严重急性呼吸综合征的临床特征及其治疗与预后——附220例临床报告

首都医科大学学报 ›› 2003, Vol. 24 ›› Issue (4): 361-368.

严重急性呼吸综合征的临床特征及其治疗与预后——附220例临床报告

王香平, 张建, 魏嘉平, 王力红, 刘佑琴, 冯明, 贾强, 杨强, 聂秀红, 李坤成, 尹建国, 王立, 续大田, 张泰昌, 王育琴, 韩玫, 王克杰, 李宗信, 丁秀娟, 徐玲, 吴晓光, 汤哲

首都医科大学宣武医院SARS专家组

收稿日期:2003-07-20 修回日期:1900-01-01 出版日期:2003-10-15 发布日期:2003-10-15

Clinical Features,Treatment and Outcome of Severe Acute Respiratory Syndrome

Wang Xiangping, Zhang Jian, Wei Jiaping, Wang Lihong, Liu Youqin, Feng Ming, Jia Qiang, Yang Qiang, Nie Xiuhong, Li Kuncheng, Yin Jianguo, Wang Li, Xu Datian, Zhang Taichang, Wang Yuqin, Han Mei, Wang Kejie, Li Zongxin, Ding Xiujuan, Xu Ling, Wu Xiaoguang, Tang Zhe

Xuanwu Hospital, Capital University of the Medical Sciences

Received:2003-07-20 Revised:1900-01-01 Online:2003-10-15 Published:2003-10-15

摘要/Abstract

摘要： 为探讨严重急性呼吸综合征(SARS)的临床特征以及治疗与预后,对2003年5月6日至6月27日宣武医院收治的220例SARS患者的临床、实验室、影像学资料,临床治疗及转归进行回顾性分析。结果220例SARS患者年龄7～86岁,平均(41.33±18.40)岁。男性112例(50.9%),女性108例(49.1%)。医务人员33例(15.0%)。有明确接触史148例(67.3%)。并存基础病60例(27.3%)。临床表现发热218例(99.1%),咳嗽144例(65.5%),畏寒64例(29.1%),气促91例(41.4%),胸闷80例(36.4%),肌痛66(30%)。血常规早期白细胞总数正常或降低、淋巴细胞降低。T细胞亚群CD₃、CD₄、CD₈绝对值降低。胸部X线或高分辨率CT早期单侧或双侧局灶性斑片状渗出性改变,影像多变、短期内增多,进展高峰期呈云雾、磨玻璃影或实变影增大。在可分析的145例血气中,低氧血症63例(43.4%)。220例SARS患者发展为急性呼吸窘迫综合征(ARDS)25例(11.4%);使用机械通气31例(14.1%)。201例康复出院,19例死亡,病死率8.64%。早期鼻导管吸氧、进展期合理使用激素及机械通气可阻止病情进展。合理使用抗生素及抗真菌药物可预防及治疗混合感染(细菌、真菌)。提示流行病接触史、发热、白细胞计数正常或减少、淋巴细胞降低、胸部X线或CT显示渗出病灶是诊断SARS的临床依据。年龄、合并基础病、肺部病变程度、低氧血症、T细胞亚群CD₃, CD₄, CD₈绝对值降低、激素剂量、混合感染等是影响SARS预后的重要因素。病程进展高峰期合理应用激素、抗生素及适时机械通气对降低SARS的病死率有重要意义。

关键词: 严重急性呼吸综合征(SARS), 诊断, 治疗

Abstract: The objective was to discuss clinical features treatment and outcome of severe acute respiratory syndrome(SARS).Methods:Clinical data of220probable SARSpatients admitted from Jun.27,2003to May.6,2003 in Xuanwu Hospital was analyzed retrospectively.Result:220 probable SARSpatients were aged from 7to 86 years(averaged41.33±18.40),among them112were males(50.9%)and108females(49.1%).33cases were medical staffs(15.0%).148 cases had clear contact history(67.3%).60cases(27.3%)had underlying diseases.Clinical feature clusters were fever(218 cases,99.1%),cough(144 cases,65.5%),coldness(64 cases,29.1%),breathlessness(91 cases,41.4%),chest discomfortness(80 cases,36.4%)and myalgia(66 cases,30%).Lymphopenia and normal or decreased blood white cell count were found in the early stage,while T cell subgroups(CD₃,CD₄ and CD₈ )dropped continually along with the development of the course of SARS.Chest file or high resolution CT showed monolateral or bilateral localized mottling infiltration,and polymorphic change increased in a short term at the start of SARS.Patchy or confluent shadows,opacities or enlarged size of consolidation could be seen at fastigium.Among the analyzable blood gas analysis in 145 cases,hypoxeamia were found in 63 cases(43.4%),and25of them developed into ARDS(11.4%).Assisted ventilation was carried out on 31 cases(14.1%).201cases were clinically cured and discharged,and only 19 cases died(8.64%).Early oxygen administration by nasal cannulae,proper corticosteroid administration and assisted ventilation during evolutional stage could hold back the developing course of SARS.Rational and proper use of antibiotics and antifungals can prevent and treat combined infection(bacterial and fungal).Conclusion:Epidemic contact history,fever,normal-to-low leucocytes count,lymphopenia and infiltrate changes on chest X-ray or CT are the evidence of clinical diagnosis.Age,underlying disease,the extent of lung pathological changes,hypoxaemia,the absolute value drop in Tcell subgroups(CD₃,CD₄ and CD₈ ),corticosteroids dosage and combined infection are important factors for the prognosis of SARS.The rational and normal use of corticosteroids and antibacterials,proper use of assisted ventilation are significant to the decrease of SARS mortality.

Key words: SARS, diagnosis, treatmeat

中图分类号:

R563.1

王香平;张建;魏嘉平;王力红;刘佑琴;冯明;贾强;杨强;聂秀红;李坤成;尹建国;王立;续大田;张泰昌;王育琴;韩玫;王克杰;李宗信;丁秀娟;徐玲;吴晓光;汤哲. 严重急性呼吸综合征的临床特征及其治疗与预后——附220例临床报告[J]. 首都医科大学学报, 2003, 24(4): 361-368.

Wang Xiangping;Zhang Jian;Wei Jiaping;Wang Lihong;Liu Youqin;Feng Ming;Jia Qiang;Yang Qiang;Nie Xiuhong;Li Kuncheng;Yin Jianguo;Wang Li;Xu Datian;Zhang Taichang;Wang Yuqin;Han Mei;Wang Kejie;Li Zongxin;Ding Xiujuan;Xu Ling;Wu Xiaoguang;Tang Zhe. Clinical Features,Treatment and Outcome of Severe Acute Respiratory Syndrome[J]. Journal of Capital Medical University, 2003, 24(4): 361-368.

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