老年SARS患者的临床诊断、治疗及预后分析

目的了解老年严重急性呼吸综合征(severeacuterespiratorysyndrome,SARS)患者的临床特点、治疗方法及预后。方法回顾性分析北京协和医院2003年3月～5月的老年SARS患者的临床资料,并以同时期非老年SARS患者为对照。结果临床资料完整的老年SARS患者共24例,非老年SARS53例为对照。老年组合并高血压、糖尿病等基础疾病高于对照组,出现咳嗽、咯痰、呼吸困难的比例高于对照组(P<0.05)。老年组合并呼吸衰竭占50%,对照组仅为7.5%,两组相比差异有显著性(P<0.05)。血小板减低的比例老年组高于非老年组(P<0.05)。所有患者均接受了利巴韦林和抗菌素治疗,接受三代头孢菌素或亚胺培南治疗的比例老年组高于对照组(P<0.05)。老年组病死率也明显高于非老年组(33.3%vs3.8%,P<0.05)。单因素分析发现,老年、血小板减少、呼吸衰竭是死亡的危险因素,而Logistic回归分析发现,3者均不是死亡的独立危险因素。结论虽然老年SARS患者发病率相对较低,但基础病多,病情相对较重,治疗难度较大,病死率高。

Clinical diagnosis, treatment and prognosis of elderly SARS patients

To discuss the clinical manifestations,therapeutic strategy and prognosis of patients with severe acute respiratory syndrome (SARS)older than60years.Methods Eldly patients diagnosed as SARS in Peking Union Medical College Hospital were compared with younger patients.Results Twenty-four eldly patients and53younger patients were analysed.Eldly patients had more coexisting conditions,such as hypertention,diabetes,coronary heart disease,and renal disease than control group(P<0.05).Rate of respiratory failure in eldly patients was higher than that in control group(P<0.05).Eldly patients had more respiratory symptoms,such as cough,sputum,and shortness of breath(P<0.05).Rate of lymphocytopenia and thrombocytopenia in eldly patients was higher than that in control group.All patients were given ribavirin and antibiotics.More patients in eldly group were given3rd generation cephalosporin and imipenem.Mortality rate in eldly group was higher than that in control group(33.3%vs3.8%,P<0.05).Univariate analysis showed that age,respiratory failure,and thrombocytopenia were risk factors of death,but logistic analysis did not find any independent risk factor.Conclusions Though the eldly patients have a lower morbidity of SARS,they have more coexisting conditions.The therapy of eldly patients is more difficult than that of control group,and the mortality in eldly patients is high.