Some problems in long-term prevention of streptococcal infection among children with rheumatic heart disease in Taiwan.
Some problems in long-term prevention of streptococcal infection among children with rheumatic heart disease in Taiwan.
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台湾风湿性心脏病儿童链球菌感染长期预防的若干问题.
DOI：
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发表时间：
1976
期刊：
影响因子：
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通讯作者：
H. Wei
中科院分区：
文献类型：
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作者：
H. Lue;C. Chen;H. Wei
在台湾，风湿热（RF）和风湿性心脏病（RHD）仍然很普遍，构成了一个健康问题。风湿性儿童链球菌感染的长期预防也未能普及，但很少受到重视。因此，RF复发仍然普遍。为了评估长期药物预防管理的困难，1967年开始了一项前瞻性研究。对105例风湿性心脏病和风湿性心脏病患者进行了1 ~ 6年的随访，平均4.4年。102例患者每月注射苄星青霉素G 6个月~ 6年，其中10例改用磺胺类药物每日1次，1例口服青霉素6年，12例磺胺类药物6个月~ 5年。51例（48.6%）在项目中保持良好，22例（21.0%）留在项目中但不依从，32例（30.4%）在项目中不久或超过1年后退出。导致不遵守规定的主要风险因素是：1）疾病明显康复或恢复正常活动; 2）学校补习班; 3）缺乏简便的医疗保健系统;以及4）缺乏卫生工作者和全科医生的积极参与。目前的研究证实，链球菌感染的长期预防是有效的，并有助于RF复发率从30%以上下降到6%。我们的研究表明，这一重要的预防计划不能只靠医院工作人员来实现，而应该由所有医生、卫生和社会工作者、学校教师和家长共同参与。
In Taiwan, rheumatic fever (RF) and rheumatic heart disease (RHD) remain widespread and constituting a health problem. The long-term prevention of streptococcal infections among rheumatic children has also failed to prevail, and yet has seldom been emphasized. Therefore, recurrence of RF remained prevalent. For an appraisal of the difficulties in the administration of long-term medication prophylaxis, a prospective study was started in 1967. One hundred and five consecutive cases of RF and RHD were followed up for more than 1 year to 6 years with an average of 4.4 years. One hundred and two cases received monthly injections of benzathine penicillin G for 6 months to 6 years, of whom 10 were switched to daily sulfa drugs; 1 case had oral penicillin daily for 6 years; in 12 cases, sulfa drugs were given for 6 months to 5 years. Fifty-one cases (48.6 %) stayed well in the program; 22 (21.0 %) stayed but were not compliant; 32 (30.4 %) dropped out soon or after staying in for more than 1 year. Major risk factors leading to non-compliance are; 1) apparent recovery from the illness or resumption of the normal activity; 2) cram session at school; 3) lack of easy medical care system; and 4) shortage of active participation by the health workers and general practitioners. The present study confirmed that the long-term prevention of streptococcal infection was effective and contributed to the decline of RF recurrence rate from more than 30 % down to 6%. Our study implicates that this important preventive program can not be achieved just only by the hospital staff, but should be approached jointly by all doctors, health and social workers, school teachers and the parents.