38例重症传染性非典型肺炎的临床分析

目的:探讨重症传染性非典型肺炎的易患因素、临床特点、治疗以及预后。方法:回顾性分析广州呼吸疾病研究所于2002年12月至2003年4月临床诊断重症传染性非典型肺炎(AP)的临床资料,并对重症AP病例的性别、发病年龄、基础病、呼吸道症状、影像学资料、治疗及预后进行分析。结果:重症传染性非典型肺炎共38例,89％为60岁以下患者(34/38);87％有明确的接触史(33/38)。感染的危险因素是密切接触。临床特点:高热,干咳,呼吸衰竭较早(平均4.98±1.37 d)出现,X线示迅速出现双肺的浸润。治疗以糖皮质激素和机械通气为主,辅以抗生素、抗病毒药等。30例病愈出院(78.9％),其中11例(11/30)出院时X线胸片示有肺纤维化改变(36.7％);8例死亡(21.1％)。结论:重症传染性非典型肺炎发病与密切接触病人有关,多发生于青壮年,但老年慢性病病人感染后痛死率高。病情发展迅速,经合理的治疗其预后尚好。

Retrospective Analysis of 38 Cases of Critical Infectious Atypical Pneumonia

Objective: To find out the clinical feature, therapeutic outcome, prognosis and major predisposing factors of critical infectious atypical pneumonia (AP) . Methods: Patients with critical infectious atypical pneumonia referred to Guangzhou Institute of Respiratory Disease ( GIRD) between Dec 2002 and Apr 2003 were retrospectively studied. Their demographic data, respiratory symptoms, chest radiograph, treatment and prognosis were analyzed. Results:38 cases of critical infectious atypical pneumonia were diagnosed,89% of them were young persons aged 20 -59,and 87 percent had contacts with AP patient. Transmission occurred commonly after close contact. The most common presenting symptoms were high fever and dry cough, rapidly followed by dyspnea associated with bilateral infiltrates on chest radiography. Empirical therapy most commonly included corticosteroids, antibiotics, oseltamivir and mechanical ventilation. 25 cases recovered - 5 had pulmonary fibrosis and 8 died. Conclusion: critical infectious AP is associated with close contact with patient, generally infecting the young. But the mortality is higher in elders with chronic diseases. Although the patients underwent rapidly deteriorating process of the disease,most of them recovered through reasonable treatment.