武汉市金银潭医院141例新型冠状病毒肺炎死亡病例临床特征分析  

Clinical features of 141 fatal cases of coronavirus disease in Jinyintan Hospital in Wuhan,China

作　　者：肖一佳 董璇 杨红忠[1] 谭洪毅 周若兰 陈垣[1] 沈湘波 晏木云[1] Xiao Yijia;Dong Xuan;Yang Hongzhong;Tan Hongyi;Zhou Ruolan;Chen Yuan;Shen Xiangbo;Yan Muyun(Department of Respiratory Disease and Intensive Care,Changsha Central Hospital,Changsha 410001,China;Department of North 6,Jinyintan Hospital,Wuhan 430000,China)

机构地区：[1]长沙市中心医院呼吸与危重症医学科,410001 [2]武汉市金银潭医院北六区,430000

出　　处：《中华结核和呼吸杂志》2021年第4期354-359,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的回顾性分析湖北省武汉市金银潭医院新型冠状病毒肺炎(COVID-19)141例死亡患者的流行病学特点及临床资料,以期为临床诊治提供依据。方法回顾性分析2020年1月20日至3月6日湖北省武汉市金银潭医院141例确诊COVID-19死亡患者的流行病学、临床特征、实验室和影像学资料及临床治疗方法进行。结果141例COVID-19死亡患者中,年龄24~92岁,中位年龄77岁,其中男92例、女49例;3例(2%)有华南海鲜市场接触史,6例(4%)为家庭聚集性发病,8例(5%)为院内感染,116例(72%)无明确流行病史;101例(72%)合并慢性基础疾病,最常见为高血压、糖尿病及冠心病。141例患者的临床表现主要包括发热121例(85%)、咳嗽77例(54%)、气促23例(16%)、胸闷15例(10%)、乏力7例(4%)、头痛3例(2%)、意识障碍2例(1%)、腹泻2例(1%)、腰痛1例(0.7%)。141例患者实验室检查方面,132例(94%)淋巴细胞减少,但141例(100%)C反应蛋白、121例(89%)降钙素、140例(99%)血清淀粉样蛋白A明显增高。141例患者中,101例(72%)患者CT表现为双肺多发散在磨玻璃阴影并以双下叶为主,15例(10%)右肺病变重于左肺病变,4例(3%)出现白肺,20例(14%)肺磨玻璃阴影与实变影共存,1例(0.7%)患者出现气胸。141例患者均使用抗生素及抗病毒药物,其中49例(35%)合并使用免疫丙种球蛋白,45例(32%)使用类固醇激素,24例(17%)接受连续肾脏替代治疗(CRRT),12例(9%)使用体外膜氧合(ECMO)。141例患者均使用氧疗,其中61例(43%)行气管插管、65例(46%)无创通气、15例(11%)经鼻导管给氧。141例患者的死亡原因中,90例(64%)死于ARDS,24例(17%)患者死于多器官功能衰竭(MODS),11例(8%)死于心源性猝死,8例(6%)患者死于病毒性心肌炎,4例(3%)患者死于急性心肌梗死,3例(2%)患者死于脑血管意外,1例(0.7%)患者死于消化道出血。结论COVID-19死亡病例大多数合并慢性疾病,老年男性伴慢性疾病的患者病死率高,死亡原因依次�Objective To describe the epidemiological characteristics and clinical features of patients with fatal coronavirus disease(COVID-19),in order to provide evidence for clinical diagnosis and treatment.Methods In this retrospective study,we analyzed data on 141 fatal cases of confirmed COVID-19 that occurred among patients in Jinyintan Hospital in Wuhan,China,from January 20 to March 6,2020.We analyzed their epidemiological characteristics,clinical and radiological features,laboratory results,and treatment.Results Of the 141 patients(49 females,92 males),the median age was 77 years(range:24-92 years).The most likely source of exposure included the Huanan seafood market(n=3,2%),family members(n=6,4%),and hospital-acquired infection(n=8,6%).The remaining 116 patients(72%)had no known source of exposure.Of the patients,101(72%)had chronic diseases.The most common comorbidities were hypertension,diabetes and coronary heart disease.The most common clinical manifestations were fever(n=121,85%),dry cough(n=77,54%),shortness of breath(n=23,16%),and chest pain(n=15,10%).Less common clinical manifestations included fatigue(n=7,4%),headache(n=3,2%),disorders of consciousness(n=2,1%),diarrhea(n=2,1%)and lumbago(n=1,0.7%).In terms of laboratory tests,the absolute value of lymphocytes in most patients was reduced(n=132,94%),but C-reactive protein(n=141,100%),procalcitonin(n=121,89%),serum amyloid(n=140,99%)were significantly increased.The most common findings on imaging of the lungs were bilateral multiple mottling and ground-glass opacity(n=101,72%),mainly in the lower lobes(n=15,10%),with lesions being more common on the right.Other imaging findings included diffuse consolidation(n=4,3%),ground-glass opacity and consolidation(n=20,14%),and pneumothorax(n=1,0.7%).All patients were treated with antibiotics and antiviral drugs.Other treatments included immunoglobulin(n=49,35%),corticosteroids(n=45,32%),continuous renal replacement therapy(n=24,17%),and extracorporeal membrane oxygenation(n=12,9%).All patients were treated with oxy

关 键 词：新型冠状病毒肺炎 肺炎 病毒性 呼吸窘迫综合征 成人 

分 类 号：R563.1[医药卫生—呼吸系统]