老年新型冠状病毒肺炎患者的临床特征  

Clinical characteristics of elderly patients with coronavirus disease 2019

作　　者：刘振家 熊滨[1] 韩林[1] 向淑麟[1] 陈翔 LIU Zhen-jia;XIONG Bin;HAN Lin;XIANG Shu-lin;CHEN Xiang(Department of Critical Care Medicine Ward 1,the People′s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院重症医学科一区,南宁市530021

出　　处：《广西医学》2021年第15期1873-1879,共7页Guangxi Medical Journal

基　　金：广西南宁市青秀区科技重点研发计划(2019036)。

摘　　要：目的总结老年新型冠状病毒肺炎(COVID-19)患者的临床特征。方法回顾性分析18例老年COVID-19患者的临床资料,包括一般资料、临床表现、实验室检查和影像学资料、治疗措施及转归情况。结果(1)18例老年COVID-19患者中,普通型COVID-1912例(66.7%)、重型/危重型COVID-196例(33.3%)。12例(66.7%)患者合并基础疾病,其中危型/危重型COVID-195例、普通型COVID-197例,以高血压、糖尿病最为常见。(2)老年COVID-19患者最常见的症状为发热,其次为咳嗽、气促/呼吸困难、咽痛/咽部不适。(3)与普通型COVID-19患者相比,重型/危重型COVID-19患者入院时中性粒细胞比例、D-二聚体、乳酸、降钙素原、白细胞介素6水平升高,淋巴细胞计数、血清白蛋白、氧合指数明显降低。(4)与普通型COVID-19患者相比较,重型/危重型COVID-19患者肺部CT病灶范围更大。(5)在对症支持治疗的基础上,6例重型/危重型COVID-19患者均联合使用静脉广谱抗菌药物,其中4例短期使用糖皮质激素,4例采用俯卧位通气治疗,2例使用COVID-19患者恢复期的血浆治疗,2例使用体外膜肺氧合治疗,2例使用血液净化治疗。(6)所有重型/危重型COVID-19患者均出现并发症,普通型COVID-19患者均未出现严重并发症。入院后28 d时共14例(77.8%)患者痊愈出院,2例(11.1%)重型/危重型患者转入普通病房,2例(11.1%)重型/危重型患者继续在ICU治疗。结论老年COVID-19患者常存在多种基础疾病,其中重型/危重型COVID-19患者易出现合并症;应动态监测相关指标及CT影像学的变化,预防普通型COVID-19患者向重型/危重型COVID-19发展,从而降低老年COVID-19感染患者的病死率。Objective To summarize the clinical characteristics of elderly patients with coronavirus disease 2019(COVID-19).Methods The clinical data of 18 elderly patients with COVID-19 were retrospectively analyzed,including general data,clinical manifestations,laboratory examinations and imaging data,therapeutic measures and outcomes.Results(1)Among 18 elderly CPVID-19 patients,12(66.7%)cases were diagnosed as common type and six(33.3%)cases as severe/critical type.Twelve(66.7%)patients,including five cases of severe/critical type and seven of common type,had underlying disease mainly involving hypertension and diabetes mellitus.(2)The most common syndrome in elderly COVID-19 patients was fever followed by cough,tachypnea/dyspnea,pharyngalgia/throat discomfort.(3)Compared with patients with common-type COVID-19,patients with severe-/critical-type COVID-19 possessed higher neutrophil proportion,elevated levels of D-dimer,lactic acid,procalcitonin and interleukin 6,and notably decreased lymphocyte count,serum albumin and oxygenation index at admission.(4)Compared with patients with common-type COVID-19,those with severe/critical type had increased extension of lesions on lung CT.(5)Based on symptomatic and supportive treatment,six patients with severe-/critical-type COVID-19 underwent combined intravenous therapy of broad-spectrum antibiotics,wherein four were treated with short-term glucocorticoid,four with prone ventilation,two with plasma originated from convalescent COVID-19 patients,two with extracorporeal membrane oxygenation,and two with blood purification.(6)All COVID-19 patients of severe/critical type suffered from complications,but those of common type had no severe complications.Twenty-eight days after admission,14(77.8%)patients were cured and discharged from hospital,two(11.1%)of severe/critical type were transferred to the general ward,and two(11.1%)of severe/critical type continued to receive treatment in ICU.Conclusion The majority of elderly COVID-19 patients have various underlying diseases,wherein those

关 键 词：新型冠状病毒肺炎 老年人 临床特征 重型 治疗 转归 

分 类 号：R563.12[医药卫生—呼吸系统]