传染性非典型肺炎死亡危险因素分析

目的 分析山西省24例SARS死亡病例临床特征及导致死亡危险因素。方法 对2003-03-07～2003-06-04山西省24例SARS死亡病例的临床资料进行回顾性分析。结果 24例患者男13例(54．2％)，女11例(45．8％)；主要临床表现为发热、咳嗽、畏寒、气促等。实验室检查早期的白细胞计数、淋巴细胞百分比均下降。胸部X线显示肺部斑片状阴影。短期内病灶增多。7d内死亡3例(12．5％)，7～14d死亡11例(45．8％)，14d以上死亡10例(41．7％)。14例(58．3％)病人有基础疾病(共18例基础疾病)，其中4例(22．2％)糖尿病，3例(16．7％)脑血管病，3例(16．7％)心血管病，6例(33．3％)高血压，1例(5．6％)表皮松懈症，1例(5．6％)精神分裂症；7例(38．9％)同时合并2种或2种以上疾病。24例SARS死亡患者中16例死于急性呼吸窘迫综合征(ARDS)(66．7％)，ARDS并发多器官功能障碍综合征(MODS)死亡5例(20．8％)，患者感染SARS后原有基础疾病加重导致死亡3例(12．5％)。多因素分析结果显示年龄大于50岁、缺乏心理治疗、早期淋巴细胞减少为死亡独立危险因素。结论 年龄大于50岁、早期淋巴细胞减少是SARS死亡独立危险因素；心理治疗是保护因素。

Risk factor analysis for death of severe acute respiratory syndrome

Objective To analyze clinical features and risk factors for death in adults with SARS in Shanxi province. Methods Twenty four patients diagnosed with SARS died from March 7 to June 4, 2003 in Shanxi Province were retrospectively analyzed . Results There were 13(54.2%) male patients and 11(45.8%) female patients. The main clinical features were fever, coughing and dyspnea, et al. The amounts of white blood cell and lymphocyte obviously decreased in the early stage. Chest X ray examination revealed the changes related to pneumonia. There were 3 patients (12.5%) died within 7 days, 11 patients (45.8%) died from 7 to 14 days, and 10 over 2 weeks. There were 14 patients (58.3%) had basal diseases, of these, 4 (22.1%) patients with diabetes, 3 (16.7%) patients with cerebrovascular diseases,3 (16.7%) patients with heart disease,6 (33.3%) patients with hypertension, and 7(38.9%) patients with two or more than two diseases. Sixteen of these 24 patients died directly of ARDS, 5 died of MODS, and 3 died of deleterious of basal diseases. Multivariate Logistic analysis demonstrated that the independent risk factors associated with death were age more than 50 years, the early stage lymphopenia and lack of psychological therapy. Conclusion The age more than 50 years and the decrease of lymphopenia at the early stage are the independent risk factors for death of SARS. The psychological therapy is the preventive factor.