四川省危重型新型冠状病毒肺炎3例死亡病例分析

目的分析危重型新型冠状病毒肺炎死亡病例的临床特征,提高对重症病例诊治的认识。方法收集2020年1月—5月成都市公共卫生临床医疗中心接诊的危重型新型冠状病毒肺炎死亡病例资料,回顾性分析其临床资料和影像学特征。结果 3例危重型COVID-19死亡病例均有冠心病、伴或不伴肺部疾病、肾功能障碍等基础疾病,均有发热、咳嗽、咳痰症状,入院APACHEⅡ评分和PSI评分均为高危,实验室检查结果提示肌酸激酶、肌钙蛋白、脑钠肽、C-反应蛋白及血清淀粉样蛋白A明显升高,而T淋巴细胞计数明显下降,胸部影像学提示双肺磨玻璃斑片影。入院后给予积极的抗病毒、抗细菌、增强免疫治疗及有创机械通气呼吸支持。3例患者均并发脓毒性休克及多器官功能衰竭综合征等严重并发症,起病到死亡的平均时间为13.7 d。结论高龄、合并心脏病等基础疾病、免疫功能低下者是危重型新型冠状病毒肺炎死亡的高危人群。

Analysis of 3 death cases of critical COVID-19 in Sichuan

Objective To analyze the clinical characteristics of critical COVID-19,and we improve the understanding of the diagnosis and treatment of severe cases.Methods Death cases with critical COVID-19 in Public Health Clinical Medical Center of Chengdu from January to May 2020 were collected,and their clinical data and imaging features were retrospectively analyzed.Results The three cases of severe type COVID - 19 deaths,all have basic diseases,such as coronary heart disease,with or without lung diseases,renal disfunction ,they all have symptoms of fever,cough,sputum.Athospital admission,APACHE Ⅱscore and PSI rating were high-risk,laboratory examination results suggested lactate dehydrogenase,creatine kinase,troponin,brain natriuretic peptide,C- reactive protein and serum amyloid A were significantly increased,and T lymphocyte count droped apparently,chest imaging suggested pulmonary grinding glass patch shadow.After admission,the patients were given active antiviral,anti-bacterial,immunological and invasive mechanical ventilation support.All 3 patients had severe complications such as septic shock and multiple organ failure syndrome,and the average time from onset to death was 13.7 days.Conclusions Old-age people combined with heart disease and other basic diseases,and immunodeficiency are the high-risk groups of critical COVID-19.