医院聚集性感染的重症急性呼吸综合征96例临床分析

目的　初步探讨重症急性呼吸综合征 (SARS)的流行规律、发病特点、临床特征、治疗及预防。方法　分析我院聚集性感染的SARS患者的临床资料。结果　SARS患者 96例 ,男 2 0例 ,女76例 ,年龄 16～ 6 2岁 ,其中医务人员 90例 ,占 93 8% ,均受感染于同一社区患者 ,同期发病。潜伏期1～ 2 0d ;初始体温 (38 3± 0 6 )℃ ,最高体温 (39 2± 0 6 )℃ ;持续发热 (9 0± 4 2 )d。主要症状有乏力、咳嗽、少量咳痰、畏寒、头痛、全身酸痛、肌痛。X线胸片显示肺部病变以双侧、中下肺野为主。6 7 7%患者外周血白细胞计数减少。鼻导管吸氧状态下最低脉搏血氧饱和度为 (94 8± 3 1) %。6 8 8%患者使用甲泼尼龙 ,初始剂量为 (6 7 3± 2 8 2 )mg/d ,最大剂量为 (82 4± 30 5 )mg/d ,持续使用时间 (4 9± 2 4 )d。痊愈出院 95例 (99 0 % ) ,住院时间 8～ 4 7d。结论　SARS发病可呈医院聚集性 ,起病急 ,进展迅速 ,X线胸片显示以双侧肺部受累为主 ,适时使用包括糖皮质激素、抗生素、丙种球蛋白、α 干扰素、抗病毒药物等在内的综合治疗可能有助于减轻病情或缩短病程。

Clinical features of 96 patients with severe acute respiratory syndrome from a hospital outbreak

OBJECTIVE: To describe a hospital outbreak of severe acute respiratory syndrome (SARS) and summarize the clinical features and therapeutic approaches. METHODS: Clinical data in this cohort were collected prospectively as they were identified. RESULTS: The outbreak started with a SARS patient from the community on 30 January 2003, followed by a total of 96 people [76 women and 20 men; mean age (29.5 +/- 10.3) years; 93.8% of whom were health care workers] infected in a short period of time after their exposure to this source patient. The incubation period ranged from 1 to 20 days, with a mean of (5.9 +/- 3.5) days. The initial temperature was (38.3 +/- 0.6) degrees C, while the highest was (39.2 +/- 0.6) degrees C (P < 0.001), with a mean fever duration of (9.0 +/- 4.2) days. Other common symptoms included fatigue, cough, mild sputum production, chills, headache, general malaise and myalgia. The radiographic changes were predominantly bilateral and in the middle or lower lung zones. Leukopenia was observed in 67.7% of this cohort. The mean lowest oxygen saturation was (94.8 +/- 3.1)% with supplementary oxygen through a nasal cannula. 68.8% of the patients were treated with methylprednisolone for a mean period l of (4.9 +/- 2.4) days. The initial dose was (67.3 +/- 28.2) mg/d and the maximal dose was (82.4 +/- 30.5) mg/d. Ninety-five patients (99.0%) had a complete clinical recovery, and 1 patient died of progressive acute respiratory distress syndrome. The mean hospitalized duration was (17.2 +/- 8.0) days. CONCLUSION: SARS appears to be highly contagious and potentially lethal among health care workers, characterized by acute onset and rapid progression. Corticosteroids, antibiotics, human gamma-globulin, interferon-alpha, and antiviral drugs, although used empirically, might be of some benefits in shortening the clinical course.