医院内SARS暴发流行的临床分析

目的：总结严重急性呼吸综合征(SARS，或称传染性非典型肺炎，IAP)的临床表现、诊断和治疗，以及外界输入性病例引起暴发流行的传染链特点。方法：对2例外院输入病例的临床资料和传染链进行分析，并总结41例SARS患者的临床资料。结果：①SARS患者的传染性极强，防范不当可使大量人群感染；②SARS的临床特征主要是发热(100．0％)，有相当部分患者在发病初期(1—3d)呼吸道症状并不明显(占53．7％)，并伴有外周血白细胞(52．6％)和淋巴细胞(68．4％)比例减少；②早期给予利巴韦林、甲基氢化泼尼松和免疫增强治疗对控制病情的进一步发展有一定效果。结论：重视防范、早发现、早隔离和早治疗，对改善SARS的预后和控制其蔓延有着十分重要的意义。     

SARS转运中急救车医疗舱的消毒与防护管理

2003年春流行的“严重急性呼吸综合征”(Severe Acute Respiratory Syndrome，SARS)是对医疗界的一次大挑战，其特点是传染性极强，首先被感染的是医护人员。SARS的流行对于医护人员提出了新的挑战。在应对SARS过程中，我们通过加强对医疗舱的管理，实现了急救人员零感染。我们的具体做法是：(1)加强医疗舱消毒管理；(2)加强医疗器械消毒管理；(3)加强患者物品消毒管理；(4)加强急救人员防护管理；(5)加强急救人员防护物品消毒管理。在这次抗击SARS过程中，我中心无1名急救人员被感染，这与严格执行消毒隔离措施是密不可分的。     

112例SARS病人及疑似病例的临床护理与隔离管理

目的：探讨SARS病人的临床护理和隔离消毒管理方法。方法：对112例SARS病人及疑似病例进行全面细致的基础护理；严密监测生命体征、动脉血氧变化，观察治疗、用药反应；做好并发症的护理和心理护理；严格执行隔离消毒和自我防护措施。结果：病人全部康复出院，无1例病人死亡，未发生院内交叉感染，未发生医护人员感染。结论：落实护理措施，严格隔离消毒管理、可行、有效，能提高SARS病人的护理质量，有效地预防和控制疾病的传播。     

中国山西省411例医护人员严重急性呼吸综合征预防情况调查

目的：调查临床使用的严重急性呼吸综合征(severe acute respiratory syndrome，SARS)预防药物的有效性和安全性，为前瞻性临床试验设计提供临床数据。方法：回顾性问卷调查山西省2个主要SARS定点医院中与SARS患密切接触的医护人员，了解其SARS暴露危险度及相应预防措施(药物和非药物)，根据预防药物使用情况分为蚯蚓核酸酶和蛋白酶(earthworm’s nucleases and protease，ENP)组、干扰素组和空白对照组。比较各组间暴露危险因素差异、可疑隐性感染率和不良反应出现率。结果：3组采用的SAPS非药物预防措施一致性较好，但3组间暴露强度的差异有统计学意义，对预防药物临床有效性评价结果可能有影响。ENP组、干扰素组和空白对照组可疑隐性感染率分别为4．5％、4．5％和9．9％，但其差异无统计学意义；不良反应率分别为19．6％、13．6％和0％，但前两组间差异无统计学意义，且两组症状都较轻。结论：ENP组、干扰素组可疑隐性感染率较空白对照组明显降低，提示该两种药物对预防SARS可能有效。ENP与干扰素的不良反应率相当，症状均较轻，证实其临床安全性与体外实验结果一致。但本研究混杂因素较多，特别由于组间暴露危险因素分布不均，影响结果的论证强度，仅供下一步前瞻性临床试验设计参考。     

重症SARS医护人员的护理

2003年春季以来我国部分地区发生了严重急性呼吸综合征(SARS)，这是一种新型呼吸系统传染性疾病。传染性强、起病急、进展快、合并症多，常危及生命。由于缺乏特异性的预防、诊断、治疗措施，在疫情发生的早期有相当数量的医护人员被感染。由于天津某医院疫情较重，我院于2003年5月组成赴天     

重症SARS医护人员的护理

20 0 3年春季以来我国部分地区发生了严重急性呼吸综合征(SARS) ,这是一种新型呼吸系统传染性疾病。传染性强、起病急、进展快、合并症多,常危及生命。由于缺乏特异性的预防、诊断、治疗措施,在疫情发生的早期有相当数量的医护人员被感染[1] 。由于天津某医院疫情较重,我院于2     

SARS的预防控制措施探讨

目的 探讨严重急性呼吸综合征(SARS)定点收治医院的护理预防控制措施。方法 本院2月～6月期间收治的SARS病例，进行个案调查和相关科室的流行病学调查。结果 (1)无一例工作人员发生感染。通过控制传染源、加强病区通风换气、定时消毒和医护人员加强防护等各项措施落实后，医院感染得到有效控制；(2)经调查发现，本次感染SARS的主要传播途径为呼吸道飞沫传播和密切接触传播，其次为气溶胶传播。结论 通过采取有针对性的预防控制措施，SARS是可控可防的。     

综合医院对疑似SARS患者的早期诊断和治疗

目的 通过临床观察，探索疑似严重急性呼吸综合征(severe acute respiratory syndrome，SARS)患者的诊断以及相关因素的影响，完成最终诊断及相应的治疗处理。方法 采用前瞻性研究方法对100例疑似SARS患者的症状、实验室检查、肺部影像学检查以及治疗进行追踪分析。结果 100例疑似患者中，确诊SARS66例，排除34例(其中支原体肺炎4例、肺结核2例，其余为一般细菌性肺炎)。结论 SARS没有特征性临床表现，在没有金标准诊断的情况下，对疑似SARS患者的消毒隔离应等同于SARS患者，诊断治疗应综合考虑，以防漏诊、误诊。     

2例SARS病人的护理

目的探讨SARS病人护理要点及切断SARS传播途径的有效方法.方法根据SARS的临床表现和流行病学特性,对病人进行综合治疗及护理,并做好消毒隔离措施,切断传播途径.结果 2例病人由于发病急、病情严重,先后并发呼吸窘迫综合征(ARDS)及多器官衰竭,抢救无效死亡;专护期间无医护人员发生感染.结论密切观察SARS病人病情,做好呼吸道、发热的护理,严格执行消毒隔离制度,切断传染途径等是救治SARS病人的重要措施.     

综合医院严防SARS医院感染工作的组织管理

严重急性呼吸综合症(SARS)是一种强烈的呼吸道传染病，可以通过近距离的空气飞沫或接触病人的分泌物及血液传播，具有医院或家庭聚集性的特点，医护人员是本病的高危人群；因此，医院内切断感染途径，保护医护人员是降低感染，控制SARS流行的关键。在SARS流行期间，我院根据各级卫生部门下发的有关文件精神，密切结合医院实际，迅速制定了《严防     

伴有腹泻的危重型SARS病人的临床特点分析与治疗

目的　了解伴有腹泻的危重型严重急性呼吸综合征 (SARS ,即非典型肺炎 )病人的临床特点以及探索临床有效的治疗方法。方法　对 2 0 0 3- 0 4～ 0 5入院的 8例出现消化道症状的危重SARS病人的临床资料进行分析。这些危重病人除采取综合治疗措施以外 ,及早使用甲泼尼龙冲击治疗 ,并给予无创呼吸机辅助通气。结果　 8例病人 5例死亡 ,3例病情逐渐缓解 ,好转后出院。结论　 8例出现消化道症状的危重SARS病例 ,其病情严重 ,临床进展快 ,死亡率高 ,病人应在出现发热症状后及早诊断和治疗 ,并高度注意出现合并症。     

SARS与社区获得性肺炎的对比研究

目的 :研究严重急性呼吸综合征 (SARS)与社区获得性肺炎 (CAP)的不同特点。方法 :比较 2 0 0 3年 4月 5— 2 0日 4 5例住院 SARS患者和 2 0 0 2年 10月 1日— 2 0 0 3年 4月 1日 80例急诊 CAP患者的临床症状、血象、放射学表现、转归等方面的特点 ,总结 SARS的发病特点及病情发展规律。结果 :1SARS患者出现 38.5℃以上的发热、干咳、胸闷、憋气、头痛、肌痛、腹泻症状的比例显著高于 CAP患者 (P<0 .0 1) ;2 SARS患者白细胞降低的比例显著高于 CAP患者 (P<0 .0 1) ,白细胞升高的比例显著低于 CAP患者 (P<0 .0 1) ;3SARS组只有 2 2 .2 %的患者起病后 2 4 h内出现 X线胸片异常 ,71.1%的患者间隔 4 8h胸片有进展 ;CAP组患者在首诊时全部有 X线胸片异常 ,未见胸片进展病例 ,两者比较有显著差异 (P<0 .0 1) ;4 SARS患者对治疗反应差 ,CAP患者经治疗 3d明显好转 ,两者有显著差异 (P<0 .0 1) ;5 SARS患者重症肺炎率及病死率显著高于 CAP患者 (P均 <0 .0 1)。结论 :SARS与 CAP在临床表现、血象、放射学表现、对治疗的反应和转归等方面均有不同特点 ,应注意鉴别 ,争取作到及早诊断、及早隔离 ,避免疫情播散。     

77例SARS院内感染患者临床特征分析

目的 :分析严重急性呼吸综合征 (SARS)患者的临床特征及院内感染特征。方法 :总结 2 0 0 3年 4月16日— 5月 2 8日由天津首例输入性 SARS引起 77例院内感染患者的临床特点及救治体会。结果 :77例中男性 2 7例 ,女性 5 0例 ;平均年龄 (37.7± 13.7)岁。所有患者均有明确的接触史 ,潜伏期 1～ 11d;均表现为发热 ,大部分有干咳、呼吸困难、周身不适、头痛及低氧血症 ,胸部查体可以闻及水泡音和爆裂音 ;80 %的患者出现了淋巴细胞减少 ,部分患者出现转氨酶的轻度升高 ,血肌酐水平正常。连续性 X线胸片检查表现为肺部明显的炎症改变。其中 1例死于进行性呼吸衰竭 ,1人自杀。所有的患者自出现症状后均接受了甲基氢化泼尼松及病毒唑治疗 ,治疗时间为 (18.6± 5 .4 ) d;早期均接受了抗生素治疗 ,无明显效果。结论 :以甲基氢化泼尼松和病毒唑为主的综合治疗对 SARS有较好的疗效。     

Eight-month prospective study of 14 patients with hospital-acquired severe acute respiratory syndrome

OBJECTIVE: To define the clinical characteristics and clinical course of hospital-acquired severe acute respiratory syndrome (SARS). PATIENTS AND METHODS: This 8-month prospective study of 14 patients with hospital-acquired SARS in Taipei, Taiwan, was conducted from April through December 2003. RESULTS: The most common presenting symptoms in our 14 patients with hospital-acquired SARS were fever, dyspnea, dizziness, malaise, diarrhea, dry cough, muscle pain, and chills. Lymphopenia and elevated serum levels of lactate dehydrogenase (LDH) and C-reactive protein (CRP) were the most common Initial laboratory findings. Initial chest radiographs revealed various pattern abnormalities and normal results. Five of the 14 patients required mechanical ventilation. The need for mechanical ventilation was associated with bilateral lung involvement on the initial chest radiograph and higher peak levels of LDH and CRP. Clinical severity of disease varied from mild to severe. At 8 months after disease onset, patients with mild or moderate SARS had normal findings or only focal fibrosis on chest high-resolution computed tomography. However, bilateral fibrotic changes remained in the 4 patients who had recovered from severe SARS, 1 of whom had mild restrictive ventilatory impairment. One patient with severe SARS died; she was elderly and had other comorbidities. Five additional patients had reduced diffusing capacity. CONCLUSION: The clinical picture of our patients presenting with hospital-acquired SARS revealed atypical pneumonia associated with lymphopenia, elevated serum levels of LDH, rapid clinical deterioration, and lack of response to empirical antibiotic therapy. Substantially elevated levels of LDH and CRP correlated with severe illness requiring mechanical ventilatory support. In those receiving mechanical ventilation, pulmonary function was only mildly reduced at 6 to 8 months after acute illness, consistent with the natural history of acute respiratory distress syndrome due to other causes.     

The impact of the SARS outbreak on an urban emergency department in Taiwan

OBJECTIVE: Emergency departments (ED) were on the front lines for possible cases of transmission during the severe acute respiratory syndrome (SARS) epidemic. The purpose of this study was to investigate the impact of the SARS catastrophe on an urban ED. METHODS: The patients' characteristics in an urban ED were collected from March to May 2003 during the SARS outbreak in Taiwan. The crisis period was divided into 2 periods: 30 days before (period 1) and after (period 2) April 21, the date of the first hospital-associated transmission. Problem severity in the ED and stress levels of ED staff during the SARS catastrophe were rated from mild (1 point) to severe (5 points). RESULTS: The number of ED patients declined 33.4% in period 2. There was a 2.1% (95%CI, 0.4-3.8) increase in the percentage of male patients, a 2.5% (95% CI, 1.5-3.7) increase in percentage of fever (>38 degrees C), and a 4.0% (95% CI, 2.6-5.4%) increase in chief complaint of fever in period 2. The number of nontrauma patients younger than 18 years had declined by 44.5% in period 2. The total charge for reimbursement from an insurance institution declined 21.7%. During the SARS outbreak, the most severe stress experienced by either physicians or nurses occurred during emergency resuscitation (median stress rating point, 4; interquartile range, 1). CONCLUSION: The SARS catastrophe affected the ED visit volume, finances, various patient characteristics, and stress levels in the ED physicians and nurses. EDs must be fully prepared to face the challenges of the next outbreak of SARS or other infectious disease.     

SARS: Key factors in crisis management

This study was conducted at a single hospital selected in Taipei during the SARS (Severe Acute Respiratory Syndrome) outbreak from March to July, 2003 in Taiwan. During this period of time, 104 SARS patients were admitted to the hospital. There were no negative reports related to the selected hospital despite its being located right in the center of an area struck by the epidemic. The purpose of this study was to identify the key factors enabling the hospital to survive SARS unscathed. Data were collected from in-depth interviews with the nursing directors and nursing managers of the SARS units, along with a review of relevant hospital documents. The five key elements identified as survival factors during this SARS crisis are as follows: 1. good control of timing for crisis management, 2. careful decision-making, 3. thorough implementation, 4. effective communication, and 5. trust between management and employees. The results of this study reconfirmed the selected hospital as a model for good crisis management during the SARS epidemic.     

126例SARS患者恢复期病状调查

目的：调查出院严重急性呼吸综合征(SARS)患者残留病状，为康复治疗提供依据。方法：对东城区所辖社区及本市其他区域患者SARS出院后来北京中医医院门诊的患者进行问卷调查或诊查，记录症状、舌脉、理化检查等情况，并进行归纳总结。结果：共调查病例126例，其中接受理化检查89例，临床症状中气短、乏力、胸闷、汗出、口干苦、五心烦热等症状占47％以上，舌红、苔厚腻、脉滑细数较常见，尤其多见于用过激素的患者中；理化检查中，仍有10％～20％的患者有淋巴细胞计数、转氨酶、心肌酶、尿素氮、血糖等的异常，不到10％的患者有心电图异常，X线检查中55例遗留肺部阴影吸收不全(包括炎性病变、间质病变及纤维化)。结论：SARS患者康复期仍有接受治疗及医学观察的必要。     

118例SARS患者胸部X线表现分析

目的：总结严重急性呼吸综合征(SARS)的胸部X线表现特点及变化规律。方法：分析118例经临床确诊的SARS患者胸部X线显示肺部病变出现的时间、部位、范围及影像学特点，以及与临床表现的关系。结果：99．2％的患者在病程中胸部X线显示有肺部病变，79．7％的患者在发病后4d内X线胸片显示肺部病变；52．5％的患者为双肺、多肺叶病变；7例死亡病例的肺部病变出现早，而且累及范围广、病情进展快。结论：肺部病变出现越早、范围越广、进展越快，临床症状越重，预后差。     

Transmission of SARS to healthcare workers. The experience of a Hong Kong ICU

Objective To describe the extent and temporal pattern of transmission of severe acute respiratory syndrome (SARS) to intensive care unit staff. Design Retrospective observational cohort study. Setting University hospital intensive care unit, caring solely for patients with SARS or suspected to have SARS. Participants Thirty-five doctors and 152 nurses and healthcare assistants who worked in the ICU during the SARS epidemic. Interventions: Infection control measures designed to prevent transmission of disease to staff were implemented. Measurements and results Sixty-seven patients with SARS were admitted to the intensive care unit. Four nurses and one healthcare assistant contracted SARS, with three of these developing symptoms within 10 days of admission of the first patient with SARS. Doctors were exposed to patients with SARS for a median (IQR) of 284 (97–376) h, while nurses and healthcare assistants were exposed for a median (IQR) of 119 (57–166) h. The ICU did not meet international standards for physical space or ventilation. Conclusions In an ICU in which infection control procedures are rigorously applied, the risk to staff of contracting SARS from patients is low, despite long staff exposure times and a sub-standard physical environment. Electronic supplementary material The electronic reference of this article is The online full-text version of this article includes electronic supplementary material. This material is available to authorised users and can be accessed by means of the ESM button beneath the abstract or in the structured full-text article. To cite or link to this article you can use the above reference.