重症传染性非典型肺炎的治疗及死亡危险因素的分析

目的　探讨重症传染性非典型肺炎 (世界卫生组织又称严重急性呼吸综合征 ,SARS)的治疗方法以及预测死亡的可能危险因素。方法以 2 0 0 2年 12月至 2 0 0 3年 3月临床诊断重症SARS37例患者为对象 ,通过回顾性分析 ,比较 33例应用持续气道内正压的方式进行无创通气前后的呼吸频率和脉搏容积血氧饱和度 (SpO2 ) ,并对其中 18例吸氧 5L/min、安静下SpO2 只有 90 %～ 93%的患者 ,进行无创通气前轻微活动、安静状态及无创通气 1h后SpO2 的比较 ;对年龄、基础疾病、血小板减少、白细胞升高、淋巴细胞减少 5个因素预测死亡的可能危险性采用Mantel Haenszelχ2 检验进行统计学分析。结果　 33例患者无创通气 1h后较通气前呼吸频率明显减慢 (P <0 0 1) ,分别为 (2 9 6±10 0 )次 /min和 (34 6± 8 4 )次 /min ;SpO2 明显提高 (P <0 0 1) ,分别为 (96 1± 2 4 ) %和 (89 9±3 5 ) %。 18例吸氧 5L/min、安静下SpO2 只有 90 %～ 93%的患者 ,轻微活动后SpO2 明显下降 ,无创通气 1h后SpO2 明显提高 ,SpO2 分别为 (91 7± 0 9) %、(88 5± 1 4 ) %和 (96 9± 1 8) % (P均 <0 0 1) ;以血小板减少、年龄 >5 0岁、基础疾病、血白细胞升高、淋巴细胞减少 5个因素预测死亡的可能危险性 ,其相对危险度 (RR )分别为 2

Management of critical severe acute respiratory syndrome and risk factors for death

OBJECTIVE: To investigate the management of critical severe acute respiratory syndrome (SARS) and possible risk factors for death. METHODS: Thirty-three patients with SARS referred to Guangzhou Institute of Respiratory Disease (GIRD) between December 2002 and March 2003 were studied retrospectively. Paired t-test using statistical software SPSS 10.0 was employed to compare the respiratory frequency and pulse O(2) saturation (SpO(2)) before and after noninvasive ventilation with continuous positive airway pressure (CPAP) on the 33 patients. Among them, 18 patients who presented with SpO(2) of 90% - 93% at rest under O(2) inhalation 5 L/min were further recorded for their SpO(2) during slight physical movement and CPAP. The possible death-related risk factors including age, underlying diseases, leucocytosis, thrombocytopenia, and lymphopenia were analyzed by the Mantel-Haenszel chi(2) test. RESULTS: The respiratory frequencies were significantly decreased and SpO(2) was improved in the 33 patients after one hour of noninvasive ventilation. The SpO(2) in the latter 18 patients fell during slight physical movement and improved one hour after CPAP (p < 0.01). The RRs of the five death predictors concerning thrombocytopenia, age (> 50 yrs, underlying diseases, leucocytosis, and lymphopenia were 25.83, 8.57, 6.40, 1.64, and 1.17, respectively, with the 95% CI of 3.64 - 183.59, 1.94 - 37.83, 1.75 - 23.33, 0.38 - 7.05 and 0.16 - 8.48, respectively. Management with corticosteroids effectively ameliorated and suppressed the development of pulmonary fibrosis. CONCLUSIONS: Noninvasive ventilation relieves dyspnea and SpO(2) in patients with critical SARS, and should also be employed in those with SpO(2) of 90% - 93% at rest under O(2) inhalation 5 L/min. Noninvasive as an add-on management may probably cut down on the dosage and duration of corticosteriod therapy. Among 5 possible risk factors, 3 were recognized as death-related, turning out to be thrombocytopenia, age (> 50 yrs) and underlying diseases.