严重急性呼吸综合征的临床特征及其治疗与预后——附220例临床报告  

Clinical Features,Treatment and Outcome of Severe Acute Respiratory Syndrome

作　　者：王香平[1] 张建[1] 魏嘉平[1] 王力红[1] 刘佑琴[1] 冯明[1] 贾强[1] 杨强[1] 聂秀红[1] 李坤成[1] 尹建国[1] 王立[1] 续大田[1] 张泰昌[1] 王育琴[1] 韩玫[1] 王克杰[1] 李宗信[1] 丁秀娟[1] 徐玲[1] 吴晓光[1] 汤哲[1] 

机构地区：[1]首都医科大学宣武医院SARS专家组

出　　处：《首都医科大学学报》2003年第4期361-368,共8页Journal of Capital Medical University

摘　　要：为探讨严重急性呼吸综合征(SARS)的临床特征以及治疗与预后,对2003年5月6日至6月27日宣武医院收治的220例SARS患者的临床、实验室、影像学资料,临床治疗及转归进行回顾性分析。结果220例SARS患者年龄7～86岁,平均(41.33±18.40)岁。男性112例(50.9%),女性108例(49.1%)。医务人员33例(15.0%)。有明确接触史148例(67.3%)。并存基础病60例(27.3%)。临床表现发热218例(99.1%),咳嗽144例(65.5%),畏寒64例(29.1%),气促91例(41.4%),胸闷80例(36.4%),肌痛66(30%)。血常规早期白细胞总数正常或降低、淋巴细胞降低。T细胞亚群CD3、CD4、CD8绝对值降低。胸部X线或高分辨率CT早期单侧或双侧局灶性斑片状渗出性改变,影像多变、短期内增多,进展高峰期呈云雾、磨玻璃影或实变影增大。在可分析的145例血气中,低氧血症63例(43.4%)。220例SARS患者发展为急性呼吸窘迫综合征(ARDS)25例(11.4%);使用机械通气31例(14.1%)。201例康复出院,19例死亡,病死率8.64%。早期鼻导管吸氧、进展期合理使用激素及机械通气可阻止病情进展。合理使用抗生素及抗真菌药物可预防及治疗混合感染(细菌、真菌)。提示流行病接触史、发热、白细胞计数正常或减少、淋巴细胞降低、胸部X线或CT显示渗出病灶是诊断SARS的临床依据。年龄、合并基础病、肺?The objective was to discuss clinical features treatment and outcome of severe acute respiratory syndrome(SARS).Methods:Clinical data of220probable SARS patients admitted from Jun.27,2003to May.6,2003in Xuanwu Hospital was analyzed retrospectively.Result:220probable SARS patients were aged from7to86years(averaged41.33±18.40),among them112were males(50.9%)and108females(49.1%).33cases were medical staffs(15.0%).148cases had clear contact history(67.3%).60cases(27.3%)had underlying diseases.Clinical feature clusters were fever(218cases,99.1%),cough(144cases,65.5%),coldness(64cases,29.1%),breathlessness(91cases,41.4%),chest discomfortness(80cases,36.4%)and myalgia(66cases,30%).Lymphopenia and normal or decreased blood white cell count were found in the early stage,while T cell subgroups(CD 3 ,CD 4 and CD 8 )dropped continually along with the development of the course of SARS.Chest file or high resolution CT showed monolateral or bilateral localized mottling infiltration,and polymorphic change increased in a short term at the start of SARS.Patchy or confluent shadows,opacities or enlarged size of consolidation could be seen at fastigium.Among the analyzable blood gas analysis in145cases,hypoxeamia were found in63cases(43.4%),and25of them developed into ARDS(11.4%).Assisted ventilation was carried out on31cases(14.1%).201cases were clinically cured and discharged,and only19cases died(8.64%).Early oxygen administration by nasal cannulae,proper corticosteroid administration and assisted ventilation during evolutional stage could hold back the developing course of SARS.Rational and proper use of antibiotics and antifungals can prevent and treat combined infection(bacterial and fungal).Conclusion:Epidemic contact history,fever,normal-to-low leucocytes count,lymphopenia and infiltrate changes on chest X-ray or CT are the evidence of clinical diagnosis.Age,underlying disease,the extent of lung pathological changes,hypoxaemia,the absolute value drop in T cell subgroups(CD 3 ,CD 4 and CD 8 ),corticosteroids dosage and combine

关 键 词：严重急性呼吸综合征 传染性非典型肺炎 SARS 临床特征 治疗 预后 

分 类 号：R563.1[医药卫生—呼吸系统] R473.5[医药卫生—内科学]