185例SARS死亡病例分析及原因探讨

目的 :回顾性分析 SARS患者死亡原因 ,为临床降低病死率提供可借鉴的经验。方法 :对 185份 2 0 0 3年 6月 2 0日源自北京市各综合医院提供上报给北京市 SARS治疗指挥中心的死亡病例资料进行回顾性分析 ,包括年龄、基础疾病、实验室检查、影像学检查以及治疗措施等。结果 :185例 SARS死亡病例中男 10 2例 ,女 83例 ;平均年龄 5 6 .4岁 ,大于 6 0岁者 85例。有基础疾病者 14 7例 (79.5 % ) ,其中心血管疾病 5 7例 ,占第一位 ;糖尿病 4 1例 ,占第二位 ;脑血管病 19例 ,占第三位 ;消化道疾病 15例。有并发症者 5 2例 (2 8.1% ) ,依次为急性呼吸窘迫综合征 (ARDS) ,继发感染 ,多脏器功能障碍综合征 (MODS)等。部分入院资料齐全者显示入院时生命体征均稳定。血液学与动脉血气分析检查显示 :疾病晚期与入院时相比 ,血糖、白细胞均升高 (P均 <0 .0 0 1) ,而淋巴细胞显著降低 (P<0 .0 0 5 ) ,动脉氧分压 (Pa O2 )、氧合指数进行性下降 (P<0 .0 0 5 ,P<0 .0 0 1) ;有近一半的患者血生化指标异常。结论 :年龄和基础疾病是 SARS死亡十分敏感的指标 ,而 SARS冠状病毒导致的肺损伤、顽固性低氧血症和高血糖代谢紊乱以及激素和抗生素的滥用所致继发感染均是 SARS患者死亡的主要原因。

Analysis and causation discussion of 185 severe acute respiratory syndrome dead cases

Objective: To proceed the retrospective analysis of the dead reasons of patients with severe acute respiratory syndrome(SARS), in order to provide experience for decreasing mortality of SARS patients in clinic. Methods: Retrospective analyze of 185 dead cases of SARS patients, including age, basic diseases, laboratory tests, radiological test and therapy. Results: There were 102 men and 83 women in 185 dead cases of SARS, in which average age was 56.4 years, 85 cases were older than 60 years. 147 cases (79.5%) had basic diseases, cardiovascular disease (57 cases) was at the first place; diabetes mellitus (41 cases) was at the second place; cerebrovascular disease (19 cases) was at the third place; 15 patients had alimentary disease. 52 patients (28.1%) suffered from complications, which were acute respiratory distress syndrome (ARDS), secondary infection and multiple organ dysfunctional syndrome (MODS) by order. Some of the patients having complete information showed that life symptoms were stabilization. Hemogram and blood gas analysis showed that blood sugar and white blood cell(WBC) increased (P<0.001); lymphocyte decreased significantly (P<0.005) and PaO 2, PaO 2/FiO 2 decreased progressively (P<0.005,P<0.001) in late stage of SARS versus just entering the hospital. Half patients showed the abnormality of biochemical indexes. Conclusion: Age and basic diseases are sensitive indexes for predicting dead tendency of SARS. Lung injury, obstinate hypoxemia, abnormality metabolize of hyperglycemia and misusing glucocorticoids and antibiotic leading to secondary infection are the main reasons for SARS patients dying.