重症新型冠状病毒肺炎患者的临床特点及其死亡的影响因素研究  

Clinical Characteristics and Death Risk Factors of Patients with Severe COVID-19

作　　者：李敏 刘建雄[1] 胡庆兵[1] LI Min;LIU Jianxiong;HU Qingbing(Intensive Care Unit,Affiliated Hospital of Xiangnan University,Chenzhou 423000,China)

机构地区：[1]湘南学院附属医院重症医学科,湖南省郴州市423000

出　　处：《实用心脑肺血管病杂志》2020年第6期1-5,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：背景新型冠状病毒肺炎(COVID-19)传播性极强,较2003年非典型肺炎疫情更为严重,多数患者死于严重呼吸困难,目前关于重症COVID-19的研究较少。目的分析重症COVID-19患者的临床特征及其死亡的影响因素,以为临床诊疗提供参考。方法回顾性分析2020年2月1日—3月11日黄冈市中心医院黄冈大别山区域医疗中心重症监护室(ICU)收治的重症COVID-19患者46例,均采用常规方案治疗。收集患者临床资料,并根据转归将所有患者分为死亡组(n=12)和好转组(n=34),比较两组患者性别、年龄、呼吸频率、心率、平均动脉压(MAP)、体温、合并症、血气分析、凝血功能、多层螺旋CT(MSCT)评分、肝功能、肾功能、心脏相关主要指标、发病至入ICU时间、血常规、C反应蛋白、降钙素原(PCT)、红细胞沉降率、气管插管情况,采用多因素Logistic回归分析重症COVID-19患者死亡的影响因素。结果46例重症COVID-19患者中,男36例(78.3%),女10例(21.7%);年龄<30岁2例(4.3%),30~49岁12例(26.1%),50~69岁20例(43.5%),70岁及以上12例(26.1%);合并症:低钾血症14例(30.4%),心血管系统疾病13例(28.3%),内分泌系统疾病11例(23.9%),呼吸系统疾病7例(15.2%),神经系统疾病3例(6.5%),肿瘤2例(4.3%);临床症状:咳嗽28例(60.9%),发热26例(56.5%),胸闷13例(28.3%),腹泻3例(6.5%),乏力2例(4.3%),咽喉不适2例(4.3%),无症状2例(4.3%),鼻塞流涕1例(2.2%);体温:36.0~37.2℃18例(39.1%),37.3~38.0℃12例(26.1%),38.1~39.0℃14例(30.4%),39.1~41.0℃2例(4.3%);MSCT评分:0~4分6例(13.1%),5~8分18例(39.1%),9~12分15例(32.6%),13~16分7例(15.2%);治疗方法:高流量给氧22例(47.8%),无创机械通气11例(23.9%),有创机械通气13例(28.3%),体外膜肺氧合(ECMO)支持治疗2例(4.3%);转归:死亡12例(26.1%),好转34例(73.9%);实验室检查指标:白细胞计数升高14例(30.4%),中性粒细胞分数升高37例(80.4%),淋巴细胞分数下降42例(91.3%),红细胞沉降率升高44例(95.7%),PCT升Backgroud The COVID-19 is more serious than SARS epidemic in 2003.Most of COVID-19 patients died of severe dyspnea.However,there is few studies on severe COVID-19.Objective To investigate the clinical characteristics and death risk factors in patients with severe COVID-19,to provide a reference for clinical diagnosis and treatment of this disease.Methods A retrospective study was conducted on the clinical data of 46 severe COVID-19 patients who received routine treatment from the ICU,Dabieshan Medical Center,Huanggang Central Hospital from February 1 to March 11,2020.According to the outcome,the patients were divided into death group(n=12)and survival group(n=34),and intergroup differences in terms of gender ratio,age,respiratory rate,heart rate,MAP,temperature,complications,results of arterial blood gas analysis,coagulation function,MSCT score,liver function,renal function,main cardiac function indicators,time from onset to the ICU,and routine blood test,CRP,PCT,erythrocyte sedimentation rate and use of endotracheal intubation were analyzed.The influencing factors of death were identified by multivariate Logistic regression analysis.Results Among the participants,gender distribution:78.3%(36/46)were male and 21.7%(10/46)were female.Age-related prevalence of severe COVID-19:4.3%(2/46),26.1%(12/46),43.5%(20/46),26.1%(12/46)of the participants aged less than 30 years,30-49 years old,50-69 years old,and 70 years or over,respectively.Complications:14(30.4%)had hypokalemia,13(28.3%)had cardiovascular system disease,11(23.9%)had endocrine system disease,7(15.2%)had respiratory disease,3(6.5%)had nervous system disease,and 2(4.3%)had tumor.Clinical symptoms:28(60.9%)had cough,26(56.5%)had fever,13(28.3%)had chest distress,3(6.5%)had diarrhoea,2(4.3%)had fatigue,2(4.3%)had throat discomfort,2(4.3%)were asymptomatic,and 1(2.2%)had stuffy running nose.Temperature:temperature was 36.0-37.2℃for 18 cases(39.1%),37.3-38.0℃for 12(26.1%),38.1-39.0℃for 14(30.4%),and 39.1-41.0℃for 2(4.3%).MSCT score:MSCT score was 0-4 for

关 键 词：新型冠状病毒肺炎 临床特点 死亡 影响因素分析 

分 类 号：R563.19[医药卫生—呼吸系统]