77例SARS院内感染患者临床特征分析

目的 :分析严重急性呼吸综合征 (SARS)患者的临床特征及院内感染特征。方法 :总结 2 0 0 3年 4月16日— 5月 2 8日由天津首例输入性 SARS引起 77例院内感染患者的临床特点及救治体会。结果 :77例中男性 2 7例 ,女性 5 0例 ;平均年龄 (37.7± 13.7)岁。所有患者均有明确的接触史 ,潜伏期 1～ 11d;均表现为发热 ,大部分有干咳、呼吸困难、周身不适、头痛及低氧血症 ,胸部查体可以闻及水泡音和爆裂音 ;80 %的患者出现了淋巴细胞减少 ,部分患者出现转氨酶的轻度升高 ,血肌酐水平正常。连续性 X线胸片检查表现为肺部明显的炎症改变。其中 1例死于进行性呼吸衰竭 ,1人自杀。所有的患者自出现症状后均接受了甲基氢化泼尼松及病毒唑治疗 ,治疗时间为 (18.6± 5 .4 ) d;早期均接受了抗生素治疗 ,无明显效果。结论 :以甲基氢化泼尼松和病毒唑为主的综合治疗对 SARS有较好的疗效。

Clinical features of 77 patients with severe acute respiratory syndrome

OBJECTIVE: To analyze the clinical features of the severe acute respiratory syndrome (SARS) and the value for caring of patients suspected of having this disease. METHODS: The data of the clinical presentations and course of disease in 77 epidemiologically linked patients (27 men and 50 women, 15 to 74 years old) in whom SARS was diagnosed after April 16, 2003 in Tianjin, China were summarized. RESULTS: Exposure to ailing patients and occurrence of the disease ranged from minimal to close contact, such as between patient and health care personnel. The incubation period ranged from 1 to 11 days. All patients presented fever, and some of them complained of rigor, dry cough, dyspnea, malaise, headache, and hypoxemia. Physical examination of the chest revealed bubbling rales and dullness on percussion. Lymphopenia was observed in 80% of all patients, and some patients had mildly elevated aminotransferase levels but normal serum creatinine levels. Serial chest radiographs showed progressive inflammatory changes. One patient died of progressive respiratory failure; pathological examination of the lung showed diffuse alveolar damage. One patient died of suicide. There was no evidence of infection by Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumophila. All patients received corticosteroid and ribavirin therapy for a mean of (18.6+/-5.4) days after the onset of symptoms, and were treated with a combination of beta-lactams and macrolide early for (4.0+/-1.9)days, but with no clinical or radiologic evidences of improvement. CONCLUSION: The combination treatment, especially including corticosteroid and ribavirm, is efficient.