193例SARS患者舌象分析

目的观察SARS患者的舌象，为SARS舌诊提供客观依据。方法各医院指定专人分别采用600万像素富士数码相机、佳能数码相机、奥林巴斯数码相机均在上午9～10时自然光线单次摄影。经专家筛选后确定193舌象照片并结合90名SARS一线专家问卷调查结果，采用SPSS软件存储处理。结果(1)193例SARS患者照片中舌质淡红70例(36．27％)，舌质红60例(31．09％)，舌尖红25例(12．95％)，舌质暗红12例(6．22％)，舌质紫红11例(5．70％)，舌质绛6例(3．11％)，舌紫暗5例(2．59％)；(2)193例SARS患者照片中舌苔以白腻、薄白、灰黑苔、少苔、薄黄为主。舌苔白腻65例(36．68％)，舌苔薄白25例(12．95％)，灰黑苔23例(11．92％)，少苔20例(10．36％)，舌苔薄黄20例(10．36％)，舌苔黄厚腻15例(7．77％)，舌苔黄垢腻13例(6．74％)，舌苔黄腻10例(5．18％)舌苔黄燥5例(2．59％)；(3)193例SARS患者照片中SARS的舌体以边有齿痕、舌有裂纹和舌有瘀斑为主。舌边齿痕90例(46．63％)，舌有裂纹57例(29．53％)，舌有瘀斑46例(23．83％)。结合调查问卷结果SARS早期多在发病后1～5d左右，病机以热湿遏阻，卫气同病为特点，舌质主要表现为：舌淡红、舌红，苔薄白或薄黄微腻为主；中期多在发病后3～10d左右，病机以湿热蕴毒，正邪交争，邪阻少阳为特点，舌质主要表现为：舌暗红、紫红，苔白腻或黄厚腻为主；极期(高峰期)多在发病后7～14d左右，病机以湿热毒盛，耗气伤阴，淤血内阻为主要特点。舌质主要表现为：舌红绛，舌紫暗为主，苔白腻或黄腻；恢复期多在发病后10～14d以后，病机以正虚邪恋，易挟湿挟瘀为主要特点，舌象主要表现为：舌淡红，质嫩，边有齿痕，苔少或苔薄少津，或舌淡略暗，苔薄腻。结论SARS患者舌象和病情有一定相关性，研究SARS患者舌象对分析病情和判断预后有一定指导意义。     

89例SARS患者抑郁与焦虑状态的调查分析

SARS是一种全新的具有强烈传染性的疾病，除了复杂多变的躯体症状，往往还伴随有精神症状或心理问题。方法通过向住院患者发放Zung抑郁自评量表(SDS)和Zung焦虑自评量表(SARS)，我们对89例SARS患者住院期间的抑郁与焦虑状况进行的调查分析。结果SARS患者中，出现抑郁与焦虑的女性明显多于男性；年龄分布上，20岁至50岁之间的抑郁患者明显多于20岁以下和50岁以上的患者，焦虑患者年龄分布比较均一；应用糖皮质激素治疗组患者抑郁、焦虑的发生率明显高于未用激素组。     

36例SARS患者外周血象检查结果分析

目的　通过对 3 6例严重急性呼吸综合征 (SARS)患者外周血细胞数据的研究 ,动态监测SARS患者的血象变化 ,探讨血象在发生、发展转归中的临床意义。　方法　收集江门市医院 3 6例确诊SARS患者的外周血检查数据 ,进行动态分析。　结果　入院时 3 6例患者外周血白细胞计数 (WBC)均值为 ( 5 2± 3 0 )× 10 9/L随后WBC升高 ,至第4周有 91 6%病例WBC计数恢复正常 ,入院时淋巴细胞值低于 1 5× 10 9/L者占 88 9% ( 3 2 / 3 6) ,均值为 ( 1 0± 0 5 )×10 9/L ,入院 4周后有 86 1%患者淋巴细胞绝对数恢复正常。 1例血小板降低 ,占 2 8%。其他细胞分类及血红蛋白无明显异常。　结论　白细胞降低或正常及淋巴细胞降低可作为SARS的早期诊断指标 ,淋巴细胞降低可作为SARS早期诊断的标准之一 ;淋巴细胞的降低显示SARS病毒严重侵犯患者免疫功能 ,淋巴细胞是否回升可作为监测患者免疫功能是否重建的指标     

50例传染性非典型肺炎患者合并肝功异常临床分析

传染性非典型肺炎(SARS)是一种由新型变异冠状病毒感染，主要以呼吸道感染为主的新的呼吸道传染病。该病传染性强，病情进展快，除对肺组织损伤严重外，对肝、心等脏器均有损害，尤其对肝组织损害较为常见。现将我们对解放军小汤山医院5区住院治疗的50例“非典”患病历进行总结，发现绝大部分患肝功能均有不同程度的损害，现总结分析如下。     

SARS患者和医护人员心理障碍及对策分析

SARS是一场突如其来的疫病，许多人不幸卷入其中。由于SARS的突发性，传播性和病因不是十分明确，没有特效治疗方法和预防措施，隔离后的孤独引发了患者复杂的心理行为反应(包括恐惧、焦虑、抑郁、愤怒等)，表现为对周围事物缺乏兴趣，长时间闷闷不乐，敏感多疑，敌视医护人员或其病友，注意力不集中、失眠、过分依赖医护人员等。     

SARS患者的临床表现及实验室诊断

今年初，部分国家和地区出现非典型肺炎疫情，世界卫生组织(WHO)向全球发出疫情警示，并将其命名为严重急性呼吸综合症(SARS)。截至2003年5月8日，全球共有32个国家和地区出现疫情，累计报告病例7000例，死亡495例。WHO报告最新研究结果表明，该疾病病因为新型冠状病毒，以前从未在人类身上发现过的变异冠状病毒，发病机制不明，潜伏期最少为4天，而最长可以达17天。患者表现发     

发热门急诊病例分析（附2例SARS患者病情分析）

目的 探讨发热门急诊工作中发热病因素，为在实际工作中能尽早的对发热患者做出正确的诊断提供帮助，同时探讨SARS患者的发病过程，为实际工作中SARS的诊断提供帮助。方法 分析2003年4-6月间瑞金医院发热门急诊患者的临床资料。结果 就诊人员中性别、年龄之间无显著差别。发病年龄以21-60岁之间为最多。发热患者首次发病伴有以呼吸道为主要症状148例占65．8％。肺炎患者97例，占43．1％。SARS患者2例。结论 年轻患者多可能与他们工作压力大，社会交往多有关。要加强做好对呼吸道疾病的防范工作。对有明显SARS接触史的患者，一定要高度警惕，密切观察，不要轻易放过。在SARS诊断中，病情的动态观察十分重要，特别是对病情在短时间内变化进展快的患者。     

SARS合并免疫力低下患者的护理

目的 探讨严重急性呼吸综合征(SARS)合并免疫力低下患者的护理问题及对策，帮助患者减轻不适。预防合并新的感染。方法 对20例SARS合并免疫力低下的患者除进行常规的对症、支持、营养等护理外，重点采用保护性隔离措施。结果 20例患者未合并新的感染，呼吸功能完全或基本恢复正常出院。结论 对SARS合并免疫力低下患者在积极治疗的基础上，采取相对应的护理措施，可使患者逐渐走向康复。     

2003年北京市民工SARS患者的流行病学分析

本文对北京市民工SARS患者进行了流行病学分析，探索疾病在这类人群的分布特点，现报道如下。     

严重急性呼吸综合征合并肝损害的临床及病理研究

目的研究严重急性呼吸综合征(SARS)合并肝损害的临床及病理学特征。方法在病程不同时期,动态观察60例SARS患者肝功能指标变化情况,比较SARS重症组病例与普通组病例的肝损害差异。结果76.7%患者ALT升高(146.3±118.3)u/L、40.0%患者AST升高(81.3±29.8)u/L,30.0%患者Bil升高(35.3±15.6)μmol/L;病程第2周肝损害最多见。SARS重症组ALT,AST和Bil异常升高率高于普通组,但仅AST差异有显著性。激素治疗组与非激素治疗组间肝功能异常发生率的差异并无显著性。约93.5%患者经常规保肝治疗3周后肝功复常。1例尸检显示肝脏广泛轻度非特异炎症反应。结论SARS病人合并肝脏损伤相当普遍,表现为转氨酶的轻中度升高,少部分病例伴有胆红素的轻度异常,适当保肝治疗是必须的,也是有效的。     

Clinical analysis of 45 patients with severe acute respiratory syndrome

Objective To explore the clinical and radiological features of severe acute respiratory syndrome (SARS).Methods Analysis of the clinical presentation, chest radiographs, course of disease and features of severe pneumonia in 45 SARS patients diagnosed at our hospital in Beijing between April 5 -20,2003. Also included is a summation of the clinical features of SARS.Results (1) SARS appears to have high infectivity; (2) the most common symptom is fever; (3)the count of leukocyte is normal or decreased; (4) most patients (35/45, 77.8% ) had experienced a 24-hour fever prior to the abnormal chest X-ray changes which showed progression of pulmonary infiltrates within 48 hours in 71.1% (32/45) of the patients and, (5) the percentage of patients who developed severe pneumonia (24.4%) is higher than those who developed typical pneumonia.Conclusion SARS is a disease with high infectivity and has its own clinical and radiological featuresEarly recognition, prompt isolation, and appropriate therapy are the key to combate this infection.     

严重急性呼吸综合征682例临床分析

目的探讨严重急性呼吸综合征(severe acute respiratory syndrome,SARS)的临床特点.方法回顾性统计分析北京小汤山医院收治的682例SARS临床病例资料.结果682例SARS患者的年龄分布于13～76岁.356例(52.2%)有明确的接触史,有171例(25.1%)发病前曾到过医院.677例(99.3%)患者出现发热,5例患者体温正常.其它主要症状包括咳嗽(44.3%)、气促(12.2%)、腹泻(8.9%);外周血白细胞计数正常或降低占87.4%;ALT和CPK升高的比例分别为16.4%、2.5%;全部患者都有肺部病变,累及双肺占69.8%;死亡6例.结论该病有较强的传染性,医院是重要的传播场所;发热、咳嗽、胸片异常及外周血白细胞正常或降低是该综合征的主要临床特点.     

A retrospective study of 78 patients with severe acute respiratory syndrome

Objective To summarize the clinical features of severe acute respiratory syndrome (SARS) and to discuss diagnosis and management of the disease. Methods A retrospective study was conducted on 78 cases of SARS referred to the Guangzhou Institute of Respiratory Diseases (GIRD) between December 22, 2002 and near the end of March 2003. Items reviewed cover all data concerning clinical manifestations, laboratory investigation and radiology. Results The patients in the study consisted of 42 males and 36 females, aged 20-75 yrs (mean age 37.5±11.6 yrs), including 44 affected health-care professionals. Clinical symptoms seen in the group were fever (100.0%), cough (88.5%), and dyspnea (79.5%). There were 12 cases (15.3%) with WBCs <4.0×10(9)/L, 49 cases (62.8%) ranging between （4.0-10.0）×10(9)/L and 17 cases (21.8%) over 10.0×10(9)/L. The average was（7.58±4.96）×10(9)/L, with 0.75±0.14 (neutrophil) and 0.18±0.11 (lymphocyte). Chest films and CT scanning revealed changes related to pneumonia. The transmission of the disease was likely via close contact with contagious droplets. The prevalences of acute lung injury (ALI, in 37cases) and acute respiratory distress syndrome (ARDS, 21 out of 37 cases) were considerably high among the patients. Seven patients who developed ARDS complicated with multiple organs dysfunction syndrome (MODS) died. Conclusions A history of close contact, fever, sign of pneumonia by X-ray and normal-to-lowered WBC counts are favorable for the diagnosis of SARS. Recognition of ALI as the important index for critical SARS and comprehensive supportive management are of paramount in decreasing the mortality of the disease.     

Cardiovascular complications of severe acute respiratory syndrome

Background and Aims

Severe acute respiratory syndrome (SARS) is a virulent viral infection that affects a number of organs and systems. This study examined if SARS may result in cardiovascular complications.

Methods and Results

121 patients (37.5 (SD13.2) years, 36% male) diagnosed to have SARS were assessed continuously for blood pressure, pulse, and temperature during their stay in hopsital. Hypotension occurred in 61 (50.4%) patients in hospital, and was found in 28.1%, 21.5%, and 14.8% of patients during the first, second, and third week, respectively. Only one patient who had transient echocardiographic evidence of impaired left ventricular systolic function required temporary inotropic support. Tachycardia was present in 87 (71.9%) patients, and was found in 62.8%, 45.4%, and 35.5% of patients from the first to third week. It occurred independent of hypotension, and could not be explained by the presence of fever. Tachycardia was also present in 38.8% of patients at follow up. Bradycardia only occurred in 18 (14.9%) patients as a transient event. Reversible cardiomegaly was reported in 13 (10.7%) patients, but without clinical evidence of heart failure. Transient atrial fibrillation was present in one patient. Corticosteroid therapy was weakly associated with tachycardia during the second (χ² = 3.99, p = 0.046) and third week (χ² = 6.53, p = 0.01), although it could not explain tachycardia during follow up.

Conclusions

In patients with SARS, cardiovascular complications including hypotension and tachycardia were common but usually self limiting. Bradycardia and cardiomegaly were less common, while cardiac arrhythmia was rare. However, only tachycardia persisted even when corticosteroid therapy was withdrawn.     

严重急性呼吸综合征合并心脏、肝脏损害的临床分析

目的：了解严重急性呼吸综合征(severe acute respiratory syndromc，SARS)发病过程中合并心脏和肝脏损害的情况。方法：对我院近期收治的69例SARS患者病程中出现的与心脏、肝脏功能有关的临床表现、心电图及实验室检查结果进行分析。结果：69例患者中有48例(69．57％)出现心脏损害，42例(60．87％)出现肝脏损害，多数症状较轻；生化检查表现为心肌酶谱及肝功能指标异常；大部分患者有心电图改变，以窦性心动过速为主，部分有房性期前收缩和ST—T变化。经一般治疗预后较好。死亡7例，均死于呼吸衰竭或多器官功能衰竭；其中1例尸检，光镜及电镜下均见肝脏和心脏的病理损害表现。结论：SARS病程中合并心脏、肝脏损害较多见，这种损伤可能主要是病原本身所致，缺氧及药物可进一步加剧损害。     

Measurement of subgroups of peripheral blood T lymphocytes in patients with severe acute respiratory syndrome and its clinical significance

Objective To investigate the changes of subgroups of peripheral blood T lymphocytes in patients with severe acute respiratory syndrome (SARS) and its clinical significance. Methods Subgroups of blood T lymphocytes in 93 patients with SARS were detected by flow cytometer. The results detected in 64 normal subjects and 50 patients with AIDS served as controls. Results The numbers of CD3+, CD4+, and CD8+ lymphocytes all significantly decreased in acute phase of patients with SARS ［(722±533)/μl, (438±353)/μl, (307±217)/μl)］ compared with those in normal controls ［(1527±470)/μl, (787±257)/μl, (633±280)/μl, all P<0.01)］, which was different from what we observed in patients with AIDS who had decreased CD4+ ［(296±298)/μl］ but increased CD8+ ［(818±566)/μl］ counts. The counts of CD3+,CD4+, and CD8+ lymphocytes decreased more apparently in patients with severe SARS. All the five patients who died had CD4+ counts less than 200/μl. As the patients’ condition improved, CD3+, CD4+, and CD8+ counts gradually returned to normal ranges. Conclusion The damage of cellular immunity is probably an important mechanism of pathogenesis of SARS.     

严重急性呼吸综合征24例临床分析

对 2 0 0 3年 5月 10～ 2 8日收治的 2 4例临床确诊的严重急性呼吸综合征 (SARS)患者的临床资料进行回顾性分析 ,以了解其流行病学特征。 2 4例患者中男 19例 ,女 5例。年龄 18～ 5 6岁 ,平均 (2 9.3± 9.0 )岁。有明确接触史者 11例 (4 5 .83% )。结果表明 SARS具有强传染性 ,任何人群均易感 ,发热为首发表现 ,白细胞以降低和正常为主 ,肺部病变以右肺和双肺为主     

Clinical and imaging findings in patients with severe acute respiratory syndrome

Objective To investigate the clinical and imaging characteristics of severe acute respiratory syndrome(SARS), and to study their relationship.Methods Forty-six SARS confirmed patients were admitted to our hospital from February to April,2003. X-ray examination documents were available in all cases and chest CT scanning was acquired in 6 cases, which were analyzed retrospectively, accompanied by their clinical features.Results Fever was found in 97. 8% of the patients. Clinical symptoms were mild, but X-ray and CT findings were distinct. CT scanning demonstrated ground glass like lesions and large patchy exudation and consolidation at the early stage in 6 cases. Different findings on radiography and CT were related to the different phases of the disease. After treatment, most lesions were absorbed completely, but slowly in patients with multi-lobe consolidation and/or extensive interstitial infiltration.Conclusion Special clinical and imaging findings could be found in SARS cases. The prognosis of SARS patients is related to the degree of lesions detected by radiography and CT.     

河南省传染性非典型肺炎病例临床分析

目的 :分析河南省传染性非典型肺炎 (SARS)的临床特点 ,并对其诊断和治疗方法进行探讨。方法 :对2 0 0 3年 4月至 2 0 0 3年 6月河南省收治的 1 5例SARS患者的症状、体征、实验室检查、影像学资料及治疗进行回顾性分析。结果 :1 5例传染性非典型肺炎患者男 :女为 1 :1 .5 ,年龄 2 0～ 5 3岁 , x±s(34.4± 9.9)岁。有明确流行病学接触史 1 1例 (73.3% )。潜伏期 4～ 1 0d , x±s(6 .6± 1 .7)d。主要症状包括 :发热 1 5例 (1 0 0 % ) ,乏力 1 3例 (87.6 % ) ,咳嗽 1 2例 (80 % ) ,呼吸困难 1 0例 (6 6 .7% ) ,畏寒或寒颤 5例 (33.3% ) ,咳痰 3例 (2 0 % )。体征包括 :呼吸增快 7例 (4 6 .7% ) ,紫绀 4例 (2 6 .7% )。WBC >1 0 .0× 1 0 9L-1 2例 (1 3.3% ) ,(4 .0～ 1 0 .0 )× 1 0 9L-1 1 1例 (73.4 % ) ,<4 .0× 1 0 9L-12例 (1 3.3% ) ,淋巴细胞计数≤ 1 .0× 1 0 9L-1 9例 (6 0 % ) ,(1 .0～ 2 .0 )× 1 0 9L-1 3例 (2 0 % ) ,>2 .0× 1 0 9L-1 3例(2 0 % )。首次胸部X线片示病变累及双侧肺叶 9例 (6 0 % )、单侧多叶 6例 (4 0 % ) ,病变发展到高峰时间 4～ 1 4d , x±s(7.7± 3.2 )d、病变开始吸收时间 6～ 2 1d , x±s(1 1 .3± 4 .1 )d、病变完全或基本吸收时间 8～ 2 6d , x±s(1 6 .4± 5 .0 )