104 非 典 型 川 崎 症 之 文 獻 回 顧 及 臨 床 照 護 劉 又 禎 1 侯 秋 萍 1 郭 秋 敏 2 梁 啟 迪 3 郭 和 昌 4* 摘 要 : 川 崎 症 是 一 個 病 因 未 知 的 全 身 性 血 管 炎 疾 病, 且 主 要 侵 犯 五 歲 以 下 的 兒 童, 也 是 造 成 兒 童 後 天 性 心 臟 病 的 主 因 川 崎 症 的 致 病 因 基 因 和 免 疫 致 病 機 轉 到 目 前 都 尚 未 釐 清 尤 其 是 非 典 型 川 崎 症 的 診 斷 與 護 理 照 護 對 於 臨 床 醫 護 人 員 更 是 一 大 挑 戰 ; 本 篇 報 告 是 非 典 型 川 崎 症 之 文 獻 回 顧 及 臨 床 照 護 簡 介, 內 容 包 含 川 崎 症 之 致 病 原 因 臨 床 表 徵 與 非 典 型 川 崎 症 的 臨 床 表 現 鑑 別 診 斷 治 療 及 疾 病 與 居 家 護 理 希 望 能 對 川 崎 症 及 非 典 型 川 崎 症 患 童 的 診 斷 與 醫 療 照 護 過 程 有 所 幫 助 關 鍵 詞 : 川 崎 症 非 典 型 川 崎 症 冠 狀 動 脈 病 變 護 理 照 護 Kawasaki disease, KD 1967 Tomisaku KawasakiKuo et al., 2009 10 69 Huang et al., 2009 Anderson, Todd, & Glode, 2005 Burns & Glode, 2004 1~2 Wang, Wu, Liu, Kuo, & Yang, 2005 Wang et al., 2005 Esper et al., 2005human coronavirus Lehmann et al., 2009Chang et al., 2006 Kuo et al., 2009; Liang, Kuo, Yang, Wang, & Ko, 2009 1 2 3 4 Kuo et al., 2009 ㈠ ㈡ ㈢ 98 12 24 99 8 9 * 83301 123 07 7317123 8795
105 ㈣ ㈤ 1.5 Kuo et al., 2009 C SGPT SGOT GGT Newburger et al., 2004 atypical or incomplete KD 5 3 5 15% Wang et al., 2005 American Heart Association, AHA Newburger et al., 2004 Wang et al., 2005 2 gm/kg/dose Kawasaki disease Toxic shock syndrome Streptococcal scarlet fever Stevens-Johnson syndrome Systemic type- Juvenile Rheumatoid Arthritis < 5 > 10 2 8 2 5 < 10 < 10 20% A 30 75% 30 50%
106 a b Albumin 3.0 g/dl, anemia for age, elevation of alanine aminotransferase, platelets after 7 days 450,000/mm 3, white blood cell count 15,000/mm 3, and urine 10 white blood cells/high-power field Diagnosis, treatment, and long-term management of Kawasaki disease: A statement for health professionals from the committee on rheumatic fever, endocarditis, and Kawasaki disease, council on cardiovascular disease in the young, American Heart Association. Newburger2004 American Academy of Pediatrics Intravenous immunoglobulin, IVIG Kuo, Wang,
107 Wang, Yu, & Yang, 2008; Kuo, Yang, et al., 2007; Yu et al., 2009 Kuo 3% Kuo, Yang, et al., 2007 Kuo et al., 2008 7.8%~38% Tremoulet et al., 2008 10.8% 1~2g/kg/dose 3~4% Kuo et al., 2009 Aspirin; 80~100mg/kg/day 3~5mg/kg/day 6~8 3~5mg/kg/day Hsieh et al., 2004; Kuo et al., 2009 5 ㈠ 2007 2008 ㈡ ㈢ 2007 ㈠ 2gm/kg/day, 400 600mg/kg/day 5ml30 12 24 48Kuo, Wang, et al., 2007; Kuo, Yang, et al., 2007 ㈡ aspirin G6PD glucose-6- phosphate dehydrogenase deficiency, Pickering, 2009 20 Reye s syndromewei et al., 2005 American Academy of Pediatrics, AAP Pickering, 2009
108 warfarin warfarin cranberry Paeng, Sprague, & Jackevicius, 2007 ㈢ 2007 6~8 Newburger et al., 2004 11 4 Liang et al., 2009; Wang et al., 2005 2007 428 481 [Wu, S. Y., & Hsu, Y. Y. (2007). Circulatory diseases and their care in children. In Y. C. Chen (Ed.), Practical pediatric nursing (5th ed., pp. 428 481). Taipei, Taiwan, ROC: Farseeing.] 2008 19 2284 290 [Weng, P. H., Lu, H. J., & Liang, H. F. (2008). A nurse s experience with a Kawasaki syndrome child and his caregiver. Chang Gung Nursing, 19(2), 284 290.] 2007 180 243 [Chang, L. Y., & Tsai, L. J. (2007). The reaction of children to hospitalization and its care. In Y. C. Chen (Ed.), Practical pediatric nursing (5th ed., pp. 180 243). Taipei, Taiwan, ROC: Farseeing.] Anderson, M. S., Todd, J. K., & Glode, M. P. (2005). Delayed
109 diagnosis of Kawasaki syndrome: An analysis of the problem. Pediatrics, 115(4), e428 e433. Burns, J. C., & Glode, M. P. (2004). Kawasaki syndrome. Lancet, 364(9433), 533 544. Chang, L. Y., Chiang, B. L., Kao, C. L., Wu, M. H., Chen, P. J., Berkhout, B., et al. (2006). Lack of association between infection with a novel human coronavirus (HCoV), HCoV- NH, and Kawasaki disease in Taiwan. Journal of Infectious Diseases, 193(2), 283 286. Esper, F., Shapiro, E. D., Weibel, C., Ferguson, D., Landry, M. L., & Kahn, J. S. (2005). Association between a novel human coronavirus and Kawasaki disease. Journal of Infectious Diseases, 191(4), 499 502. Hsieh, K. S., Weng, K. P., Lin, C. C., Huang, T. C., Lee, C. L., & Huang, S. M. (2004). Treatment of acute Kawasaki disease: Aspirin s role in the febrile stage revisited. Pediatrics, 114(6), e689 e693. Huang, W. C., Huang, L. M., Chang, I. S., Chang, L. Y., Chiang, B. L., Chen, P. J., et al. (2009). Epidemiologic features of Kawasaki disease in Taiwan, 2003-2006. Pediatrics, 123(3), e401 e405. Kuo, H. C., Wang, C. L., Liang, C. D., Yu, H. R., Chen, H. H., Wang, L., et al. (2007). Persistent monocytosis after intravenous immunoglobulin therapy correlated with the development of coronary artery lesions in patients with Kawasaki disease. Journal of Microbiology, Immunology and Infection, 40(5), 395 400. Kuo, H. C., Wang, C. L., Liang, C. D., Yu, H. R., Huang, C. F., Wang, L., et al. (2009). Association of lower eosinophilrelated T helper 2 (Th2) cytokines with coronary artery lesions in Kawasaki disease. Pediatric Allergy and Immunology, 20(3), 266 272. Kuo, H. C., Wang, C. L., Wang, L., Yu, H. R., & Yang, K. D. (2008). Patient characteristics and intravenous immunoglobulin product may affect eosinophils in Kawasaki disease. Pediatric Allergy and Immunology, 19(2), 184 185. Kuo, H. C., Yang, K. D., Liang, C. D., Bong, C. N., Yu, H. R., Wang, L., et al. (2007). The relationship of eosinophilia to intravenous immunoglobulin treatment failure in Kawasaki disease. Pediatric Allergy and Immunology, 18(4), 354 359. Lehmann, C., Klar, R., Lindner, J., Lindner, P., Wolf, H., & Gerling, S. (2009). Kawasaki disease lacks association with human coronavirus NL63 and human bocavirus. Pediatric Infectious Disease Journal, 28(6), 553 554. Liang, C. D., Kuo, H. C., Yang, K. D., Wang, C. L., & Ko, S. F. (2009). Coronary artery fistula associated with Kawasaki disease. American Heart Journal, 157(3), 584 588. Newburger, J. W., Takahashi, M., Gerber, M. A., Gewitz, M. H., Tani, L. Y., Burns, J. C., et al. (2004). Diagnosis, treatment, and long-term management of Kawasaki disease: A statement for health professionals from the committee on rheumatic fever, endocarditis, and Kawasaki disease, council on cardiovascular disease in the young, American Heart Association. Pediatrics, 114(6), 1708 1733. Paeng, C. H., Sprague, M., & Jackevicius, C. A. (2007). Interaction between warfarin and cranberry juice. Clinical Therapeutics, 29(8), 1730 1735. Pickering, L. K. (Ed.) (2009). Red book: Report of the committee on infectious diseases (pp. 413 418). Chicago: American Academy of Pediatrics. Tremoulet, A. H., Best, B. M., Song, S., Wang, S., Corinaldesi, E., Eichenfield, J. R., et al. (2008). Resistance to intravenous immunoglobulin in children with Kawasaki disease. The Journal of Pediatrics, 153(1), 117 121. Wang, C. L., Wu, Y. T., Liu, C. A., Kuo, H. C., & Yang, K. D. (2005). Kawasaki disease: Infection, immunity and genetics. Pediatric Infectious Disease Journal, 24(11), 998 1004. Wei, C. M., Chen, H. L., Lee, P. I., Chen, C. M., Ma, C. Y., & Hwu, W. L. (2005). Reye s syndrome developing in an infant on treatment of Kawasaki syndrome. Journal of Pediatrics and Child Health, 41(5-6), 303 304. Yu, H. R., Kuo, H. C., Sheen, J. M., Wang, L., Lin, I. C., Wang, C. L., et al. (2009). A unique plasma proteomic profiling with imbalanced fibrinogen cascade in patients with Kawasaki disease. Pediatric Allergy and Immunology, 20(7), 699 707.
110 Atypical Kawasaki Disease: Literature Review and Clinical Nursing Yu-Chen Liu 1 Chiu-Ping Hou 1 Chiu-Ming Kuo 2 Chi-Di Liang 3 Ho-Chang Kuo 4 * Abstract: Kawasaki disease (KD) is an acute febrile multi-systemic vasculitis of unknown etiology that primarily affects children under 5 years of age. KD has been singled out as a main cause of acquired childhood heart disease. Its etiology, genetic background, and immunopathogenesis remain unclear. Diagnosing and providing nursing care to KD patients, especially those suffering from atypical KD, present a challenge for clinicians and nurses. This report is a literature review covering pathogenesis, clinical presentation, atypical symptoms, differential diagnosis, treatment and nursing of KD and atypical KD. This review provides updated information for clinicians and nurses with care responsibilities for patients with KD and atypical KD. Key Words: Kawasaki disease, atypical Kawasaki disease, coronary artery lesion, nursing. 1 RN, NP, Department of Nursing and Pediatric Ward, Chang Gung Memorial Hospital-Kaohsiung Medical Center; 2 RN, Department of Nursing and Operation Room, Chang Gung Memorial Hospital-Chiayi Branch; 3 MD, Chief, Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; 4 MD, Assistant Professor & Visiting Staff, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Lecturer, Graduate Institute of Clinical Medical Science, Chang Gung University. Received: December 24, 2009 Revised: March 18, 2010 Accepted: August 9, 2010 *Address correspondence to: Ho-Chang Kuo, No. 123, Da-Pei Rd., Niaosong Hsiang, Kaohsiung County 83301, Taiwan, ROC. Tel: +886 (7) 731-7123 ext. 8795; E-mail: erickuo48@yahoo.com.tw