鄰苯二甲酸酯類是聚氯乙烯(PVC)製的醫療器材中，為了提升器材的柔軟性及易曲性，被拿來添加的塑化劑，其中又以鄰苯二甲酸二(2-乙基己基)酯(DEHP)最常被使用。許多兒科文獻也已證實新生兒加護病房的嬰兒尿液中能偵測出DEHP的主要代謝物之一，太酸單二乙基己基酯(MEHP)的物質。
2004年曾有瑞典學者 (Bornehag et al, 2004) 以病例--對照研究方法(Case-Control Study)探討鄰苯二甲酸與兒童氣喘(Asthma)及過敏症狀(Allergic Symptoms)的相關性。但該研究被 The European Council for Plasticisers and Intermediates (ECPI)認定為有錯誤，因為他們並未將一些眾所周知與兒童氣喘及其他呼吸相關疾病的重要因子納入考量。另外，在資料蒐集方面，病例組收案條件是: “須於初次受訪前12個月內至少在3種過敏性疾病 (氣喘、過敏性鼻炎(Allergic Rhinitis)或異位性皮膚炎(Atopic Eczema))中發生2種以上的症狀”，但當時有關居住環境中DEHP濃度的相關訊息無法獲得，而以收案後測得之濃度來分析，難以釐清兩者間因果關係。
所以，我們除收錄新生兒使用含PVC醫療器材之種類及數量外，並收錄其雙親及居家環境過敏相關資料。過敏性疾病仍以異位性皮膚炎、過敏性鼻炎、呼吸道過敏及腸胃道症狀為主。嘗試釐清PVC醫療器材之潛在毒害效應是否會對新生兒過敏症狀有顯著影響。研究結果顯示新生兒加護病房(NICU)的嬰兒確實使用醫療器材的頻率比新生兒中心(NBC)的嬰兒高。但其罹患四種過敏性疾病的風險並未因此比新生兒中心的嬰兒高。

Medical devices made from polyvinyl chloride (PVC) will add phthalates as the plasticizers to make the devices soft and pliable. The most widely used phthalate in medical devices is DEHP (di-ethyl-hexyl-phthalate). Many pediatric related literatures have demonstrated that the intensiveness of DEHP-containing product use in NICU (Neonatal Intensive Care Unit) neonates is associated with higher exposure to DEHP, as reflected in elevated urinary concentrations of MEHP (mono-2-ethylhexyl phthalate), which is one of the major urinary metabolites of DEHP.
　　In 2004, a group of Swedish scientists (led by Carl-Gustaf Bornehag) conducted a case-control study to explore the association between asthma and allergic symptoms in children and the use of phthalate plasticizers. However, the European Council for Plasticizers and Intermediates (ECPI) believes this study is flawed as it does not appear to take into consideration a number of key factors which are widely known and accepted as being significant contributors to asthma and other respiratory diseases. Furthermore, the authors indicate within the introduction that the cases and controls were actually selected from an early cross-sectional survey. Therefore, cases had at least two out of three symptoms of asthma, allergic rhinitis or atopic eczema at the start of the study, before any environmental samples were collected. This raises the real possibility that the phthalate-disease associations were a result of case status, rather than a cause.
　　Therefore, besides all information about the PVC medical devices, the parental and household allergic information will be recorded. The allergic symptoms we focus on are stomach symptom, allergic breathing passages, allergic rhinitis or atopic eczema. In this study, we try to figure out whether the potential hazardous of PVC medical devices have significant effects to allergic symptoms in neonates directly or not. The results of this study showed that the frequency of using PVC medical devices in NICU was significantly higher than NBC. However, the risks of four allergic symptoms in both units were no significant difference.

第一章	前言             …………………………………………………1
第二章	文獻回顧         …………………………………………………3
第三章	材質和分析方法   …………………………………………………6
第四章	分析結果比較     …………………………………………………8
       4.1收案過程           …………………………………………………8
       4.2基本資料描述       …………………………………………………8
       4.3基本資料比較       …………………………………………………9
          4.3.1 其他變數在兩收案單位的差異性比較…………………………10
          4.3.2 異位性皮膚炎和其他變數的相關性……………………………10
          4.3.3 呼吸道過敏和其他變數的相關性………………………………11
          4.3.4 過敏性鼻炎和其他變數的相關性………………………………12
          4.3.5 腸胃道症狀和其他變數的相關性………………………………12
          4.3.6 疾病總數和其他變數的相關性…………………………………13
第五章	結論            …………………………………………………15
第六章	討論            …………………………………………………16
附錄                        …………………………………………………19
參考文獻                    …………………………………………………51

表目錄
表1：醫療器材的材質及使用人數 …………………………………19
表2：新生兒基本資料1   ………………………………………………20
表3：新生兒基本資料2   ………………………………………………20
表4：兩收案單位在過敏疾病發生率之差異性比較 ……………………………20
表5：兩收案單位在母親過敏史差異性比較………………………………………21
表6：兩收案單位在父親過敏史差異性比較………………………………………22
表7：兩收案單位在居住環境過敏源差異性比較…………………………………23
表8：兩收案單位在醫療器材使用率之差異性比較………………………………24
表9：過敏疾病(異位性皮膚炎)與母親過敏史之相關性 …………………………25
表10：過敏疾病(異位性皮膚炎)與父親過敏史之相關性…………………………26
表11：過敏疾病(異位性皮膚炎)與居住環境過敏源之相關性……………………27
表12：過敏疾病(異位性皮膚炎)與有無使用醫療器材之相關性…………………28
表13：邏輯斯迴歸(Dependent Variable: 異位性皮膚炎; Model: (Intercept), 兩收案單位, 有無使用氧氣鼻套管(O2Cannula))  ………………………………………29
表14：邏輯斯迴歸(Dependent Variable: 異位性皮膚炎; Model: (Intercept), 兩收案單位,使用氧氣鼻套管(O2Cannula)的天數)  ……………………………………29
表15：過敏疾病(呼吸道過敏)與母親過敏史之相關性 …………………………30
表16：過敏疾病(呼吸道過敏)與父親過敏史之相關性 ………………………….31
表17：過敏疾病(呼吸道過敏)與居住環境過敏源之相關性………………………32
表18：過敏疾病(呼吸道過敏)與有無使用醫療器材之相關性……………………33
表19：邏輯斯迴歸(Dependent Variable: 呼吸道過敏; Model: (Intercept), 兩收案單位, 母親有無打噴嚏的症狀) ………………………………………………………34
表20：邏輯斯迴歸(Dependent Variable: 呼吸道過敏; Model: (Intercept), 兩收案單位, 母親有無眼睛癢的症狀) ………………………………………………………34
表21：邏輯斯迴歸(Dependent Variable: 呼吸道過敏; Model: (Intercept), 兩收案單位, 父親有無抽菸的習慣) …………………………………………………………34
表22：邏輯斯迴歸(Dependent Variable: 呼吸道過敏; Model: (Intercept), 兩收案單位, 父親有無打噴嚏的症狀)………………………………………………………35
表23：邏輯斯迴歸(Dependent Variable: 呼吸道過敏; Model: (Intercept), 兩收案單位, 父親有無打噴嚏的症狀, 父親有無抽菸的習慣, 母親有無眼睛癢的症狀, 母親有無打噴嚏的症狀)………………………………………………………………35
表24：過敏疾病(過敏性鼻炎)與母親過敏史之相關性…………………………36
表25：過敏疾病(過敏性鼻炎)與父親過敏史之相關性…………………………37
表26：過敏疾病(過敏性鼻炎)與居住環境過敏源之相關性……………………38
表27：過敏疾病(過敏性鼻炎)與有無使用醫療器材之相關性…………………39
表28：過敏疾病(腸胃道症狀)與母親過敏史之相關性…………………………40
表29：過敏疾病(腸胃道症狀)與父親過敏史之相關性…………………………41
表30：過敏疾病(腸胃道症狀)與對居住環境過敏源之相關性…………………42
表31：過敏疾病(腸胃道症狀)與有無使用醫療器材之相關性…………………43
表32：邏輯斯迴歸( Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 母親有無打噴涕的症狀)…………………………………………………………44
表33：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 母親有無流眼淚的症狀)……………………………………………………………44
表34：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 母親有無眼睛癢的症狀) ……………………………………………………………44
表35：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 有無裝置正壓呼吸器鼻套管(Nasalcpap)) …………………………………………45
表36：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 有無使用氧氣鼻套管(O2cannula)) …………………………………………………45
表37：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 有無使用保溫箱氧氣吸入管(O2Inner)) ……………………………………………45
表38：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 有無使用10%葡萄糖水(D10W)) …………………………………………………46
表39：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 有無使用5%葡萄糖水(D5W))  …………………………………………………46
表40：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 有無使用葡萄糖及電解質(T2)) ……………………………………………………46
表41：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 有無使用高葡萄糖及電解質(T5)) …………………………………………………47
表42：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 有無使用部份全靜脈營養(PPN)) …………………………………………………47
表43：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 有無使用脂質靜脈營養(FAT)) ……………………………………………………47
表44：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 有無輸血(blood transfusion)) ………………………………………………………48
表45：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 有無照光治療(Phato)) ………………………………………………………………48
表46：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 有無使用靜脈輸液(IV)) ……………………………………………………………48
表47：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 有無使用動脈輸液(Aline)) …………………………………………………………49
表48：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 有無使用周邊中央靜脈導管(PCVC)) ……………………………………………49
表49：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 有無使用口胃管(OG))  ……………………………………………………………49
表50：邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 母親過敏疾病總數) …………………………………………………………………50
表51.邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 父親過敏總數)…………………………………………………………………………50
表52.邏輯斯迴歸(Events:疾病總數；Trials: 4；Model: (Intercept), 兩收案單位, 醫療器材使用總數)……………………………………………………………………50

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