传染性非典型肺炎

近期流行的传染性非典型肺炎 (非典 )与既往非典相比 ,表现出一些新的特征。此次的传染性非典是由意大利著名传染病专家卡罗·乌尔巴尼首先在越南提出 ,随后世界卫生组织 (WHO)建议称其为“严重急性呼吸道综合征” (SevereAcuteRespiratorySyndrome ,SARS) ,是历年传染性非典中传染性最强、病情较重的一种。从SARS的病原看 ,先后有试验材料及临床表现提示为衣原体、流感病毒、副黏液病毒 ,目前认为是冠状病毒的可能性较大。国内外有关机构正在积极展开多方面研究 ,近期的防治经验表明 ,如能得到及时的支持性治疗和对症治疗 ,绝大多数…     

Severe acute respiratory syndrome (SARS): a review

Severe acute respiratory syndrome (SARS) is a newly emerged disease that rapidly spread around the world. The disease originated in southern China and a novel coronavirus (SARS CoV) has been implicated as the causative organism. The path this virus took to set up human infection remains a mystery, though preliminary data point to origins in an animal reservoir. Nosocomial transmission of SARS CoV has been a striking feature in this epidemic. The clinical illness is similar to many acute respiratory infections, although a large proportion of patients show a rapid deterioration with respiratory distress towards the end of the second week of illness. The management principles are broadly similar to treating any community acquired pneumonia but the infection control measures take a pivotal role. There is no proven antiviral agent against SARS CoV. The most remarkable feature about the SARS epidemic was the speed with which the global community acted in a coordinated way to control it.     

Severe acute respiratory syndrome (SARS) prevention in Taiwan.

Severe Acute Respiratory Syndrome (SARS) is a newly identified respiratory disease that threatened Taiwan between April 14 and July 5, 2003. Chang Gung University experienced various SARS-related episodes, such as the postponement of classes for 7 days, the reporting of probable SARS cases, and the isolation of students under Level A and B quarantines. Ninety-eight percent of the students at the university live in dormitories; thus the prevention of SARS became an important issue. Preventive strategies are classified into primary, secondary, and tertiary prevention, with a different focus and strategy for each level of prevention. The university emphasized personal hygiene and a healthy lifestyle as the key to SARS prevention. Our experiences as school nurses during this crisis can help other school nurses to prevent the spread of SARS during similar situations.     

Severe acute respiratory distress syndrome (SARS): a critical care perspective

OBJECTIVE: To review the epidemiology, clinical features, etiology, diagnosis, and management of severe acute respiratory syndrome (SARS) from a critical care perspective. DATA SOURCES: A MEDLINE search was performed using the following terms: severe acute respiratory syndrome and SARS virus. Additional information and references were obtained from the Web sites for the Centers for Disease Control and Prevention, World Health Organization, and Health Canada. STUDY SELECTION: Recent case series were used to develop a review of the epidemiology, clinical features, outcomes, and management of patients with SARS from an intensive care unit (ICU) perspective. This was supplemented by epidemiology information obtained from other Web-based sources. Recent published studies describing the etiology of SARS were also included. DATA SYNTHESIS: SARS has rapidly spread from Southeast Asia to numerous countries, including Canada and the United States. A new coronavirus has been isolated and detected from many affected patients. The mortality rate worldwide is approximately 10.5%. From five cohorts, the ICU admission rate ranged from 20% to 38%. Fifty-nine percent to 100% of the ICU patients required mechanical ventilatory support. The mortality rate of SARS patients admitted to the ICU ranged from 5% to 67%. The most common clinical symptoms and signs are fever, cough, dyspnea, myalgias, malaise, and inspiratory crackles. Common laboratory abnormalities included mild leukopenia, lymphopenia, and increased aspartate transaminase, alanine transaminase, lactic dehydrogenase, and creatine kinase. The chest radiograph pattern ranged from focal infiltrates to diffuse airspace disease. Management consisted of isolation, strict respiratory and contact precautions, ventilatory support as needed, empiric broad-spectrum antibiotics, ribavirin, and corticosteroids. Predictors of mortality included advanced age, the presence of comorbidities, and a high lactic dehydrogenase or high neutrophil count at admission. CONCLUSIONS: SARS is a highly contagious, infectious process that can advance to significant hypoxemic respiratory failure requiring ICU monitoring and support. Early recognition is critical for effective management and containment of this disease.     

Severe acute respiratory syndrome (SARS) in Hong Kong: patients' experiences

BACKGROUND: This past year there was an outbreak of Severe Acute Respiratory Syndrome (SARS) in Hong Kong. During that time we investigated the clinical features, treatment, and nursing care of 36 patients and reported on 12 of these patients' perceptions of their illness experience. PURPOSE: The purpose of this article is to describe the clinical features, treatment, nursing care and perceptions of the illness experience of patients with SARS in Hong Kong in order to better inform nurses caring for patients with this highly contagious and potentially lethal disease. METHOD: We abstracted data from the medical and nursing records on the clinical features, treatment and nursing care of 36 patients (21 women, 15 men) in whom SARS was diagnosed and who were admitted to the Queen Mary Hospital in Hong Kong between March 15 and April 15, 2003. A review of the hospital's policy and procedures on infection control was also undertaken. Semi-structured interviews were conducted with 12 of the patients to elicit their perceptions of the illness experience. FINDINGS: The most common symptoms were cough (83%), dyspnea (80.6%), malaise (69.4%) and fever (61%). Less common symptoms included headache (38.9%), diarrhea (38.9%), dizziness (30.6%), myalgia (25%), chills (19.4%), nausea and vomiting (19.4%) and rigor (the occurrence of a sensation of hot-and-cold and shivering in addition to teeth chattering and bed shaking) (8.3%). All 36 patients received a combination of corticosteroids and ribavirin. The patients were at risk of drug-related adverse reactions and deterioration of respiratory function, and nursing vigilance was required. CONCLUSION: Nursing patients with SARS was challenging as the disease was highly contagious and potentially lethal, and not much was known about this disease. In addition to the use of frontline treatment, infection control and sensitivity to individual responses to sudden and catastrophic illness were required to support these patients. From this outbreak of SARS, we have learned the importance of infection control in containing and controlling the disease. Other lessons included the need to strengthen the surge capacity in our hospitals and support health care workers during the crisis.     

误诊为严重急性呼吸道综合征的病例分析

2 0 0 3年春季我国发生了 2 0 0 0多例严重急性呼吸道综合征 (SARS) ,其中 10 0多人被夺去了生命。今年 1月初我国的广东省和台湾地区又有关于SARS的个案报告 ,在这种谈SARS色变的社会背景下 ,医院收治的病人 ,一旦出现发热、咳嗽、X线胸片有病变的呼吸道疾病 ,极易将其误诊为SARS。北京佑安医院收治的 195例SARS ,即有 15例为其他疾病误诊为SARS,占 0 77% ,这给患者带来了不必要的精神负担。上述误诊情况还见诸于临床各个学科。现正值春季 ,是呼吸道疾病特别是呼吸道传染病的高发季节 ,本刊就呼吸道疾病再次组织专题讨论。本栏王书抗医师报告的“其他肺部疾病误诊为肺结核”及梁连春医师报告的“其他疾病误诊为SARS”的误诊原因具有共性 ,且具有普遍性 ,值得一阅 ,或许在其中能获得一些指导临床工作的经验和教训。各种疾病可以是同症异病 ,也可以是异病同症 ,临床医生特别是经验较少的医生在诊断时容易犯形式逻辑思维的错误 ,把患者特有的症状与体征与某一疾病对号入座。例如前篇文章报告在 2年之内将 2 0例其他疾病误诊为肺结核 ,这是临诊者在思维中把具有发热、咳嗽、X线胸片等影像变化的多种疾病所共有的症状、体征局限于常见的肺结核病上 ;而另一篇报告的 15例其他疾病误诊为SARS的文章 ,也是因为     

Learning from the severe acute respiratory syndrome (SARS) epidemic

Aims and objectives. This study uses two models of nursing practice, conventional and modular design, to compare nursing activities, hand hygiene, time efficiency and nurse–patient satisfaction in medical and surgical wards. Background. Learning from the SARS epidemic pointed to the importance of quality nursing practice considerations that minimize cross‐transmission of infection while maximizing patient‐focused care. Hence, a modular nursing model was adopted. Design and method. This study comprised pre‐ and postintervention phases. Data collection tools to evaluate modular nursing practice included a work sampling observation checklist, focused group interviews with nurses, questionnaires addressing nurses’ perceived competence and caring attributes, a patient satisfaction questionnaire, and a hand hygiene audit. A series of education sessions were conducted between the two phases. Quantitative and qualitative analyses were used for data triangulation. Results. Modular nursing practice, focusing on continuity of care, led to changes in the nature of direct care activities and improvement in patient/family education frequency. Also, a general increase in nurses’ hand washing frequency was noted. However, when nurses perceived time pressure, a lapse in hand hygiene compliance was found. Because of human resource and inefficiency issues, some nurses in the studied wards did not embrace geographical separation for infection control. Positive correlations were found for nurses’ perceived infection control practice competence and their perceived caring attributes. Relevance to clinical practice. In examining nursing practice models within complex clinical situations, the significance lies not only in the model's effects but also in other operational outcomes.     

严重急性呼吸综合征(SARS)早期胸部影像学表现

目的:探讨SARS胸部影像的早期变化。方法:观察24例符合SARS临床诊断标准的患者在发病3天之内的胸部平片及CT扫描结果。回顾性分析这些胸部平片及CT图像,观察、对比平片及CT图像1~3天内异常征象的发展,并对异常改变包括病变的数目、位置、大小和分布加以分析。结果:发病当天就诊并摄胸部平片的患者,胸部改变均为阴性,而CT扫描显示均为阳性改变。第二天摄片,大部分胸片为阳性改变,部分为可疑,少数仍为阴性改变。而CT改变较当日明显增大、增多。第三日摄片,胸片大部分为阳性改变。早期SARS病变胸部影像改变为小斑片状阴影,密度小而淡,约1~2cm,极易漏诊,随病变发展,CT出现棉团样改变。结论:根据SARS病情发展快、变化快的特点,早期诊断要定期复查胸片,时间不宜过长,最好每天复查,有条件应做胸部CT扫描。     

Clinical brief: severe acute respiratory syndrome (SARS).

The World Health Organization (http:/www.who.int/en/) and Centers for Disease Control and Prevention (http://www.cdc.gov) websites are updated daily as new information is learned about the Severe Acute Respiratory Syndrome (SARS) phenomena. The transmission of SARS appears to occur predominantly through direct contact with infectious material. This includes dispersed respiratory droplets, making touching contaminated objects a potential concern. Occupational health nurses must educate themselves and their employees about SARS to allow for accurate and timely sharing of information.     

The effect of severe acute respiratory syndrome (SARS) on emergency airway management

From early March 2003 to late May 2003, severe acute respiratory syndrome (SARS) was detected in Singapore. The increase in workload and new infection control procedures were thought to affect resuscitation and airway management. Our aim was to study the effects of wearing of personal protective equipment (PPE) and powered air-purifying respirator (PAPR) and the restriction in the number of resuscitation personnel on airway management during the SARS crisis. Data was collected prospectively through an ongoing emergency airway registry. The data was divided into three periods: (1) before PPE was instituted from 1 November 2002 to 31 March 2003; (2) during SARS (when PPE use was mandatory) from 1 April to 31 July 2003; (3) post-SARs (when PPE use was non-mandatory but encouraged) from 1 August to 31 March 2004. There was no change in patient demographics during the three periods. There were significant increases in the proportion of resuscitation cases and airway interventions during the SARS period compared to the pre-SARS period. The resident medical officer intubation rate decreased from 45.1% pre-SARS to 35.2% during SARS and 17.7% post-SARS. The complication rates were 10.5%, 9.9% and 9.4% in periods 1-3, respectively. Restriction in the number of healthcare staff attending to each patient may have influenced the department's decision to allow only the most confident or experienced personnel to manage the airway. The exposure of junior medical officers in emergency airway management during SARS and the immediate post-SARS period was decreased. This trend should be monitored further and intervention may be necessary should it continue to decline.     

SARS (severe acute respiratory syndrome): reflective practice of a nurse manager

Aims and objectives. This paper describes the reflective practice of a nurse manager in Hong Kong in supporting frontline nurses to overcome the crisis of SARS. Background. SARS infection was a crisis for everyone in endemic areas because of its threat to physical and emotional health. Hong Kong was the second leading endemic area in the world. Inadequate supplies of protective devices and the death of a nurse infected with SARS triggered nurses’ negative emotions. Methods. A model of structured reflection was adopted to examine one's practice. A problem‐solving model for crisis intervention was integrated into the reflective stage of structured reflection. Results. Promotion of nurses’ safety and emotional stability were the major goals in handling the crisis. Strategies were employed including self‐awareness, empowerment and team building, information sharing, provision of personal protective equipment and emotional support for frontline nurses. Conclusions. SARS infection threatens the physical and emotional health of nurses. From a positive perspective, such a crisis created an opportunity to learn and grow in terms of ethical, personal and aesthetic arenas. Relevance to clinical practice. SARS epidemic raised worldwide attention and challenged the Hong Kong's health care system. Reflective practice is useful to guide and examine nurses’ professional action during the crisis, and to put the experience into a learning perspective.