重症SARS患者32例治疗初探

目的：总结32例重症严重急性呼吸综合征(SARS)患者的救治经验。方法：32例重症SARS患者中，男性13例，女性19例；年龄19～72岁，平均43．06岁，50岁以上者10例；有严重基础疾病者13例，其中心脑血管疾病患者9例，糖尿病2例，肾功能不全1例，慢性阻塞性肺疾病1例。治疗采用广谱抗病毒药物、糖皮质激素、机械通气、抗生素、免疫增强剂等。结果：24例患者治愈出院，治愈率75．00％；2例患者死于呼吸衰竭(6．25％)，6例患者死于严重基础疾病，总病死率25．00％；12例出现二重感染，17例使用无创呼吸机患者中3例(占17．65％)造成肺损伤(纵隔气肿、气胸等)，4例血糖升高，4例上消化道出血，6例出现左心衰竭。结论：对重症SARS患者的救治应加强基础疾病治疗，为避免二重感染等并发症的出现不宜长期使用激素，在进行机械通气治疗的同时应警惕肺损伤的发生。

Preliminary analysis of treatment in 32 patients with critical severe acute respiratory syndrome

Objective: To summarize the experience of treatment in 32 critical severe acute respiratory syndrome(SARS) patients. Methods: The age of 32 patients ranged from 19 to 72 years, the average was 43 06 years. Among them, 13 patients were having serious primary diseases, i. e. cardiocerebralvascular disease in 9 patients, diabetes in 2 patients, renal dysfunction in 1 patient, and chronic obstructive pulmonary disease(COPD) in 1 patient. The treatment included antiviral agents, glucocorticoid, mechanical ventilation, antibiotics and immunologic enhancement, etc . Cure rate, mortality and complications were analyzed. Results: Among 32 patients, 24 were cured, 2 died of respiratory failure, 6 died of their primary diseases, and the overall mortality was 25 00 percent. Superimposed infection occured in 12 patients, and among 17 patients who required noninvasive ventilation, 3 patients were complicated by lung injury (mediastinal emphysema, pneumothorax). In addition, hyperglycemia was found in 4 patients, upper intestinal hemorrhage occurred in another 4 patients and cardiac failure occurred in 6 patients. Conclusion: The treatment of the preexisting diseases should be emphasized in the treatment of critical SARS. Glucocorticoid should not be used for a longterm . Vigilance should be paid to avoid lung injury during mechanical ventilation.