6例严重急性呼吸综合征排除诊断分析

目的 探讨对疑诊严重急性呼吸综合征(Severe acute respiratory syndrome，SARS)病例进行鉴别诊断的要点。方法 回顾性总结6例SARS排除诊断病例的临床资料。结果 排除病例无SARS密切接触史，有基础疾病史并出现SARS不能解释的临床表现。中性粒细胞常逐渐升高，用敏感抗菌素后下降。血小板计数无降低。肝酶多为轻度升高。低氧血症少见而易纠正。胸片很少出现ARDS表现。特异性的病原学检测常可提示真正的病原体而除外SARS。结论 细致的问诊和查体，必要的病原学检查以及对病情进展快的病例早期经验性应用较广谱抗生素对于除外SARS诊断非常重要。

Cases Analysis of ruling out of suspected SARS

Objectives To identify the main points on differential diagnosis of suspected SARS cases. Methods 6 SARS-ruled-out cases were summarized retrospectively. Results The SARS-ruled-out cases were lack of close contact history and had some clinical presentations that were not consistent with SARS. Neutrophils often increased and responded well to sensitive antibiotics. Platelets didn't decrease, while liver enzymes usually elevated mildly. Hypoxemia seldom occurred and could be corrected easily. Typical radiographic features of ARDS were rare. Specific microbiological investigations were critically important to make the alternative diagnosis. Conclusions Careful collection of illness history and physical examination, indispensable pathogenic test and the empirical application of broad-spectrum antibiotics to rapidly progressive cases may be helpful to rule out SARS.