严重急性呼吸综合征的临床特征

目的：探讨严重急性呼吸综合征(SARS)的临床特征，以便早期诊断SARS，避免SARS的传播。方法：用回顾性方法对64例SARS病例的临床资料进行总结。结果：有密切接触史45例(70．3％)，发热为早期主要表现者58例(90．6％)。以X线胸片改变为首要表现6例(9．4％)。早期发热特征为体温逐渐升高，不伴寒战。咳嗽症状一般轻微，为干咳，不伴有流泪鼻塞，打喷嚏等卡它症状。咳嗽轻与X线胸片改变明显不成比例，肺部体征少而轻与X线胸片改变明显不成比例。X线胸片最终呈双肺病变者57例(89．1％)。白细胞减低(26．5％)或正常，淋巴细胞分类降低(73．9％)，PLT下降(29．7％)。血沉可增快(40％)。多脏器损伤多见，心肌酶增高者50例(78％)。IgG类抗体1周内检测阳性率低(14．3％)，1周后阳性率逐渐升高。IgM类抗体更敏感。结论：SARS临床表现多样化，但有其特征性。     

225例严重急性呼吸综合征临床诊断病例临床特点分析

目的:观察SARS患者临床表现变化规律并寻找早期诊断线索.方法:收集2所收治SARS病例医院的225名患者的临床病历资料进行回顾性分析,包括发病-住院时间、症状、白细胞和中性粒细胞、X线等资料.结果:225名患者中男性121名,女性104名,患者年龄基本一致,平均入院时间为7.45 d.住院前症状与首发症状中发热出现比例分别为99.11%和97.33%,住院前咳嗽和胸闷症状出现的比例显著高于首发症状(P<0.05);白细胞总数和中性粒细胞比例在病程0～8 d明显低于病程9～14 d(P<0.05);胸部X线在发病3 d后有96.0%～100.0%的病例出现异常.结论:利用患者的临床症状、白细胞、中性粒细胞和X线的动态变化规律可为SARS早期诊断提供线索.     

190例严重急性呼吸综合征疑似病例结果分析

目的探讨SARS疑似病例的临床诊断依据,以提高SARS临床诊断的准确率.方法对190例SARS疑似病例的流行病学、体温、外周血白细胞计数、胸片结果及抗生素治疗效果,进行回顾性分析.结果临床诊断SARS流行病学史极为重要,而临床症状、外周血白细胞计数、胸部X线征象及抗生素治疗效果,在临床诊断SARS中仅具有辅助诊断价值.结论流行病学史在临床诊断SARS中至关重要.     

严重急性呼吸综合征

自2002年11月从广东开始出现的非典型肺炎已蔓延到了全球30多国家和地区、国内20多个省市，给人民群众的健康和生命带来了极大的威胁和危害。2003年3月15日WHO向全球发布了“非典”的疫情警报。     

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     

上海地区严重急性呼吸综合征病例的临床特征、影像学动态演变和治疗转归

目的　总结上海地区严重急性呼吸综合征 (SARS)临床诊断病例的临床特征、胸部影像学动态变化和诊治体会。方法　对 2 0 0 3年 3～ 6月上海地区收治的 8例SARS患者的疾病病程、临床诊断及治疗进行回顾性分析。结果　上海地区SARS患者以输入性为主 ,8例患者中 4例年龄 >5 0岁。均以发热为首发症状 ,伴咳嗽、呼吸加速和呼吸困难等。T细胞免疫亚群检测CD3、CD4和CD8下降。胸部影像学显示肺部病灶进行性扩大 ,以双侧片状阴影改变为主。 7例重症病例应用糖皮质激素和BiPAP面罩辅助机械通气 ,2例死亡。结论　上海地区SARS患者病情重 ,胸部影像学病灶出现早、变化快 ,重症病例有呼吸困难者需尽早应用糖皮质激素和机械通气支持等综合治疗     

严重急性呼吸综合征轻型和重型病例的临床比较

目的：寻找较为敏感的严重急性呼吸综合征(SARS)的临床症状指标，以便于临床及时观察病情以及对SARS患者的及早处理。方法：收集24例SARS轻型患者的临床症状资料，并与已报道的较重的SARS患者的临床症状相比较。结果：SARS轻型患者与较重患者在临床表现上存在很大不同，尤其是呼吸困难的出现，前者仅为4．2％，后者报道有74．4％。轻型患者发热、肌酸肌痛乏力、咳嗽、咳痰的发生率分别为100％(24／24)、79．1％(19／24)、29．7％(7／24)、20．8％(5／24)，重型患者分别为100％(83／83)、38．6％(32／83)、83．1％(69／83)、55．4％(46／83)。结论：对于SARS的病情判断，临床表现仍是一个重要的观察因素，特别是呼吸困难的出现。     

严重急性呼吸综合征134例死亡病例特征分析

目的:分析严重急性呼吸综合征死亡病例的特征,为早期诊断和治疗该疾病提供参考.方法:收集某市SARS死亡病例134例和同期临床诊断病例2 522例的资料,如发病-死亡时间、性别、年龄、临床症状等进行计算和比较.结果:死亡病例中男性74例,女性60例.患者从发病到死亡的时间中位数为11 d.随着年龄的增大,病死率增高.死亡病例中,31～50岁者占28.36%,51岁以上者占66.41%.死亡病例早期症状中咳痰、胸闷、呼吸困难和气促出现比例较高.结论:发病后11 d是SARS病例死亡的高峰;51岁以上人群是患者死亡的高危人群;早期呼吸道症状在死亡病例中的出现比例较高.     

40例严重急性呼吸综合征的临床特点

回顾性分析我院及我院医务人员在北京酒仙桥医院收治的40例严重急性呼吸综合征(severe acute respiratory syndrome,SARS)患者临床资料。 1.资料与方法:40例均为4月6日～5月12日收治的发热患者,根据WHO的诊断标准确诊为SARS。 (1)一般情况:40例中男23例,女17例,男∶女为1.35∶1,年龄最小18岁,最大76岁,平均年龄(38±15)岁。职业:医务人员7人(17.5％),学生及教师6人(15.0％),服务人员4人(10.0％),工人6人(15.0％),其他17人(占42.5％)。     

重症急性呼吸综合征临床特点分析

目的了解本地区重症急性呼吸综合症(severe acute respiratory syndrome,SARS)的临床特点及治疗和预后.方法回顾性分析广东省佛山市第一人民医院2002年11月～2003年2月收治的16例SARS病人的临床资料,分为普通型、重症两组.结果本组病例年龄在20～57岁,男9例,女7例,青壮年为主,44%为医护人员.潜伏期平均为6.7±3.4天.重症7例,占44%.重症SARS较普通型肺部病灶发现晚,发热持续时间长,多累及双肺,易并发急性呼吸窘迫综合症(ARDS),多器官功能损害.重症患者采用早期氧疗,充分镇静及抗病毒,抗细菌感染,激素,增强免疫功能等综合治疗.结论重症SARS患者临床表现严重,但经过积极综合治疗,及早氧疗、采取"肺保护性策略"人工通气,预防和处理好并发症,是可以治愈的.     

Misdiagnostic analysis of clinically diagnosed severe acute respiratory syndrome after following up 197 convalescent patients

The severe acute respiratory syndrome （SARS） is an emerging and highly contagious infection caused by a newly discovered strain of coronavirus. Since the clinical case definition of SARS is similar to other severe atypical pneumonias, specific laboratory tests that can accurately diagnose SARS-associated coronavirus （SARS-CoV） infection are important. However, published data are insufficient to investigate whether clinically diagnosed SARS patients may include some non-SARS pneumonia. Therefore, we aimed to determine clinical and laboratory features to differentiate SARS patients from non-SARS pneumonias that could reduce misdiagnosis of SARS. A retrospective analysis of clinical and laboratory characteristics after the initial onset of SARS, as well as its convalescent-phase, was examined from clinically diagnosed 197 SARS patients.     

A hospital outbreak of severe acute respiratory syndrome in Guangzhou, China

Objective To describe a hospital outbreak of severe acute respiratory syndrome (SARS) and summarize its clinical features and therapeutic approaches.Methods The outbreak started with a SARS patient from the community, and a total of 96 people (76 women and 20 men, mean age (29.5±10.3) years, 93.8% of whom were health care workers) who had exposure to this source patient became infected in a short time. Clinical data in this cohort were collected prospectively as they were identified.Results (1) The incubation period ranged from 1 to 20 (mean: 5.9±3.5) days. The duration of hospitalization was （17.2±8.0） days. (2) The initial temperature was （38.3±0.6）℃, while the highest was （39.2±0.6）℃ (P&lt;0.001), with fever duration of （9.0±4.2） days. (3) Other most common symptoms included fatigue (93.8%), cough (85.4%), mild sputum production (66.7%), chills (55.2%), headache (39.6%), general malaise (35.4%) and myalgia (21.9%). (4) The radiographic changes were predominantly bilateral in the middle or lower lung zones. The number of affected lung fields was 1.2±0.8 on presentation, which increased to 2.9±1.4 after admission (P&lt;0.001). The interval from the beginning of fever to the onset of abnormal chest radiographs was （3.5±2.3） days, which increased in size, extent, and severity to the maximum （6.7±3.5） days later. The time before the lung opacities were basically absorbed was （14.9±7.8） days. (5) Leukopenia was observed in 67.7% of this cohort. The time between the onset of fever and leukopenia was （4.4±2.3） days, with the lowest white blood cell count of （2.80±0.72）×10(9)/L. (6) The lowest arterial oxygen saturation was （94.8±3.1）% with supplementary oxygen. (7) Antibiotical therapies included tetracyclines (91.0%), aminoglycosides (83.3%), quinolones (79.2%); 18.8% of the patients received a combination of tetracyclines and aminoglycosides, while 11.5% received a combination of tetracyclines and quinolones, and 63.5% received a combination of tetracyclines, aminoglycosides and quinolones. Vancomycin was used in 13.5% of the patients. (8) 68.8% of the patients were treated with methylprednisolones for a mean interval of （4.9±2.4） days. The initial dose was （67.3±28.2） mg/d and the maximal dose was （82.4±30.5） mg/d. (9) Human γ-globulin, interferon-α, antiviral drugs (oral ribavirin or oseltamivir) were used respectively in 68.6%, 46.9% and 92.7% of the patients. (10) Ninety-five patients (99.0%) had a complete clinical recovery, and only 1 patient (1.0%) died.Conclusions SARS appears to be quickly infectious and potentially lethal among health care workers, characterized by acute onset and rapid progression, and mostly bilateral lung involvement on chest radiographs. Proper administration of glucocorticosteroids seems to be of some benefits. Antibiotics, human γ-globulin, interferon-α, and antiviral drugs, although empirically, might be useful to shorten the clinical course. Chin Med J 2003; 116(6):811-818     

传染性非典型肺炎的临床诊断和治疗

目的 :探讨传染性非典型肺炎 (SARS)的临床诊断和治疗 ,以提高对本病的治愈率和降低死亡率。方法 :根据诊断SARS的临床实践和体会 ,参考相关资料 ,综合评价本病的早期诊断和治疗。结果 :SARS由冠状病毒引起 ,患者主要有发热 (体温常 >38 0℃ )、畏寒、头痛、干咳、胸闷气短、呼吸困难等临床症状 ,肺部体征不明显或仅有少量湿性音 ;外周血白细胞正常或降低 ,或伴血小板降低 ;胸部X线或CT检查可见多叶或双侧肺异常阴影 ;单纯用抗生素治疗无效。早期应用糖皮质激素、利巴韦林、氧疗、无创机械通气、对症支持、中医中药及抗生素等综合治疗措施治疗 ,效果令人满意。结论 :SARS由冠状病毒引起 ,诊断主要依据流行病学和临床综合资料 ,积极有效的内科综合治疗可提高SARS治愈率、降低其病死率。     

传染性非典型肺炎的临床X线表现分析--附32例报告

目的：探讨传染性非典型肺炎的临床及X线表现特征，提高对本病的认识。方法：依据广东省传染性非典型肺炎诊断标准，总结经临床及X线诊断的传染性非典型肺炎32例，分析其临床、X线表现特征。结果：32例均有发热，21例干咳，13例有全身酸痛、乏力，4例患以发热，腹痛、腹泻为主要症状；29例血白细胞正常或降低。胸片表现可分为三期：即肺间质性炎变期(25例)，肺实变期(32例)、吸收消散期(转归期)。结论：本病具有一定的临床特点，综合：分析X线表现和实验室检查，可作出传染性非典型肺炎的诊断。     

Pathogenesis of severe acute respiratory syndrome

Severe acute respiratory syndrome （SARS） first emerged in Guangdong province, China in November 2002. During the following 3 months, it spread rapidly across the world, resulting in approximately 800 deaths. In 2004, subsequent sporadic cases emerged in Singapore and China. A novel coronavirus, SARS-CoV, was identified as the etiological agent of SARS.1＇2 This virus belongs to a family of large, positive, single-stranded RNA viruses. Nevertheless, genomic characterization shows that the SARS-CoV is only moderately related to other known coronaviruses.3 In contrast with previously described coronaviruses, SARS-CoV infection typically causes severe symptoms related to the lower respiratory tract. The SARS-CoV genome includes 14 putative open reading frames encoding 28 potential proteins, and the functions of many of these proteins are not known.4 A number of complete and partial autopsies of SARS patients have been reported since the first outbreak in 2003. The predominant pathological finding in these cases was diffuse alveolar damage （DAD）, This severe pulmonary injury of SARS patients is caused both by5 direct viral effects and immunopathogenetic factors, Many important aspects of the pathogenesis of SARS have not yet been fully clarified. In this article, we summarize the most important mechanisms involved in the complex pathogenesis of SARS, including clinical characters, host and receptors, immune system response and genetic factors.