溫水拭浴對兒童發燒之降溫成效 The Effectiveness of Tepid Water Sponging in Febrile Children 戴仲宜、陳若蘋、陳可欣、高靖秋 台北醫學大學 ˙ 市立萬芳醫院 護理部 Chung-Yi Tai, Jo-Ping Chen, Kee-Hsin Chen, Ching-Chiu Kao Department of Nursing, Taipei Medical University- WanFang Hospital

前言 Introduction  發燒是兒童感染疾病常見的症狀，卻經常造成家長的恐慌。  九成以上的父母認為發燒可能產生腦部傷害、痙攣或死亡。  監測體溫及發燒照護為護理人員獨立護理功能之一，護理人員若能 清楚小兒發燒之正確的處理流程，將可提供正確的訊息以及適當的 處置，以使病童獲得良好的照顧。  Fever is a common symptom in children particularly with infective diseases, but it often panics the parents.  Over ninety percent of the parents think that fever may cause brain injury, seizures or death.  Body temperature monitoring is one of the independent nursing practices. Nurses who are aware of the proper treatment of fever in children, will be able to provide the correct information and appropriate management, so that children can have high quality of care.

目的 Purposes 以系統性文獻回顧方式，探討針對 18 歲以下兒童使用溫水拭浴等蒸發性 物理降溫措施之成效。 The aim of this systematic literature review is to evaluate the effectiveness of the evaporative physical cooling methods,such as tepid water sponging in febrile children under 18 years of age. 定義 Definitions 溫水拭浴是指用水溫約 26.7 ℃ -37 ℃之濕毛巾，進行病人全身的擦拭，擦 拭時間約為 分鐘，期望以蒸發的物理導熱方式，增加體熱的散失， 進而達到體溫下降的效果。 Tepid water sponging is using the wet towel which is 26.7 ℃ -37 ℃ to wipe the children’s body for minutes, in order to lower the body temperature by thermal evaporation.

文獻搜尋策略 Search Strategy 以關鍵字：「 fever AND child AND tepid sponging OR external cooling 、發燒 AND 兒童 AND 溫水拭浴」於 PubMed 、 Cochrane Library 、 Medline 、 NGC 、中文電子期刊服務系統 CEPS 、國家圖書館全國博碩士論 文資訊網等資料庫進行中、英文文獻搜尋。 We searched the PubMed, Cochrane Library, Medline, NGC, Chinese Electronic Periodical Services system (CEPS), National Library of the National Repository Information Network and other databases by using the keywords: "fever AND child AND tepid sponging OR external cooling, fever AND children AND bathing".

納入及排除條件 Selection Criteria 研究對象界定於 1 個月以上、 18 歲以下之發燒 ( 腋溫大於 37.5°C 或核心溫度大於 38°C) 病童，考量新生兒期感染可能以低體溫方式呈 現，並且在降溫處置上，有異於其他年齡層兒童，故予以排除之。 We included children who were aged 1 month to 18 years with fever (axillary temperature higher than 37.5°C or core temperature higher than 38°C). Neonates were excluded because of the different ways in management, and neonates with infection may present with very low body temperature.

研究設計 Types of studies 隨機或類隨機對照試驗 (Randomized or quasi-randomized controlled trials) ，比較單獨使用溫水拭浴、單獨使用口服退燒藥， 或溫水拭浴加口服退燒藥使用等方式之退燒效果。 We included the studies which were randomized or quasi- randomized controlled trials comparing the effectiveness about tepid water sponging or oral antipyretic or combine both.

結果測量指標 Types of outcome measures 主要結果測量指標為使用後退燒速度，其他測量指標包括 ：退燒持續時間、病人舒適程度及主要照顧者之滿意度。 Main outcome measurement included the speed of body temperature reducing, and the other metrics : the duration of afebrile, patients’ comfort and caregivers’ satisfaction.

結果 Results 符合納入條件共有 9 篇文獻，以 Scottish Intercollegiate Guidelines Network(2002) 所提出之證據等級認定標準 ( 表一 ) 加以評讀之，其摘要內容及 評讀結果詳見表二。經分析後發現，若單獨使用溫水拭浴來降低體溫，其效 果僅限於開始治療後 30 分鐘左右 ( 表三 ) ；而使用溫水拭浴等蒸發散熱降溫方 法之成效雖然比退燒藥差，但二者合併使用卻有助於延長退燒藥之效果長達 90 至 150 分鐘，優於單獨使用退燒藥或溫水拭浴 ( 表四 ) 。 There are nine articles meeting the inclusion criteria,and a critical appraisal was done according to the standard developed by Scottish Intercollegiate Guidelines Network (2002) (Table 1). The results of the critical appraisal are shown in Table 2. After data analysis, we found that the effect of tepid water sponging only last about 30 minutes after initiation (Table 3). Though the effect of tepid water sponging only is less effective than using antipyretic, the combination of both could extend the effect for 90 to 150 minutes. It is better than the use of antipyretics or tepid water sponging alone. (Table 4).

結論 Conclusion 综合以上文獻顯示，若單獨使用溫水拭浴來降溫，其效果僅限於開始治療後的短 暫時間，且使用溫水拭浴合併退燒藥的降溫效果，優於單獨使用退燒藥或溫水拭浴。 然而，溫水拭浴導致病人哭泣、寒顫或躁動不安等情形卻明顯高於使用退燒藥的族群 。而且，對於相對於成人體表面積較大、無感性水份及熱能喪失較快的幼童而言，物 理性體溫調節方式之安全性仍待驗證。此外，溫水拭浴的降溫效果是否具有統計上的 顯著意義，仍需仰賴更多相關的研究加以證實之。 According to the literatures review, the effect of tepid water sponging only is less effective than using antipyretics, but the combination of both could extend the effectiveness of using antipyretics. However, tepid water sponging has higher incidence of making a child to cry, and feel uncomfortable than the use of antipyretics alone. Moreover, children have larger body surface area than adults, and have faster insensible water or heat loss. The physical body temperature regulation hasn’t yet proven its safety. In addition, whether the effectiveness of reducing body temperature by tepid water sponging has statistically significant meaning, more researches are still needed.

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