新型冠状病毒肺炎危重型患者临床特征及早期肺外器官功能变化

目的 分析新型冠状病毒肺炎(COVID-19)危重型患者的临床特征及早期肺外器官功能损伤特点,总结临床诊疗经验.方法 对我院2020年1月21日至3月15日收治的15例COVID-19危重型患者的临床资料,实验室检查及胸部影像学资料进行回顾性.结果 分析15例COVID-19危重型患者平均年龄(64±13)岁,男性12...

Clinical features and early extra-pulmonary organ changes in patients with new corona virus pneumonia

Objective To analyze the clinical features and early damage of extra-pulmonary organ in patients with new corona virus pneumonia(COVID-19),and to summarize clinical diagnosis and treatment experience. Methods The clinical data,laboratory tests and chest imaging data of 15 patients with COVID-19 critically ill treated in our hospital from January 21 to March 15,2020 were retrospectively analyzed. Results The average age of 15 critically ill patients with COVID-19 was(64 ±13) years,12 were males,the male to female ratio was 4 ∶1,46.7% have a history of hypertension,14 had a clear epidemiological history,and 6 were family cluster cases. Patients with fever,dry cough,and fatigue are the main symptoms,and some may have symptoms such as shortness of breath,muscle aches,and diarrhea.15 critically ill patients were admitted to the hospital as non-critical cases. The average time from onset to critical illness was(12.3± 5.9)days. Of these,the positive rate of new corona virus acid detection in blood accounted for 62.5%(5/8),66.7%(10/15) of chest CT were multiple lung lesions,mostly irregular or flaky ground glass density. The biochemical index value within 48 hours after the disease progressed to critical illness was significantly higher than that within 48 hours after admission,including procalcitonin(0.139(0.144,1.310) ng/mL vs 0.138(0.110,1.098) ng/mL],C-reactive protein(82±38)mg/L vs(45±34)mg/L],white blood cells(11.6±3.5)×109/L vs(6.6±2.5)×109/L],neutral Granulo-cytes(10.7±3.4)% vs(5.1±2.6)%],lactate dehydrogenase 521(291,649)U/L vs 255(151,463)U/L],troponin0.033(0.013,0.109) μg/L vs 0.011(0.005,0.210) μg/L],urea (11.0 ±7.1) g/L vs(7.8 ±4.7) g/L],D-dimer5 890(3 060,16 880)ng vs 1 270(850,1 740)ng];and lymphocytes(0.53±0.20)%和(1.05±0.72)%],oxygenation index(100±12) mmHg vs(268±82) mmHg]and other indicators decreased significantly within 48 hours after admission,the differences were statistically significant(P<0.05). The treatment mainly consisted of oxygen therapy,anti-virus,antisecondary infection,immune regulation,and intestinal microecology. 13 patients were eventually discharged,1 patient maintained dialysis,and 1 died. Conclusion Elderly male patients with hypertension are a high-risk group of COVID-19 critically ill patients. In the early stage of critically ill patients are mainly lung lesions,and extra-pulmonary organ damage is mostly not serious. Clinicians should not be taken lightly because of the damage to the extra-pulmonary organ.