关键词: 严重急性呼吸综合征(SARS), 死亡, 相关因素

Abstract: 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.

Key words: SARS, death, correlated factor