广东省114例老年重症登革热患者临床特点及救治措施  

Clinical characteristics and treatment measures of 114 elderly patients with severe dengue in Guangdong Province

作　　者：王长泰 杨慧勤[1] 洪文昕[1,3] 廖璐 林炳亮 彭劼[5] 陈学福[6] 王建 蔡卫平[1] 李凌华[1] 张复春[1] WANG Changtai;YANG Huiqin;HONG Wenxin;LIAO Lu;LIN Bingliang;PENG Jie;CHEN Xuefu;WANG Jian;CAI Weiping;LI Linghua;ZHANG Fuchun(Department of Infectious Diseases,Guangzhou Eighth People's Hospital,Guangzhou Medical University,Guangzhou,Guangdong 510440,China;The Second Hospital of Anhui Medical University,Hefei,Anhui 230601,China;Guangzhou Red Cross Hospital,Guangzhou,Guangdong 510220,China;The Third Affiliated Hospital of Sun Yat-Sen University,Guangzhou,Guangdong 510630,China;Nanfang Hospital,the Affiliated South Hospital of the Southern Medical University,Guangzhou,Guangdong 510510,China;Guangdong Provincial People's Hospital,Southern Medical University,Guangzhou,Guangdong 510080,China)

机构地区：[1]广州医科大学附属市八医院感染病中心,广东广州510440 [2]安徽医科大学第二附属医院,安徽合肥230601 [3]广州市红十字会医院,广东广州510220 [4]中山大学附属第三医院,广东广州510630 [5]南方医科大学南方医院,广东广州510510 [6]南方医科大学附属广东省人民医院,广东广州510080

出　　处：《中国热带医学》2024年第12期1534-1539,共6页China Tropical Medicine

基　　金：广州市科技计划项目校(院)联合资助专项(No.2023A03J0810)

摘　　要：目的 分析广东省老年重症登革热(severe dengue,SD)患者的临床特点及救治措施,为老年SD患者的临床救治提供科学依据。方法 收集2014—2023年在广东省4个市住院的老年SD患者的临床资料,比较年轻老人(<80岁)和高龄老人(≥80岁)的临床特点差异,统计不同治疗措施及临床转归。结果 114例老年SD患者中高龄老人占34.21%,合并基础疾病为81.58%,其中常见为高血压(64.04%)、慢性心脏病(42.98%)、脑血管疾病(28.07%)、糖尿病(21.05%)。42.11%白细胞计数正常或升高,81.58%血小板计数<50×109/L,52.63%白蛋白<30 g/L。年轻老人和高龄老人比较,症状、体征及实验室指标的差异均无统计学意义(P>0.05)。重症表现中严重血浆渗漏、严重出血和严重器官损伤发生率分别为29.82%、34.21%和63.16%,年轻老人和高龄老人比较,差异无统计学意义(P>0.05)。所有患者入院后给予静脉补液、器官支持、营养支持等治疗,输注人血白蛋白、血小板、红细胞、糖皮质激素、静注人免疫球蛋白和抗菌药物的使用率分别为60.53%、55.26%、19.30%、35.96%、30.70%和78.95%。22.81%和8.77%患者接受机械通气和肾替代治疗。最终32.46%患者入住重症监护室,16.67%患者死亡。结论 老年SD患者常合并基础疾病,严重器官损伤多见,病死率高,年轻老人和高龄老人的临床特点类似。临床上尽早识别重症,以基础疾病和临床特点为基础制定个体化综合救治措施是老年SD患者治疗关键。Objective To analyze the clinical characteristics and treatment measures of elderly patients with severe dengue(SD)in Guangdong Province,providing a scientific basis for the clinical treatment of elderly SD patients.Methods Clinical data of elderly patients with SD hospitalized in four cities in Guangdong Province from January 2014 to December 2023 were collected.The clinical characteristics of elderly patients between the younger elderly(<80 years old)and the older elderly(≥80 years)were compared,and different treatment measures and clinical outcomes were statistically analyzed.Results Among the 114 elderly SD patients,34.21%were the older elderly,and 81.58%had underlying diseases,including hypertension(64.04%),chronic heart disease(42.98%),cerebrovascular disease(28.07%),and diabetes(21.05%).Among elderly SD patients,42.11%had normal or elevated white blood cell counts,81.58%had a platelet count of<50×109/L and 52.63%had albumin levels<30 g/L.There was no statistically significant difference in symptoms,signs,and laboratory indicators between the younger elderly and the older elderly(P>0.05).The incidence rates of severe plasma leakage,severe bleeding,and severe organ damage in severe manifestation were 29.82%,34.21%,and 63.16%respectively,with no statistically significant difference between the younger elderly and the older elderly(P>0.05).All patients were treated with intravenous infusion,organ support,nutritional support,and other treatments upon admission,with the usage rates of human serum albumin,platelets,red blood cells,glucocorticoids,intravenous immunoglobulin,antibiotics,and antifungal drugs being 60.53%,55.26%,19.30%,35.96%,30.70%,and 78.95%respectively.Mechanical ventilation and renal replacement therapy were administered to 22.81%and 8.77%of patients.Finally,32.46%of patients were admitted to the intensive care unit,and 16.67%died.Conclusions Elderly patients with SD often have underlying diseases and severe organ damage is more common,with a high mortality rate.The clinical characteristics of

关 键 词：登革热 重症登革热 临床特点 治疗 老年 广东 

分 类 号：R373[医药卫生—病原生物学]