93例成人新型冠状病毒肺炎患者临床特征及预后危险因素的回顾性分析  

Clinical Features and Prognostic Risk Factors of COVID-19 in Adults:a Retrospective Analysis of 93 Cases

作　　者：蔡妙甜[1] 李侗曾[1] 张龙玉 徐辉[1] 牟丹蕾[1] 梁连春[1] CAI Miaotian;LI Tongzeng;ZHANG Longyu;XU Hui;MOU Danlei;LIANG Lianchun(Integrated Department of Infectious Diseases,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院感染综合科,北京市100069

出　　处：《中国全科医学》2021年第2期196-204,共9页Chinese General Practice

基　　金：中国初级卫生保健基金会佑安肝病艾滋病基金——新型冠状病毒肺炎应急防控公益项目(BJYAYY-2020ZQN-04)。

摘　　要：背景2020年3月后,我国新增确诊新型冠状病毒肺炎(COVID-19)及死亡病例明显减少,但境外确诊病例快速增加,早诊断、早治疗对改善COVID-19患者预后意义重大。目的探讨COVID-19成人患者的临床特征及预后相关危险因素,为临床诊疗工作提供参考。方法回顾性分析2020年1-2月北京佑安医院收治的93例成人COVID-19患者的临床资料,参考国家卫生健康委员会发布的《新型冠状病毒肺炎诊疗方案(试行第七版)》病情分型,依据住院期间最严重病情将患者分为:普通型组、重型组、危重型组。收集患者一般资料、主要临床表现、入院24 h内基线实验室检查指标、入院24 h内急性生理学和慢性健康评估量表(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、影像学检查、合并症和并发症、治疗及结局。结果COVID-19患者中普通型57例(61.3%)、重型22例(23.7%)、危重型14例(15.0%)。普通型、重型患者以女性为主,危重型患者以男性为主,但组间性别构成差异无统计学意义(P>0.05)。普通型组、重型组、危重型组中位年龄分别为45.0、62.0、81.0岁,各组>60岁患者比例分别为15.8%、54.5%及92.9%,组间比较差异有统计学意义(P<0.05)。相比普通型组及重型组,危重型组SARS-CoV-2核酸转阴率较低,发病后病毒脱落持续时间较长,发病至出现呼吸困难间隔时间较短(P<0.05)。发热、咳嗽是最常见临床表现,总体发生率分别为88.2%及87.1%,但各组间发生率差异无统计学意义(P>0.05)。重型、危重型组呼吸困难发生率为100%,明显高于普通型组(31.6%)(P<0.05)。危重型组淋巴细胞减少的发生率为100%,明显高于普通型组(49.1%)及重型组(59.1%)(P<0.05)。急性肝损伤是最常见并发症(58.1%),其在重型组及危重型组中发生率(77.3%、92.9%)明显高于普通型组(42.1%)(P<0.05)。中药总体使用率为75.3%,其中重型组中药使用率(90.9%)显著高于危重型组(50.0%)(P<0.05)。�Background Since April 2020,the number of newly diagnosed cases and death cases of COVID-19 have decreased significantly in China but increased rapidly abroad.Early diagnosis and treatment are of great concern to improving the prognosis of COVID-19 patients.Objective To investigate the clinical features and prognostic risk factors of adult patients with COVID-19,offering a reference for clinical diagnosis and treatment of this disease.Methods A retrospective design was used.Participants were 93 adult cases of COVID-19 who were treated in Beijing Youan Hospital between January and February 2020.They were categorized into common,severe and critical types by the most serious conditions during hospitalization,in accordance with the Diagnosis and Treatment Protocol for COVID-19(Trial Version 7)issued by the National Health Commission of the People's Republic of China.Indications such as general information,major clinical manifestations,baseline laboratory parameters,APACHE II and SOFA scores within 24 hours of admission,imaging findings,comorbidities and complications,treatments and outcomes were collected.Results There were 57 cases of common type(61.3%),22 of severe type(23.7%)and 14 of critical type(15.0%).The male ratio was slighter higher in critical group,and female ratio was slighter higher in other groups,but sex composition showed no significant differences across the groups(P>0.05).The median age for common,severe and critical groups was 45.0,62.0 and 81.0 years,respectively,showing significant differences(P<0.05).And the proportion of patients older than 60 years differed across common,severe and critical groups(15.8%vs 54.5%vs 92.9%)(P<0.05).Compared with common and severe groups,the rate of positive-to negative inversion of SARS-CoV-2 viral load detected by nucleic acid test was decreased,the duration of viral shedding was prolonged,and the interval from onset to dyspnea was shortened,markedly in critical group(P<0.05).Fever and cough were the most common clinical manifestations whose overall incidences w

关 键 词：新型冠状病毒肺炎 新型冠状病毒 临床特征 成年人 预后 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]