严重急性呼吸综合征62例临床分析

目的分析严重急性呼吸综合征(SARS)患者的临床特点,加深对临床诊断标准的认识,进一步总结和探讨其治疗方法。方法对62例SARS患者的临床、实验室、影像学资料进行回顾性分析。结果36例(58.1%)有密切接触SARS患者的历史。死亡7例,病死率11.3%;55例痊愈出院。年龄14~68岁,平均(36±15)岁。发热98.4%、咽痛11.3%、胸闷气紧58.1%、咳嗽85.5%、湿口罗音24.2%。死亡的7例患者在其病程中都有白细胞和淋巴细胞计数的减低,有6例在疾病早期和进展期白细胞计数减低,死亡时白细胞计数升高,有1例白细胞计数先减低,后升高,死亡时又减低;有5例在其病程中淋巴细胞计数始终低于正常值,有2例在疾病早期和进展期淋巴细胞计数减低,死亡时淋巴细胞计数升高。胸部X线和/或CT显示:肺部斑片状阴影,短期内病灶增多,累计单侧18例(29.0%),双侧44例(71.0%)。61例(98.4%)应用甲泼尼龙,剂量40~750 mg/d,疗程(21±10)d;54例(87.1%)应用了氧疗,其中给予无创机械通气的有9例(3例存活,4例死亡,2例转为有创机械通气后亦死亡),给予有创机械通气的有3例(均死亡)。结论流行病学史,发热,X线肺炎表现及白细胞、淋巴细胞计数的正常或减少可以作为诊断本病的临床依据,且密切接触患者,白细胞和淋巴细胞计数的减少与患者的病情、预后有一定的相关性,患者对激素的敏感性、氧疗及综合支持治疗措施对减低本病的病死率有重要意义。

Clinical analysis of 62 patients with severe acute respiratory syndrome

Objective To summarize and analyze the clinical characteristics and the treatment method of patients with severe acute respiratory syndrome(SARS).Method A total of 62 clinically diagnosed SARS patients were enrolled.The data reviewed included clinical,laboratory and roentgenologic manifestations.Results Of the 62 patients,36 had closely exposed to SARS patients,7 were dead(case-mortality 11.3%),and 55 were cured.The patients aged 14～68(36±15) years.Clinical symptoms of these patients were fever(98.4%),dyspnea(58.1%),and coughing(85.5%).The laboratory test showed 7 dead patients with leukopenia and lymphopenia.Chest X-ray and CT scanning revealed changes related to pneumonia.In the treatment,cortiscosteroids were used in 61(98.4%)patients,and oxygen used in 54(87.1%).Conclusion A history of close contact,fever,X-ray sign of pneumonia and normal or lowered WBC counts are favorable for the diagnosis of SARS.Close exposure to SARS patients,leukopenia and lymphopenia are correlated with prognosis.The sensitivity to cortiscosteroids,oxygen and comprehensive supportive management are important for decreasing the case-mortality of patients with SARS.