41例老年严重急性呼吸综合征患者的临床特点和治疗分析

为分析老年严重急性呼吸综合征(SARS)患者的临床特点、治疗和转归,以提高治愈率。对我院2003年5月6日至6月27日收治的41例老年SARS患者的临床资料进行分析,并与同期住院的非老年SARS患者进行对比。结果老年SARS患者以发热为首发症状,以中等度热为主,高热、畏寒、寒战的发生率明显低于非老年SARS患者(P<0.05);老年SARS患者血淋巴细胞降低的发生率及T淋巴细胞亚群的水平明显低于非老年SARS患者(P<0.05);老年SARS患者血清白蛋白明显低于非老年SARS患者(P<0.01);老年SARS患者肺部体征的阳性率高,肺部X线胸片表现双侧多发病变的发生率明显多于非老年SARS患者(P<0.01);老年SARS患者治疗中并发精神障碍、二重感染的发生率明显多于非老年SARS患者,老年SARS患者并存基础病和并发症的发生率明显高于非老年SARS患者(P<0.01);病死率老年SARS患者为24.4%,显著的高于非老年SARS患者的5.5%(P<0.01)。提示我院收治的老年SARS患者临床以发热为首发症状,高热的发生率低,肺部表现以双侧多发病变多见,细胞免疫功能减低,临床分型重型和极重型比例高,并存基础病、并发症数量多,治疗复杂困难,病死率高。

Clinical Characteristics and Therapeutic Analysis of 41 Old-Aged SARS Patients

The objective was to analyze the medical records,clinical characteristics,treatment and outcomes old-aged SARS patients,and try to improve the diagnosis and curative ratio of SARS.Clinical records of41old-aged SARS patients who were admitted to Xuanwu Hospital from May6to June27in the year of2003were analyzed,and the data obtained were compared with those of164non-aged SARS patients who were admitted to the same hospital in the same period.Results:From the observation of the old-aged SARS patients,they were found more frequently having moderate fever(P<0.05),with the main manifestations of SARS,such as high fever,fear of coldness and chills,occurred less commonly than those of the non-aged SARS patients(P<0.05).The incidence ratio of lymphopenia and the level of T lymphocyte subgroups were obviously lower than the non-aged group(P<0.05).The serum albumin level of old-aged SARS patients was also evidently lower than the non-aged group(P<0.01).Chest X-ray showed that the bilateral multi-pathological changes occurredmore frequently than those in the non-aged group(P<0.01).The simultaneously occurred underlying diseases and complications occurredmore frequently than those of the non-aged SARS patients(P<0.01).Complicated mental disturbance and dual infection were more commonin the old-aged SARS patients than the non-aged SARS patients(P<0.01).The death rate of the old-aged SARS patients was24.4%which was remarkably higher than that of the non-aged SARS patients(5.5%,P<0.01).Conclusion:The old-aged SARS patients admitted to Xuanwu Hospital showed a lower occurrance of high fever which is one of the main symptoms among SARS patients;They usually expressed multi-pathological lesions bilaterally in their lunge and a decrease of cellular immunity.They also showed a higher distribution in heary severe and extremely severe SARS.More simultaneously occurred underlying disease and complications were found in the old-aged SARS patients,which means more difficulties in the treatment of SARS and higher mortality.