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。

Clinical investigation of outbreak of nosocomial severe acute respiratory syndrome

OBJECTIVE: To summarize and analyze the clinical manifestation, diagnosis and therapeutic strategy of severe acute respiratory syndrome (SARS), and its characteristics of outbreak in hospital via infection transmission cluster associated with SARS patients. METHODS: (1) Two hospitalized community acquired SARS cases with their clinical data and epidemiologically linked transmission clusters in our hospital were analyzed; (2) The clinical data from 41 SARS cases were summarized. RESULTS: (1) The contagiousness of SARS virus in SARS patients was extremely strong, especially in their acute stage. (2) The majority of clinical manifestations were fever (100% cases), and there were no obvious respiratory symptoms in more than half of the patients (53.7%) at early SARS stage (day 1 to day 3), accompanied by leucopenia(52.6%) and lymphopenia (68.4%). (3) Timely administration of Ribavirin, Methylprednisolone, immunoenhancer (such as interferon alpha-2b, thymosin-alpha1) to SARS patients was efficacious to certain extent in controlling the development of the disease. CONCLUSION: It is very important for clinicians to pay great attention to protect themselves from infection of SARS. Early discovery of SARS, early isolation of SARS patients, and early treatment are very helpful to improving patient's prognosis and controlling SARS overspread.