新型冠状病毒肺炎的早期临床特点及诊疗分析:62例报告  

Clinical characteristics and outcomes of the patients with COVID-19:A report of 62 cases

作　　者：钟少华[1] 林锋[1] 施理[1] Zhong Shao-Hua;Lin Feng;Shi Li(Department of Infectious Diseases,Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University,Haikou 570311,China)

机构地区：[1]海南省人民医院/海南医学院附属海南医院感染科,海口570311

出　　处：《解放军医学杂志》2020年第4期370-374,共5页Medical Journal of Chinese People's Liberation Army

摘　　要：目的分析新型冠状病毒肺炎(COVID-19)的早期临床特点,探讨早期诊断及治疗方法。方法回顾性分析2020年1月21日-2月10日海南省人民医院收治的62例COVID-19患者的临床表现,按疾病严重程度分为普通型、重型及危重型,比较3种分型患者的白细胞、中性粒细胞、淋巴细胞计数。62例均给予对症支持、抗病毒、激素及中药治疗等。结果 79.03%(49/62)的患者有武汉旅居史,潜伏期为(6.85±4.45) d。临床症状为发热(50/62,80.65%)、干咳(39/62,62.90%)、乏力(16/62,25.81%)、气促(12/62,19.35%)、呼吸困难(9/62,14.52%)、咽痛(6/62,9.68%)、鼻塞及流涕(6/62,9.68%)、全身肌肉酸痛(5/62,8.06%)、腹泻(2/62,3.23%)、呕吐(2/62,3.23%)、恶心(3/62,4.84%)。95.16%(59/62)的患者白细胞计数正常或偏低。普通型、重型、危重型患者白细胞、中性粒细胞、淋巴细胞计数比较,差异均有统计学意义(P<0.05)。77.78%(7/9)的危重症患者淋巴细胞计数低于0.8×10^9/L。90.32%(56/62)的患者典型表现为单侧/双侧肺叶磨玻璃影。CT/胸部平片进展及开始好转吸收的时间分别为(9.05±3.75) d和(14.94±7.32) d。57例出院患者的总病程为9~38(21.05±7.17) d,住院天数8~34(15.32±6.49) d。治疗后严重急性呼吸综合征冠状病毒2(SARS-CoV-2)核酸转阴时间为(11.56±6.56) d。9例危重症患者均出现明显呼吸困难,7例需要有创呼吸机支持,2例无创呼吸机支持。结论 COVID-19临床初期以发热为主要表现,个别患者无症状,CT以磨玻璃样改变为特点,危重症患者有明显的呼吸困难,可伴有肾功能损害,肺部影像提示炎症渗出进展快,可根据病情个体化给予连续性肾脏替代疗法及呼吸支持治疗。Objective To investigate the early clinical characteristics and diagnosis of and therapeutic approaches for coronavirus disease 2019 (COVID-19).Methods The clinical manifestations and treatment of 62 patients with COVID-19 admitted to Hainan Province People’s Hospital during the period from January 21 to February 10,2019 were analyzed retrospectively.The COVID-19 patients were classified into 3 groups:general,severe and critical types according to the disease severity and the white blood cell,neutrophil and lymphocyte counts were compared between the 3 groups.The 62 patients were given symptomatic and supportive,antiviral,hormonal and Chinese herbal treatment.Results 79.03% (49/62) of patients had a history of traveling or living in Wuhan.The incubation period was (6.85±4.45) d.The clinical features including fever (80.65%),dry cough (62.9%),fatigue (25.81%),shortness of breath (19.35%),and dyspnea (14.52%),sore throat (9.68%),nasal congestion and runny nose (9.68%),muscle soreness (8.06%),diarrhea,vomiting (3.23%),and nausea (4.84%).95.16% (59/62) of patients had normal or relatively low white blood cell counts.There were statistically significant differences in the counts of leukocytes,neutrophils,and lymphocytes between the 3 groups of the patients (P<0.05).77.78% (7/9) of the critically ill patients with lymphocyte counts below 0.8×10^9/L.90.32% (56/62) of patients typically presented with single or multiple lung lobes/segments showing ground glass shadow.The average time for CT and CR showing progress and starting to improve and absorb was (9.05±3.75) d and (14.94±7.32) d,respectively.The total course of disease among the 57 discharged patients was 9-38 d,with an average of (21.05±7.17) d.The length of hospital stay was 8-34 d,with an average hospital stay of (15.32±6.49) d.After treatment,the time of the negative mutation of the novel coronavirus was (11.56±6.56) d.Obvious dyspnea occurred in 9 critically ill patients,among them 7 patients needed invasive ventilator support and 2 non-invasive venti

关 键 词：严重急性呼吸综合征冠状病毒2 新型冠状病毒肺炎 临床表现 治疗 

分 类 号：R373.1[医药卫生—病原生物学]