & Otology 2008; 122: Gilead B, Tali L, Sivan B, et al: The rising incidence of adult acute epiglottitis and epiglottic abscess. Am J Oto laryngol 2003; 24: Ng HL, Sin LM, Li MF, Que TL. Anandaciva S, Acute epiglottitis in adults: a retrospective review of 106 patients in Hong Kong Emerg Med J 2008; 25, Hideaki K, Mamoru T. Acute epiglottitis: analysis of factors associated with airway intervention. The J of Laryngolgy & Otology 2005; 119: Charles R Woods. Epiglottitis (supraglottitis): Treatment and prevention UpToDate 2011 Clinical Management for Acute Epiglottitis Chang Yu-Huey, Shou Wei-Jiin Department of Pharmacy, National Taiwan University Hospital Hsin-Chu Branch Abstract Patient's sore throat and odynophagia which are common chief complains at LMD. It was diagnosed as upper respiratory tract infection. Most patients with acute epiglottitis complained of sore throat and odynophagia. Acute epiglottitis is inflammation of the epiglottis and adjacent supraglottic structures. Without treatment, acute epiglottitis can progress to life -threatening airway abstruction. In the recent days, we took care of three patients with acute epiglottitis, so we shared experiences how to treat our patients in Intensive Care Unit. 72 THE JOURNAL OF TAIWAN PHARMACY Vol.29 No.3 Sep

Gilead B, Tali L, Sivan B, et al: The rising incidence of adult acute epiglottitis and epiglottic abscess. Am J Oto- 5. 6. laryngol 2003; 24: 374-383. Ng HL, Sin LM, Li MF, Que TL.

( ) ( i n g r o w n toenail) 甲溝炎之診斷 1 2 圖 1 急性甲溝炎 (acute paronychia) 圖 2 慢性甲溝炎 (chronic paronychia) 註 : 臨床檢查發現近端甲溝處紅腫甲溝甲皮

( ) ( i n g r o w n toenail) 甲溝炎之診斷 1 2 圖 1 急性甲溝炎 (acute paronychia) 圖 2 慢性甲溝炎 (chronic paronychia) 註 : 臨床檢查發現近端甲溝處紅腫甲溝甲皮 1,2 前言 (paronychia) ( ) 甲溝炎之成因與致病菌種 (ingrown toenail) (Staphylococcus aureus) (Streptococcus pyogenes) (aerobic bacteria streptococcis.aureus Eikenella corrodens) ( a n a e ro b i c b a c t

2-4 肆 臨 床 表 徵 及 併 發 症 (90-100%) 37 (26-90%) (50-80%) (5-65%) (20-40%) 33-75% 30% (HIV ) 3.3% 5,6 伍 治 療 方 式 ( ) 一 人 工 呼 吸 道 的 建 立, 有 下 列 症 狀 的 病 人 會 建

2-4 肆臨床表徵及併發症 (90-100%) 37 (26-90%) (50-80%) (5-65%) (20-40%) 33-75% 30% (HIV ) 3.3% 5,6 伍治療方式 ( ) 一人工呼吸道的建立, 有下列症狀的病人會建