49例重型和危重型新型冠状病毒肺炎患者的临床特点  

Clinical features of 49 patients with severe and critical type of coronavirus disease 2019

作　　者：戴新贵[1] 邝代斌 罗庆凯 曹媛媛[1] 胡青[1] 曾拓业 李云峰[1] Dai Xingui;Kuang Daibin;Luo Qingkai;Cao Yuanyuan;Hu Qing;Zeng Tuoye;Li Yunfeng(Department of Critical Care Medicine,the First People's Hospital of Chenzhou,Chenzhou 423000,Hunan,China;Dabieshan Regional Medical Center of Huanggang City,Huanggang 438000,Hubei,China)

机构地区：[1]郴州市第一人民医院重症医学科,湖南郴州423000 [2]黄冈市大别山区域医疗中心,湖北黄冈438000

出　　处：《中国中西医结合急救杂志》2020年第6期646-649,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：中国博士后基金(2019M650189)。

摘　　要：目的分析49例重型和危重型新型冠状病毒肺炎(简称新冠肺炎)患者的临床特点.方法收集笔者作为驰援湖北医疗队成员支援黄冈市大别山区域医疗中心期间收治的47例重型和危重型新冠肺炎患者的临床资料以及郴州市第一人民医院收治的2例重型和危重型新冠肺炎患者的临床资料,分析其临床特点、治疗方案、并发症和预后情况.结果①一般资料:本组患者主要以老年人为主,平均年龄为(72±12)岁,且43例合并基础疾病,其中糖尿病17例(34.7%)、高血压15例(30.6%)、冠心病15例(30.6%)、脑血管疾病9例(18.4%)、恶性肿瘤2例(4.1%)、精神疾病1例(2.0%);患者主要症状有发热12例(24.5%)、咳嗽8例(16.3%)、气短7例(14.3%)、咳痰4例(8.2%)、意识障碍5例(10.2%)、头痛3例(6.1%)、腹泻3例(6.1%).入住ICU时脉搏血氧饱和度(SpO_(2):0.90±0.03比0.95±0.03)、动脉血氧分压[PaO_(2)(mmHg,1 mmHg≈0.133 kPa):75±11比85±17]、氧合指数(mmHg:202±67比282±87)、淋巴细胞计数[LYM(×10^(9)/L):0.6±0.3比0.9±0.3]、淋巴细胞比例[(10.5±1.8)%比(16.7±2.3)%]下降程度和序贯器官衰竭评分(SOFA(分):5.2±2.6比4.2±2.0)、C-反应蛋白(CRP(mg/L):232±84比124±64)、D-二聚体(mg/L:9897±1432比4020±830)升高程度均较入院时明显(均P<0.05).②影像学表现:胸部CT显示31例患者肺部均有典型的斑片状磨玻璃样高密度影,逐渐进展为肺实质和间质炎症反应.③治疗:主要给予抗病毒、抗菌、抗炎、提高机体免疫功能治疗,同时辅以中药和雾化吸入治疗,必要时行气管插管.④并发症:部分病例出现脓毒症、院内获得性肺炎、急性肾损伤(AKI)、消化道出血、气胸、心力衰竭.⑤预后:转入普通病房15例,出院4例,转入定点医院治疗基础疾病19例,死亡11例(病死率22.4%).结论早诊断、早治疗有利于降低新冠肺炎患者病死率,防止普通型新冠肺炎向重型、危重型转化是目前迫切需要解决的问题.Objective To analyze the elinical features of 49 parients with severe and eritical connavinus disease 2019(COVID-19).Methods The elinical data of 47 severe and critical C0VID-19 patients admited to Dabieshan Regional Medical Center of Huanggang City and 2 severe and critical COV ID-19 patients in the First Pople's Hospital of Chenzhou during the priond of authons as medical leam supporting Hubei were collected and their treatment plans.,complirations and prognoses were analyzed.Results①General data:the patients were mainly elderdy people,with the avenge age of(72±12)years old.Among them,43 cases were combined with underying diseases such a diabetes in 17 casrs(34.7%),hypertension 15 cases(30.6%),coronary heart disease 15 cases(30.6%),cerebrovase ular disease 9 cases(18.4%)cancer 2 cases(4.1%)and mental sickness 1 case(2.0%).The main symptons were fever 12 cases(24.5%).cough 8 cases(16.3%),shortness of breath 7 cases(14.3%),expeetoration 4 cases(8.2%),disturhance of consciousness 5 cases(10.2%),headache 3 cases(6.1%)and diarrhea 3 cases(6.1%).The levels of various indexes at admission of ICL compared with those after a period of treatment were as ollows:the pulse hlood oxygen saturation(SpO_(2):0.90±0.03 vs.0.95±0.03),aterial oxygen partial pressur[PaO_(2)mmHg,1 mmHg≈0.133 kPa:75±11 vs.85±17],osygenation index(mmHg:202±67 vs.282±87).lymphoryte count[LYM(×10^(9)/L):0.6±0.3 vs.0.9±0.3],lymphoryte prcenlage[(10.5±1.8)%vs.(16.7±2.3)%],the results of above indexes showed that they were increased after treatment:the serpuential organ failure soore[SOFA(points):5.2±2.6 vs.4.2±2.0,C-reactive protein ICRP(mg/L):232±84 vs.124±64].D-dimer(mg/L.9897±1432 vs.4020±830).the resuls of the abnve indexes after treatment were lower than those beforr Ireatment or al admission(all P<0.05).②Imaging features:chest CT showed that 31 patients had typical patchy ground glass high-density shadows,which gradually developed into inflammatory reaction of lung parenchyma and interstitial isue.③Treatments:the treatments

关 键 词：新型冠状病毒肺炎 重型和危重型 临床特点 序贯器官衰竭评分 

分 类 号：R47[医药卫生—护理学]