辽宁省重症新型冠状病毒肺炎17例临床特征分析  

Clinical characteristics of 17 cases of severe coronavirus disease 2019 in Liaoning Province

作　　者：王妍[1] 祖太坤 李丹 戴青荃 王岩[1] 宋军 吴云海[2] 刘宾[1] 刘劲阳[1] 章志丹[4] 马晓春[4] 刘洪艳[1] WANG Yan;ZU Taikun;LI Dan;DAI Qingquan;WANG Yan;SONG Jun;WU Yunhai;LIU Bin;LIU Jinyang;ZHANG Zhidan;MA Xiaochun;LIU Hongyan(Department of Infectious Diseases,Shenyang Sixth People's Hospital,Shenyang 110006,China)

机构地区：[1]沈阳市第六人民医院感染一科,沈阳110006 [2]沈阳市第六人民医院重症医学科,沈阳110006 [3]锦州市传染病医院医务科 [4]中国医科大学重症医学科

出　　处：《中国感染与化疗杂志》2021年第1期67-72,共6页Chinese Journal of Infection and Chemotherapy

基　　金：沈阳市防治新型冠状病毒肺炎科研攻关应急专项(YJ2020-9-009)。

摘　　要：目的分析重症新型冠状病毒肺炎(新冠肺炎)患者的流行病学及临床特征。方法回顾性分析2020年1月22日-3月1日入住辽宁省2所新冠肺炎集中收治医院确诊新冠肺炎患者,符合《新型冠状病毒感染的肺炎诊疗方案(试行第七版)》定义的重型、危重型患者的流行病学及临床特征。结果纳入重症新冠肺炎17例,其中重型15例,危重型2例。17例患者均存在发热,14例发生肝损伤,5例肌酸激酶升高,6例乳酸脱氢酶升高,13例出现D-二聚体升高。所有患者胸部CT均呈双肺典型病毒性肺炎表现。所有患者均需要氧气支持治疗。患者主观感受发病至出现呼吸困难中位时间8 d(1~15 d),但实际开始接受氧气治疗时间为发病第3天(1~16 d)。所有患者均接受抗病毒治疗。8例使用糖皮质激素治疗。截至2020年3月16日,治愈出院16例,死亡1例。治愈患者发病至病毒核酸阴转中位时间(咽拭子、痰液RT-PCR检测)27 d(14~50 d)。结论重症新冠肺炎患者发热持续时间长、淋巴细胞计数早期下降,随病情改善后回升,可伴有肝损害、心肌损害等,双肺典型病毒性肺炎影像表现。经鼻湿化高流量吸氧可以满足大部分患者的氧气供应。小剂量的糖皮质激素可减轻肺部渗出、改善急性呼吸窘迫综合征,未发现严重不良反应。Objective To analyze the epidemiological and clinical characteristics of severe cases of coronavirus disease 2019(COVID-19)in Liaoning Province.Methods A retrospective analysis was conducted on the patients who were admitted to two designated hospitals from January 22 to March 1,2020.The severe and critically ill cases satisfied the definition stated in Chinese Protocol for Diagnosis and Treatment of Novel Coronavirus Pneumonia(Interim Edition 7).Results A total of 17 COVID-19 cases were included,including 15 severe cases and 2 critical cases.Fever was found in 17 cases and liver injury in 14 cases.Creatine kinase increased in 5 cases.LDH increased in 6 cases.Thirteen cases showed different degrees of D-dimer elevation.All cases showed typical bilateral viral pneumonia on CT.All cases required oxygen support.The median time from subjective feeling to dyspnea was 8 days(1-15 days),but the actual starting time of oxygen therapy was on day 3(days 1-16).All cases received antiviral treatment.Eight patients were treated with glucocorticoid.As of March 16,2020,16 patients were cured and 1 died.The time from onset to nucleic acid conversion(throat swab,sputum RTPCR)was 27(14-50)days.Conclusions Severe COVID-19 cases are characteristics of fever lasting for longer time,lymphocyte count decreased at early stage and increased with improvement of the condition,which may be accompanied by liver injury,myocardial damage.The patients may have typical imaging signs of bilateral viral pneumonia.Nasal humidification and high flow oxygen inhalation can meet the oxygen supply in most cases.Short-term use of low dose glucocorticoid can reduce lung exudation and improve ARDS without serious adverse reactions.

关 键 词：新型冠状病毒肺炎 重症病例 临床特征 肺部CT 转归 

分 类 号：R563.1[医药卫生—呼吸系统]