成人SARS患者死亡的相关因素分析  

Analysis on the Relative Factors Associated with Death in Adult SARS Patients

作　　者：吴晓光[1] 汤哲[1] 阴赪宏[2] 

机构地区：[1]首都医科大学宣武医院流行病学和社会医学部,北京市100000 [2]首都医科大学附属北京友谊医院科研处

出　　处：《中国全科医学》2005年第4期276-278,共3页Chinese General Practice

基　　金：北京市科技计划重大项目 (H020920050230)

摘　　要：目的寻找导致SARS患者死亡的相关因素,为及早采取预防措施降低SARS患者的病死率提供可靠的科学依据.方法对206例成人SARS (存活187例、死亡19例)患者的流行病学、实验室及影像检查、临床治疗(激素最大冲击量)等资料与死亡的关系进行回顾性分析(单因素分析及多因素Logistic回归分析).结果 SARS患者的年龄(≥50岁)、有基础疾病、肺损伤程度(≥1/3肺视野)、T淋巴细胞(CD+3T、CD+4T和CD+8T)水平降低、GLU升高、BUN升高、LDH升高、血钾降低、动脉氧分压降低、二氧化碳分压升高及糖皮质激素日冲击量(320 mg)与SARS患者的死亡联系密切,经多因素Logistic回归分析,有基础疾病(OR:7.349,95%CI:1.830～29.523)、肺损伤面积(OR:6.382,95%CI:1.186～34.329)、动脉氧分压降低(OR:7.938,95%CI:1.729～36.442)、二氧化碳分压升高(OR:4.892,95%CI:1.191～20.091及LDH升高(OR:20.251,95%CI:1.946～210.797)是导致SARS患者死亡的独立危险因素.结论 SARS患者合并基础疾病、有严重的肺损伤、动脉氧分压降低、二氧化碳分压升高及LDH水平增高将导致病死率增加,在临床实践中要密切观察上述指标,并指导临床治疗,判断预后,降低SARS患者的病死率.Objective To provide scientific evidence for taking appropriate preventive measures and reducing the mortality of SARS by exploring the relative factors associated with death in SARS patients.Methods The relations between epidemiologic data,laboratory parameters (biochemistry,blood gas and T lymphocyte subgroup),imaging examination and clinical therapy (with a shock dose of hormone) from 206 adult SARS patients (187 patients of Survival,19 patients of death) and death were studied by using retrospective analysis (one variable analysis and multivariable Logistic regression analysis).Results The results of one variable analysis showed that in SARS patients,those who aged over 50,the degree of lung injury was over 1/3 lung visual field,with coinfecting basic diseases and lower level of T lymphocyte subgroup (CD + 3T、CD + 4T和CD + 8T),blood potassium and PaO 2,and with higher level of GLU,BUN,LDH and PCO 2,and the daily shock dose of cortisol is (320 mg) tied up with the SARS patients′ death.The Logistic regression models showed that basic diseases (OR:7 349,95%CI:1 830～29 523),lung injury(OR:6 382,95%CI:1 186～34 329,low PaO 2(OR:7 938,95%CI:1 729～36 442),high PaCO 2(OR:4 892,95%CI:1 191～20 091 and LDH(OR:20 251,95%CI:1 946～210 797) were significant predictors of death in SARS patients.Conclusion SARA patients with the basic diseases,severe lung injury,PaO 2 decrease,PaCO 2 increase and the increase level of LDH will lead to the rise of morbidity rate.It is important to guide clinical therapy,and to judge prognosis so as to reduce the mortality of SARS by monitoring the above risk factors in clinical practice.

关 键 词：SARS患者 升高 死亡 基础疾病 动脉氧分压 肺损伤 病死率 水平 结论 CI 

分 类 号：R563.1[医药卫生—呼吸系统] R719.8[医药卫生—内科学]