19例SARS死亡病例临床分析

为分析严重急性呼吸综合征(SARS)死亡患者的临床特征、治疗及死亡相关因素,对2003年5月6日至6月27日收治的220例SARS患者中19例死亡患者的临床、实验室、影像学资料、临床治疗及死亡相关因素进行回顾性分析。结果19例死亡SARS患者年龄24～86岁,平均(57.63±16.76)岁。大于45岁13例(68.4%)。男性15例(78.9%),女性4例(21.1%)。有明确接触史19例(100%)。并存基础病13例(68.4%)。死亡距发病时间14～54d,平均(35.37±11.66)d。临床表现主要有发热19例(100%),咳嗽12例(63.2%),畏寒5例(26.3%),气促10例(52.6%),胸闷11例(57.9%),肌痛5例(26.3%),腹泻6例(31.6%)。实验室检查血常规中早期白细胞总数正常或降低,淋巴细胞降低。血气分析低氧血症16例(84.2%);心肌酶肌酸激酶心肌型同工酶(CKMB)、乳酸脱氢酶(LDH)、α羟丁酸脱氢酶(HBDH)随病情的严重程度而进行性升高。T细胞亚群CD3、CD4、CD8绝对值随病情的严重程度而进行性降低。胸部X线双侧、肺病变面积>1/3者19例(100%)。临床诊断继发混合感染(细菌、真菌)19例(100%)。采用综合治疗,其中激素18例(94.7%)、机械通气15例(78.9%)。死于呼吸衰竭18例(94.7%)。提示年龄、合并基础病、肺部病变程度、低氧血症、T细胞亚群CD3、CD4绝对值降低、激素剂量、混合感染等是影响S

Retrospective Case Study of Death of 19 SARS Patients

The objective was to analyze clinical features,treatment of severe respiratory syndrome(SARS),and correlated factors for the death in SARS patients.Methods:Clinical data of19deaths were chosen from 220 SARS patients admitted from May.6,2003 to Jun.27,2003 in Xuan Wu Hospital.Retrospective analysis was based on clinical manifestations,laboratory findings,radiological findings,treatment and other factors related to death.Result:The 19 deaths all had clear contact history,and were aged from 24 to 86 years(57.63±16.76)years old in average.Among them 13 cases were over 45 years old(68.4%),15 were males(78.9%)and 4 females(21.1%).13cases had underlying diseases.Death occurred after14～25days〔averaged(35.37±11.66)d〕.Clinical features were fever(19cases,100%),cough(12cases,63.2%),fear of coldness(5cases,26.3%),breathing difficulties(10cases,52.6%),chest discomfort(11cases,57.9%),myalgia(5cases,26.3%)and diarrhea(6cases,31.6%).Laboratory findings:lymphopenia and normal or decreased blood white cell count were found in the early phases of SARS.Blood gas analysis:hypoxaemia in 16 cases(84.2%);Myocardial enzymes(CK-MB,LDH and HBDH)showed ongoing rise paralled with the development of disease while Tcell subgroups(CD₃,CD₄ and CD₈ )dropped continually.Chest X-ray:bilateral pathological changes over1/3in lung field were found in 19 cases(100%).Clinical diagnosis:secondary combined infection(bacterial and/or fungal)was found in 19 cases(100%).Patients were treated with combined therapies,such as corticosteroids(applied in 18 cases,94.7%)and assisted ventilation(in 15 cases,78.9%).18cases died of respiratory failure(94.7%).Conclusion:Age,underlying disease,the extent of lung pathological changes,hypoxaemia,the absolute value drop in Tcell subgroups(CD₃,CD₄ ),corticosteroids dosage and combined infection are important factors for the prognosis of SARS.The rational and normal use of corticosteroids and antibiotics,proper use of assisted ventilation are significant to the decrease of SARS mortality.