发热、胸部X线改变与SARS鉴别诊断的研究

目的 探讨严重急性呼吸综合征(SARS)与其他肺部疾病的相同点和不同点，包括临床表现，胸部X显影像、实验室检查、诊断及鉴别诊断等特点。方法 对我院发热门诊接诊的440例发热患者的临床表现，X线胸片及实际室资料进行回顾性分析。结果 除1例患者与SARS患者有接触史，其他患者无SARS接触史，全部患者以发热为首发症状(100％)，伴有干咳(77．0％)，气促(34．0％)；无腹泻；高热患者均有胸部X线改变，多数累及单肺，肺部体征与脑部X线表现多数一致；治疗以综合治疗为主，99．8％的患者经使用抗菌药物、抗病毒药物、糖皮质激素有明显疗效。结论 SARS传染性极强，有一定的病死率，以发热为首发症状，对有胸部X线改变的患者需要认真分析、细致研究、仔细鉴别，才能不误诊，不漏诊。

Fever, change of x-ray and diagnosis of SARS

Objective To probe into the similarities and differences between severe acute resporatory syndrome(SARS) and other lung diseases in terms of clinic symptoms,the x-ray images in chest,laboratory examination,diagnoses and differential identification and so on.Methods The blood routine examination and X-ray in chest of all patients were examined and the suspect SARS patients were re-examined in 24 hours.The clinic information of 440 fever patients in our hospital was detailedly described.Results Only one of them had ever contacted SARS infected patients.All the other patients had the same first symptom of fever(100%), 77.0 percent accompanied with hacking cough,and 34.0 percent with hurry breath,none had been affected by SARS or diarrhea.The x-ray of chest changed in all the high fever patients,and most of them had one infected lung.The lung symptoms were consistent with x-ray of the brain.Treated by the integrated therapy method,such as antibacterial,antiviral medicines and glucocorticoids,99.8 percent of the patients had an apparent curative effect.Conclusion SARS has strong infectivity and can cause a certain dead rate,but not all the patients who had the first symptoms of fever and the x-ray change in chest are definitely infected by SARS.Therefore,it is very important and necessary for doctors to earnestly analyze,carefully diagnose and differentiate in order not to make any mistake in the judgment.