重症严重急性呼吸综合征临床特点及其预警指标的分析

目的探讨重症严重急性呼吸综合征(SARS)患者的临床特点以及发生重症的预警指标,为SARS患者的病情估计、临床救治和预后提供资料。方法根据“重症SARS的诊断标准”将2003年3月至6月山西省太原市确诊的、临床资料完整的304例SARS患者分为非重症组和重症组,分析两组间临床及实验室指标的差异性,以及发生重症SARS可能的危险因素。结果①重症组患者平均年龄(44±16)岁]大于非重症组(33±12)岁],差异有统计学意义(P<0.01),重症组年龄>50岁患者比例(32.3%)及合并基础疾病者(15.0%)明显高于非重症组(10.7%、2.0%,P均<0.01)。②重症组入院后最高体温(38.8±0.9)℃]、发热持续时间(15±12)d]及胸片病变累及双肺者比例(58.6%)均高于非重症组(38.3±1.0)℃、(10±8)d和40.5%],差异均有统计学意义(P均<0.01)。③重症组病程各期呼吸频率均高于非重症组,血氧饱和度和动脉血氧分压均低于非重症组,差异均有统计学意义(P均<0.01)。④重症组病程各期血白细胞总数均高于非重症组;而淋巴细胞绝对值均低于非重症组,差异均有统计学意义(P<0.05)。⑤年龄≥50岁、呼吸频率≥24次/min和经皮血氧饱和度≥90%时发生重症SARS的危险度分别为年龄<50岁、呼吸频率<24次/min和经皮血氧饱和度<90%的3.442、1.219和0.545倍,95%可信区间分别为1.391～8.518、1.067～1.393和0.451～0.659(P值分别为0.007,0.004和0.000)。结论重症SARS患者具有年龄大、合并基础疾病多、发热持续时间长、呼吸频率快、血氧饱和度低、白细胞总数高、淋巴细胞计数低及X线胸片病变累及双肺多等特点。因此年龄≥50岁、呼吸频率≥24次/min和经皮血氧饱和度<90%可作为发生重症SARS的预警指标。

The analysis of clinical features and warning indicators in patients with critical severe acute respiratory syndrome

Objective To investigate the clinical features and warning indicators in patients with critical severe acute respiratory syndrome, and to provide data for evaluating the condition,treatment and prognosis of SARS. Method During the period from March to June in 2003, there were 304 SARS patients with complete clinical data in Taiyuan, Shanxi province. According to the diagnostic standards of critical SARS, these patients were classified into two groups: A group (critical SARS) and B group (non-critical SARS). The two groups′ index discrepancies in both clinical and laboratory were analyzed in order to find the potential risk factors for critical SARS. Results ① The average age in Group A (44±16) years old was significantly higher than Group B (33±12) years old (P<0.01). The number above 50 years old (32.3%) and with underlying diseases(15.0%)in Group A were much higher than that in Group B(10.7%,2.0%,P<0.01). ②The peak temperature ,lasted fever time, dual-lung shown on X-ray chest radiography in Group A were significantly higher than that in Group B(P<0.01). ③Respiratory frequency in Group A were higher in each period, but pulse O2 saturation(SpO2) and PaO2 were lower than that in Group B significantly (P<0.01). ④Total leukocyte number in each period in Group A were significantly higher, but the absolute value of lymphocyte was significantly lower than that in Group B(P<0.05). ⑤The OR values developed critical SARS are 3.442, 1.219, 0.545 times for patients with SARS above 50 years old, respiratory frequency ≥24 every minute, SpO2 <90% respectively, with 95% CI of 1.391~8.518, 1.067~1.393, 0.451~0.659 respectively, P=0.007, 0.004 and 0.000 respectively). Conclusions There are features of older age, underlying diseases, longer fever period, faster respiratory frequency, lower SpO2, larger number of leukocyte, lymphopenia, and dual-lung shown by X-ray chest radiography in patients with critical SARS. Above 50 years old, respiratory frequency ≥24 every minute and SpO2 <90% can be regarded as the warning indicators in patients with critical SARS.