传染性非典型肺炎的临床诊断与治疗

目的 总结传染性非典型肺炎(SARS)的临床诊断与治疗经验。方法 对本院收治的2例SARS患，检测SARS病毒RNA，SARS病毒抗体，结合胸部X光片及病史、症状、体征进行综合诊断并给予无创呼吸机、抗生素、甲基强的松、胸腺肽、丙种球蛋白、白蛋白、速尿进行综合治疗。结果 2例SARS患，发病前均有流行病学接触史；发病期唾液、血液中SARS病毒RNA均为阳性；发病后12天，血液中出现SARS抗体IgM，16天出现SARS抗体IgG；SARS病毒可引起肺、心脏、肝脏、骨髓多脏器损伤；患T淋巴细胞CD3^ 、CD4^ 、CD8^ 明显减少；无创伤呼吸机的应用可明显改善患的血氧饱和度和血氧分压；经综合治疗，2例患均痊愈。结论 在对SARS进行诊断和鉴别诊断时，患的流行病学史及病原学检查至关重要；综合治疗是治愈SARS的有效治疗方法。

Study of the clinical diagnosis and treatment of the severe acute respiratory syndromes

Objective To summarize the experience of clinical diagnosis and treatment of SARS cases.Methods Two patients with the severe acute respiratory syndromes(SARS)treated in this hospital were detected for RNA of the coronavirus in blood and gargling liquid with the PCR and antibody of the coronavirus in serum with ELISA,or the quantities and types of T lymphocyte with flow cytometry.A clear cut clinical diagnosis was made based upon the history,symptoms,physical signs and chest x ray films.They were treated by the non invasive breathing machine,antibiotics,betalone,thymus peptide,gamma globulin,albumin and furosemide.Results Both of them had history of exposure to SARS cases before the onset of the disease.Positive results of RNA of the coronavirus in saliva and blood during the attacks.SARS antibody IgM were detected in the serum 16 days after the onset,and SARS antibody IgG were found 16 days after the onset.Multiorgan damage was found in lungs,heart,liver and bone marrow.Levels of T lymphocyte CD 3 +,CD 4 +,CD 8 + were all decreased.The non invasive breathing machine could significantly improve O 2 saturation and partial pressure of O 2.Through the comprehensive treatment both patients recovered completely.Conclusion Investigation of epidemiological history of exposure and detection of disease agent are,among other things,all important in the establishment of diagnosis and differential diagnosis of SARS.Administration of comprehensive therapy is effective in the treatment of SARS.