上海地区严重急性呼吸综合征病例的临床特征、影像学动态演变和治疗转归

目的　总结上海地区严重急性呼吸综合征 (SARS)临床诊断病例的临床特征、胸部影像学动态变化和诊治体会。方法　对 2 0 0 3年 3～ 6月上海地区收治的 8例SARS患者的疾病病程、临床诊断及治疗进行回顾性分析。结果　上海地区SARS患者以输入性为主 ,8例患者中 4例年龄 >5 0岁。均以发热为首发症状 ,伴咳嗽、呼吸加速和呼吸困难等。T细胞免疫亚群检测CD3、CD4和CD8下降。胸部影像学显示肺部病灶进行性扩大 ,以双侧片状阴影改变为主。 7例重症病例应用糖皮质激素和BiPAP面罩辅助机械通气 ,2例死亡。结论　上海地区SARS患者病情重 ,胸部影像学病灶出现早、变化快 ,重症病例有呼吸困难者需尽早应用糖皮质激素和机械通气支持等综合治疗

Clinical characteristics, dynamic imaging changes, treatment and outcome of severe acute respiratory syndrome in Shanghai area

Objective To summarize the clinical characteristics, dynamic chest imaging changes, diagnosis and treatment in patients with severe acute respiratory syndrome (SARS) in Shanghai area. Methods Eight patients with SARS were admitted from March 31 to June 27, 2003 in this study. The data of clinical presentation, diagnosis and treatment in patients with SARS were analyzed retrospectively. Results The patients with SARS were afferent cases, four were over 50 years of age. All patients had fever and cough, tackypnea and dyspnoea etc. The T cell subsets showed decline of CD3, CD4 and CD8 lymphocytes. Serial images showed progressive enlargement of pulmonary lesions with patches over both lungs. Seven severe cases received corticosteroid and BiPAP mechanical ventilation, and two died. Conclusion The patients with SARS are severe in Shanghai area. The pulmonary foci appear early and rapidly progressing, with presence of dyspnoea, early treatment with corticosteroid and ventilation support should be instituded at once.