Table of Content

15 October 2003, Volume 24 Issue 4

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论著·临床研究

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

2003, 24(4):  361-368. 

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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.

Clinical Features in SARS Patients in Severe Conditions

Zhao Hong;Wei Jiaping;Li Yun;Jia Qiang;Yao Xiaoling;Yin Chunlin;Xu Liqing;He Jifan;Wu Xiaoguang

2003, 24(4):  369-373. 

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The objective was to observe and analyze the clinical features and related factors in SARS(severe acute respiratory syndrome)patients in severe condition.Methods:Clinical data of 149 patients with probable SARS in severe condition admitted in Xuanwu Hospital were analyzed retrospectively,including general appearance,clinical manifestations,laboratory findings,radiological findings,ECG,treatment and outcome respectively.Result:In 149 SARS patients in severe condition aged from 25to 75,the following were symploms:accompanied chronic diseases(40.3%),fever(96.0%),normal or decreased blood white cell count(58.0%),lymphopenia(78.7%),increased serum enzymes(60%),decreased albumin/globulin ratio(46.9%),increased glucose(37.6%),hypooxygenemia(53.1%),larger lung tissue damage site(81.8%),ECG abnormality(31.7%),complications(58.7%).Treatment included corticosteriods,antifungals,antibacterials and antivirals,immunopotentiator,traditional Chinese medicine,oxygen supply and mechanically supported respiration.The final recovery(87.2%)and mortality(12.8%)were found in these patients.Conclusion:Senility,underlying diseases,complications and larger lung tissue damag,severe abnormality in serum enzyme examination contribute to severe condition and higher mortality in SARS patient.

Retrospective Case Study of Death of 19 SARS Patients

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

2003, 24(4):  374-379. 

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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.

Clinical Characteristics and Therapeutic Analysis of 41 Old-Aged SARS Patients

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

2003, 24(4):  380-384. 

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The objective was to analyze the medical records,clinical characteristics,treatment and outcomes old-aged SARS patients,and try to improve the diagnosis and curative ratio of SARS.Clinical records of41old-aged SARS patients who were admitted to Xuanwu Hospital from May 6to June 27 in the year of 2003 were analyzed,and the data obtained were compared with those of 164 non-aged SARS patients who were admitted to the same hospital in the same period.Results:From the observation of the old-aged SARS patients,they were found more frequently having moderate fever(P<0.05),with the main manifestations of SARS,such as high fever,fear of coldness and chills,occurred less commonly than those of the non-aged SARSpatients(P<0.05).The incidence ratio of lymphopenia and the level of Tlymphocyte subgroups were obviously lower than the non-aged group(P<0.05).The serum albumin level of old-aged SARS patients was also evidently lower than the non-aged group(P<0.01).Chest X-ray showed that the bilateral multi-pathological changes occurredmore frequently than those in the non-aged group(P<0.01).The simultaneously occurred underlying diseases and complications occurredmore frequently than those of the non-aged SARS patients(P<0.01).Complicated mental disturbance and dual infection were more commonin the old-aged SARS patients than the non-aged SARS patients(P<0.01).The death rate of the old-aged SARS patients was24.4% which was remarkably higher than that of the non-aged SARS patients(5.5%,P<0.01).Conclusion:The old-aged SARSpatients admitted to Xuanwu Hospital showed a lower occurrance of high fever which is one of the main symptoms among SARS patients;They usually expressed multi-pathological lesions bilaterally in their lunge and a decrease of cellular immunity.They also showed a higher distribution in heary severe and extremely severe SARS.More simultaneously occurred underlying disease and complications were found in the old-aged SARS patients,which means more difficulties in the treatment of SARS and higher mortality.

Subgroups of Peripheral Blood T Lymphocytes in Elderly Patients with Severe Acute Respiratory Syndrome

Yang Qiang;Nie Xiouhong;Wang Shuo;Zhang Lianguo;Xiao Han;Li Xiaojing;Zhang Lin;Liu Mingfang

2003, 24(4):  385-388. 

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The objective was to investigate the changes of subgroups of peripheral blood Tlymphocytes in elderly patients with severe acute respiratory syndrome(SARS).Methods Subgroups of peripheral blood Tlymphocytes in₂₁₁patients,including 40 elderly patients with SARS were detected by flow cytometer.Results The number of CD₃,CD₄,and CD8 lymphocytes all significantly decreased in acute phase of patients with SARS.The counts of CD₃,CD₄ ,and CD8 lymphocytes decreased more apparently in elderly patients with SARS.Conclusion The cellular immunity is damaged in SARS patients,more apparently in elderly patients with SARS.

Characteristics of Peripheral Lymphocyte in Patients with Severe Acute Respiratory Syndrome

Zhang Lianguo;Li Xiaojing;Liu Mingfang;Zhang Lin;Wang Shuo;Xiao Han;Nie Xiuhong

2003, 24(4):  389-391. 

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The objective was to study the peripheral lymphocyte in patients with severe acute respiratory syndrome(SARS).The lymphocyte in peripheral blood at different stage of SARS was investigated retrospectively.Results:In the mild group,lymphopenia was found in the first two weeks of onset,and a recovery from the third week.In the severe group,lymphopenia was sustained for four weeks,and recovering was not found in four weeks.At onset,exacerbating and recovering stage,comparisons of the lymphocyte between mild/severe,mild/dead,severe/dead had no significant difference.According to the state of the illness,patients were divided into four groups including the onset stage,X-ray exacerbating stage,first period of absorption,last period of absorption.The lymphocyte was significantly different between the onset stage and lost period of obsorption,X-ray exacerbating stage and last period of absorption.The lymphocyte decreased remarkably with mild dosage(160～500mg/d),and large dosage(>500～1000mg/d)of glucocorticoid.The lymphopenia in peripheral blood can be considerd as a criterion of SARS in the earlier stage diagnosis.The recovery of lymphocyte count in peripheral blood may indicate the improvement of illness.The lymphocyte decreases remarkebly by glucocorticoid(dose of>160mg/d).

Changes of T cell and its Subgroup in Patients with Severe Acute Respiratory Syndrome

Zhang Yonghong;Wu Hao;Chen Xinyue;Yan Huiping;Wen Tao;Tan Yufen;Ji Yunxia;Wu Yanning

2003, 24(4):  392-395. 

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The objective was to observe the development and change of cell immunological function and analyze the cause.Prospective study was designed to analyze the development and changes of im-munological function in the following-up patients.Immunological function(CD₃⁺ ,CD₄⁺,CD₈⁺ )decreased most in the period of fastigium in SARS patient,and then recovered the the normal standard slowly on the60th days after onset.At the same time the ratio of CD₄⁺/CD₈⁺ was inverted in some patients of SARS.Different immunological functional damage(CD₃⁺ ,CD₄⁺,CD₈⁺)were found in differ-ent age groups(P<0.05).The change of immunological function are associated with the development of SARS,and the damage of immunological function is reversible.But we should pay attention to the phenomenon of inverting in the ratio of CD₄⁺/CD₈⁺.

Characteristics of Tongue and Chest X-Rays in SARS Patients

Li Zongxin;Huang Xiaobo;Li Bin;Li Kuncheng;Yin Jianguo;Sun Shuling;Chen Wenqiang;Wang Mingyue;Liu Guilan

2003, 24(4):  396-400. 

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The objective was to investigate the character of Traditional Chinese Medical(TCM)symptoms,its rule of evolvement and the correlation between character of tongue and chest X-rays in SARS patients.The significance of tongue observation in SARS treatment was discussed as well.Methods:The clinical menifestations,the characteristics of tongue and chest X-rays in 92 cases of SARS patients were collected.Four phases of pneumonia were defined as progression,fastigium,absorb and recovery phase.Different characteristics of tongue in different phase of pneumonia,and their correlations were analyzed by statistical methods.Results:Positive correlations were found between the appearance of prickled tongue surface and progression,fastigium phase,and more significant in fastigium P<0.05;positive correlation existed between swollen tongue,tongue with teeth prints and recovery phase,P<0.01,and P<0.05 respectively;positive correlations also existed between shedding of fur and absorb phase,recovery phase and days of illness,and were significant between absorb phase and days of illness,P<0.05.Conclusion:Significant correlation exists between characteristies of tongue and thest X-rays in SARS patients.Observation of tongue helps to detect the variety of patient's condition in the early stage.Traditional Chinese medical observation of tongue is important in SARStreatment.

Radiology of Thoracic Complications in SARS

Yin Jianguo;Li Kuncheng;Liu Shuliang;Wei Jiaping;Wang Xiangping;Zhang Jian;Wang Lihong;Liu Youqin;Feng Ming;Jia Qiang

2003, 24(4):  401-404. 

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The objective was to improve the cognition of the radiological signs of the thoracic complications in SARS by evaluating the chest plain radiographs and CT images.Methods:the 950 plain chest radiographs and74chest CTscans of 182 patients with SARS were analyzed retrospectively,with focus on observing signs of the pulmonary cavities,fibrosis,pneumothorax,pneumomediastinum,subcutaneous emphysema,and pleural effusions.Results:Among the182cases with SARS,pulmonary cavities were present in 6 cases(3.3%),which were clinically diagnosed as complicated fungal infection;pleural effusion in 10 cases(5.5%);pneumomediastinum and subcutaneous emphysema in 8 cases(4.4%),and pneumothorax in 3 cases(1.6%).Additionally,pulmonary fibrosis were diagnosed in 17 cases(31.5%)out of the 54 cases who had underwent chest CT scan,and pleural thickening and adhesion in 6 cases(11.1%).Conclusion:Acomplete understanding of the chest radiological signs in patients with SARS is beneficial to the differentiation diagnosis and guides the treatment of the syndrome.

Pattern of Evolution of Severe Acute Respiratory Syndrome on Chest Radiographs

Li Kuncheng;Yin Jianguo;Yu Chunshui;Wei Jiaping;Wang Xiangping;Zhang Jian;Wang Lihong;Liu Youqin;Feng Ming;Jia Qiang

2003, 24(4):  405-409. 

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The objective was to investigate the pattern of evolution of severe acute respiratory syndrome(SARS)on Chest radiographs.Chest radiographs of 54 SARS patients were analyzed retrospectively.Pulmorary lesions in different location,shape,number,area and density were observed in different period of time.Initial chest radiographs showed unilateral involvement(33 of 54 cases,6 cases of them evolved to bilateral involvement on the following chest radiographs)and bilateral involvement(21cases).Lower lung field(64.82%)and middle lung zone(94.44%)were more commonly involved.The evolution of shape of lesions included three patterns,the pattern of patchy opacities-shaggy cloudy shadow-increase of focal interstitial markings-absolutely absorption was found in most patients(64.82%).The evolution of number of lesions included five patterns,among which unifocal involvement(40.74%)was the most common pattern.Three patterns of evolution of lesion area were recognized:one-peak pattern(79.63%),two-peak pattern(12.96%)and progressive deterioration pattern(7.41%).The evolution of lesion density included four patterns:one-peak pattern(57.69%),two-peak pattern(29.49%),three-peak pattern(7.69%)and progressive deterioration(5.13%)pattern.Significant difference was found in disease course and the largest lesion proportion to the whole lung in different types of evolution.Conclusion To some extent,the radiographic evolution of SARS is regular and the radiographic evolution can suggest the prognosis of SARS patients.

Mechanical Ventilation in Treatment of SARS

Wang Kejie;Wang Lihong;Wei Jiaping;Yang Qiang;Jia Qiang;Feng Ming;Nie Xiuhong;Li Kuncheng;Yin Jianguo;Wang Li;Xu Datian;Zhang Taichang;Wang Yuqin

2003, 24(4):  410-413. 

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The objective was to study the application of mechanical ventilation(MV)in the treatment of SARS.Methods:We applied mechanical ventilation to the patients who did not improve after oxygen inhalation by mouth or nose.Artificial ventilation was used through noninvasive ventilator or endotracheal tube/tracheostomy.Results:There were131severe patients in 220 SARS.Mechanical ventilation were applied in 32 cases,which amounted to14.55% of 220 SARS and 24.43% of severe patients.24cases(18.32% of severe patients)used only noninvasive ventilator,which amounted to75%of the total mechanical ventilation.6cases received tracheal intubation and3cases received tracheostomy(1case received tracheostomy after tracheal intubation).16cases died in mechanical ventilation,which amounted to7.27% of 20 SARS,and12.21% of severe patients,50% of mechanical ventilation.5cases died in 6 cases of tracheal intubation.3 cases of tracheostomy all died.99 cases of severe patients did not use mechanical ventilation,with3cases of them died and 96 cases of them recovered.Conclusion:Noninvasive ventilation is useful in treatment of SARS.Tracheostomy is of little value.Endotracheal intubation should be performed with general anesthesia.

Timing of Noninvasive Positive Pressure Ventilation for Patients with Severe Acute Respiratory Syndrome

Chen Hong;Wang Xiangping;Li Fei;Yang Qiang;Zhang Lianguo;Du Jianxin;Zhao Songlin

2003, 24(4):  414-417. 

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The objective was to compare the collectable relevant physiological data of survivors and non-survivors of severe acute respiratory syndrome(SARS)on noninvasive positive pressure ventilation(NIPPV),and to evaluate the timing of NIPPV for SARS.Methods:Twenty-five SARS patients with respiratory dysfunction on NIPPV were divided into two groups:survivor group(n=13)and non-survivor group(n=12).The PAPCHEⅡscore,respiratory rate(RR),saturation of oxygen(SpO₂ )and modificative repiratory index(MRI)were compared between the survivors and non-survivors before NIPPV and after NIPPV for three to twenty four hours,respectively.Results:NIPPV administered with full-face masks avoided the need for endotracheal intubation,with rapidly improved vital signs and gas exchange and sense of dyspnea.Although NIPPV could be one of the effective treatments for improving oxygenation in both groups during the initial 3 to 24h of ventilatory support,the patients in non-survivor group had higher PAPCHEⅡscore,respiratory rates and lower SpO₂ ,MRI than those of the patients in survivor group(P<0.05)at the same intervals.The average time span from beginning of SARSto NIPPV in the non-survivor group was much longer than that in survivor group.Four patients in non-survivor group and none in survivor group were intubated at last.The non-survivors underlying diseases were easily accompanied with serious nosocomial pneumonia and multiple organ dysfunction syndrome(MODS).conclusions:Because severe SARS might rapidly deteriorate,appropriate use of NIPPV should be recommended,and NIPPV or IPPV should be given without hesitation when refractory hypoxemia is found.Noninvasive ventilation should be used as a preventive tool against endotracheal intubation rather than as an alternative treatment for acute respiratory failure related to SARS.Therefore,efforts should be made to avoid missing the timing for intubation.Because gas exchange disturbances in advanced SRAS may not be amenable to NIPPV,available indications for NIPPV should not be restricted.Several factors are vital to the success of NIPPV therapy,including training and experience of the staff,appropriate patient selection,properly timed intervention,patient coaching and encouragement and careful monitoring.Because most relevant studies have been retrospective and uncontrolled,many issues remain unresolved.The safety and efficacy of NIPPV,the most appropriate selection of patients and timing of intervention for SARS need to be further studied.

Early Effects of Noninvasive Positive Pressure Ventilation on Oxygenation of SARS Patients with Acute Respiratory Failure

Chen Hong;Wang Xiangping;Li Fei;Yang Qiang;Zhang Lianguo;Du Jianxin;Zhao Songlin

2003, 24(4):  418-421. 

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The objective was to summarize and analyze our experience in the noninvasive positive pressure ventilation(NIPPV)therapy for the acute respiratory insufficiency patients due to severe acute respiratory syndrome(SARS),and to evaluate the effects of NIPPVon treatment for SARS.25cases of SARS with acute lung injury on NIPPV were studied restrospectively in order to investigate the implications of NIPPV in improving oxygenation according to collectable relevant physical findings and laboratory measurements documented before and within 24h after initiation of support.NIPPV was an effective treatment in ameliorating dyspnea or tachypnea and tachycardia,decreasing the amount of spontaneous work of breathing and correcting the rapid shallow breathing,decreasing heart rate(HR)and respiratory rate(RR)(P<0.05),and increasing saturation of oxygen(SpO₂ )and modificative respiratory index(MRI)(P<0.05)for the majority of SARS patients with acute respiratory dysfunction within 24h after initiation of therapy.NIPPV can be considered as a valid therapeutic option in short-term stage for SARS patients with hypoxemia,and it also should be considered as first-line intervention in the early phases of SARS with acute respiratory insufficiency before eventual endotracheal intubation.The conventional use of NIPPV in SARS patients with hypoxaemic acute respiratory failure still remains controversial,however.The application of noninvasive positive pressure ventilation may be an effective treatment in correcting gas exchange abnormalities,relieving respiratory distress and,perhaps,avoiding or decreasing the need for endotracheal intubation in selected patients with acute respiratory insufficiency secondary to SARS.

Mechanical Ventilation in Treatment of Severe Acute Respiratory Syndrome

Yang Qiang;Xiao Han;Zhang Lianguo;Wang Shuo;Nie Xiuhong

2003, 24(4):  422-425. 

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The objective was to study a strategy of mechanical ventilation for patients with critically severe acute respiratory syndrome(SARS).Eight patients with critical SARS(5males and3females),aged from30to74years〔mean age(55±16)yrs〕,were enrolled in the study.After failure in routine treatment and non-invasive ventilation initiatively,all patients received tracheotomy for intermittent positive pressure ventilation.The vital sign,blood gas analysis and the oxygenation function were observed before and after ventilation.The complications and prognosis were evaluated.Results:1)All eight patients had high fever(T>38.5℃),seven showed normal white blood cell counts,and seven had dysfunction of other organs.2)The average time from onset to invasion ventilation was(27.9±12.2)d and the average time of invasion ventilation was(8.6±5.4)d.All patients used pressure controlled ventilation or pressure support ventilation plus positive expiratory end pressure(PCV/PSV+PEEP).After invasive ventilation SaO₂ increased(P<0.01).3)One patient had pneumothorax before ventilation.Bilateral pneumothorax and pneumomediastinum occurred in two patient during ventilation.4)One patient recovered after the application of mechanical ventilation.Seven patients died of severe diseases and complications.The application of mechanical ventilation in patients interminal stages of critical SARS has no obvious effect.The oxygenation and lung injury may be improved by PCV and appropriate PEEP.

Complications after Mechanical Ventilation and Respiratory Treatment Strategy in Patients with Severe Acute Respiratory Syndrome

Yang Lei;Li Fei;Li Duo;Jia Jianguo;Yang Peng;Sun Jiabang

2003, 24(4):  426-429. 

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The objective was to analyze the pneumothorax and mediastinal emphysema occurred after the non-invasive and invasive mechanical ventilation(MV)and to discuss relevant strategy in respiratory treatment in patients with critical severe acute respiratory syndrome(SARS).Altogether 31 serious cases of SARSundergoing MV were analyzed,retrospectively,in comparison with 89 cases of acute respiratory distress syndrome(ARDS)undergoing MV in surgical intensive care unit during the last two years.Re-sults:Pneumothorax and mediastinal emphysema occurred in 9 of 31serious cases of SARS with MV,and mediastinal emphysema in 1 of 189 cases of SARS without MV.Pneumothorax occurred in 1 of 89cases of ARDS with MV.The incidence of pneumothorax and mediastinal emphysema in serious cases of SARS with MV was significantly higher(P<0.01)than those in cases of SARS without MV and ARDS with MV.The peripheral blood oxygen saturation level and modified respiratory index didn't change significantly after reasonable adjustment of ventilation pressure and increase of oxygen concentration inhaled.Eight cases of pneumothorax and mediastinal emphysema improved gradually,thoracic closed drainage was performed in one case.Conclusions:The incidence of pneumothorax and mediastinal emphysema in serious SARS patients with MV is significantly higher than that in SARS patients without MV and that of ARDS patients with MV.It might be associated with SARS related pulmonary injuries,intense cough and high mechanical ventilative pressure.The pneumothorax and mediastinal emphysema improve gradually in most of the cases after reasonable adjustment of mechanical ventilative pressure.So when MV is used in the treatment of serious SARS patients to improve hypoxemia,optimized mechanical ventilative pressure should be obtained in order to avoid pneumothorax and mediastinal emphysema.

Clinical Analysis of Blood Gas in 88 Patients with Severe Acute Respiratory Syndrome

Wu Hao;Chen Xinyue;Huang Yunli;Zhang Yonghong;Ma Lina;Wang Zuomei;Zhang Tong;Li Zaicun;Wang Chen

2003, 24(4):  430-433. 

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The objective was to discuss the characteristics of metabolism of oxygen and its correlation with clinical manifestations in Severe Acute Respiratory Syndrome.Retrospective study was designed.Blood gas in 88 patients was detected up to 213 times.It was found that the decrease of PaO₂ was the most common(85.0%,181/213),the decrease of SaO₂ is the second(68.1%,145/213),and the increase of PaCO₂ is the least common(5.6%,12/213).All the data indicated that the incidence of hypoxemia was the most prevalent and the increase of carbon dioxide was the least in all these patients.Hy-poxemia,clinical typing and phase were correlated,and respiratory alkalosis was widespread.In patients who died of SARS,there were not only respiratory alkalosis but also compound disorder of blood gas.The variation of metabolism of oxygen is the decrease of PaO₂ in the initial stage and overventilation excited by hypoxemia.At the same time the decrease of PaCO₂ causes respiratory alkalosis,and the development of compound disorder of blood gas.Correlation exists between hypoxemia,clinical condition and prognosis,indicating that the treatment of oxygen in the initial stage is important.

Effects of Underlying Disease on the Prognosis in Patients with Severe Acute Respiratory Syndrome

Nie Xiuhong;Zhang Lin;Liu Mingfang;Li Xiaojing;Wang Shuo;Zhang Lianguo;Teng Guojie;Li Yan;Yang Qiang

2003, 24(4):  434-436. 

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The objective was to study the effects of underling diseases on the prognosis in patients with severe acute respiratory syndrome(SARS).All the 212 patients admitted to Xuanwu hospital from May to June in 2003 were studied retrospectively.The mortality in patients with underling diseases(20.7%)was significantly higher than patients without underlying diseases(4.5%).There was a higher mortality in patients with or above two underling diseases.By Logistic regression,among diabetes mellitus(DM),hypertension,coronary heart disease,chronic obstructive pulmonary disease(COPD),cerebral vessel disease(CVD)and hepatitis/hepatocirrhosis,CVD(P=0.000)and hepatitis/hepatocirrhosis(P= 0.001)were main death-related risk factors.The mortality seemed not to increase in SARS patients with DM.In recovered patients,60.4%of the patients with underling disease had a non-completely absorbed x-ray,and 29.9%of the patients without underling disease.SARS patients with underling disease had a significant high mortality.With more kinds of underling diseases the mortality enhance greatly.CVD and hepatitis/hepatocirrhosis are main death-related risk factors.SARS patients with underling disease have a severer damage on lung and their recovery are slower than the others.The mortality did not seem to increase in SARSpatients with DM.

Effects of Cardiovascular Risk Factors on Patients with Severe Acute Respiratory Syndrome

Li Yun;Wei Jiaping;Zhao Hong;Wu Xiaoguang

2003, 24(4):  437-440. 

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The objective was to investigate the effects of cardiovascular risk factors on different type of severe acute respiratory syndrome(SARS)and the patient's prognosis.Altogether 219 patients with severe acute respiratory syndrome were divided into three groups mild,severe and critically severe.The risk factors included age,gender,history of diabetes,hypertension,coronary artery disease,cerebrovascular disease and hypertriglyceridemia,elevated total cholesterol as well as high uric acid.These factors were estimated in different groups or types of patients with SARS.Results:More severe and critically severe cases were found in the groups of patients aged above sixty.In patients with history of hypertension,diabetes and coronary artery disease,severe and critically severe types were much more than other patients.In patients of severe and critically severe types,the level of blood glucose and systolic blood pressure were higher than patients with mild conditions.The level of uric acid in most severe patients was lower than mild patients.Gender,the level of total cholesterol and triglyceride didn't influence the conditions and prognosis of patients.Some cardiovascular risk factors such as age,hypertension and hyperglycosemia can affect patient's conditions and prognosis.Other risk factors such as gender,value of total cholesterol and triglyceride can't influence these significantly.

Renal Damage Complicated with Atypical Pneumonia

Jia Qiang;Zhang Jian;Wang Xiangping;Wang Lihong;Liu Youqin;Wei Jiaping;Feng Ming;Wang Yuqin;Zhang Taichang;Li Zongxin;Wang Kejie;Xu Datian;Li Kuncheng;Yin Jianguo;Han Mei;Wang Li;Yang Qiang;Ding Xiujuan;Xu Ling

2003, 24(4):  441-443. 

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The objective to explore the clinical features of renal damage complicated with atypical pneumonia and its effective prevention and treatment.Altogether 220 cases with atypical pneumonia were analyzed retrospectively.Results:14cases of them were found to have renal damage,with the incidence of 6.4%.The main causes of renal damage might be related to factors,such as,old age,severity of diseases,underlying diseases,long period use of large dos age of broad spectrum antibiotics,insufficient nutritional support to the patients with decreased nutritional intake,and fail to correct the disorder of fluid,electrolyte and acid-base balance.After continuous,fast and systematic treatment,8cases(57.2%)recovered completely,1case(7.1%)turned better,and5cases(35.7%)died.Conclusion:Renal damage complicated with atypical pneumonia is correlated with multiple factors.Comprehensive treatment can result in better prognosis.

Serum Myocardial Isoenzyme Level in SARS Patients

Tian Lili;Liu Chunling;Zhang Xinqing;Zuo Ya;Chen Xiumin;Qi Xiaohong;Wang Xiaojun;Zhu Xiuyun;Liu Xin

2003, 24(4):  444-446. 

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We analyzed the content of phospho creatine kinase myocardial isoenzyme(CK-MB)in the serum of SARS patients in order to find out acute myocardial damage in earlier SARS period.Methods:1)Altogether 204 patients were divided into7groups by age,and the highest CK-MB level was collected in every patient.The percentage of patients with abnormal CK-MB level were calculated and analyzed statistically.2)The patients then were divided into two groups,namely one group with normal CK-MB level and the other with abnormal level.The percentage of patients with multiple pathological changes in lung lobes was estimated for each group.Results:CK-MB abnormal percentages were:17%in the group aged below20;22%in the group aged between 41～50;26%in the group aged between 51～60.The average CK-MB levels in turn were(23±11),(19±16),(21±15),(20±10),(24±15),(36±26),and(22±11)IU/L.There were 53% patients with pathological changes in many lobes of lung in the abnormal group,and 35% in the normal group.Conclusions:Acute myocardial damage exists in part of SARS patients.The highest percentage of CK-MB abnormal level is in the group aged between 51～60years old.The highest average CK-MB level is in the group aged between 61～70years old.The percentage of patients with multiple pathological changes in lung lobes in the abnormal group is much higher than the normal group.

Adverse Drug Reaction of Gluco-corticosteroid and Associated Factors in SARS medication

Wang Yuqin;Zhang Jan;Wang Xiangping;Wang Lihong;Liu Youqin;Wei Jiaping;Feng Ming;Nie Xiuhong;Yang Qiang;Zhang Taichang;Li Zongxin;Wang Kejie;Xu Datian;Han Mei;Li Kuncheng;Yin Jianguo;Wang Li;Wu Xiaoguang;Tang Zhe

2003, 24(4):  447-450. 

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The objective to study the adverse drug reaction(ADR)of gluco-corticosteroid and its associated factors in SARS(severe acute respiratory syndrome)medication.All SARS patients(totally 220 persons)were checked in history,body examination,routine blood test and blood biochemistry examination.All SARScases in our hospital were analyzed retrospectively with statistic software SPSS 11.0.Results:The incidence of ADR in 170 patients(77.3%)with gluco-corticoid administration was much higher than that in patients without glucocoticoid.The incidence of ADR in patients treated with glococorticoid more than 320mg per day was also much higher than that in patients with glucocoticoid lower than<s 320mg per day.Avariety of ADR included decrease of potassium(17.6%)and calcium(68.3%)in the blood,increase of blood sugar(30.6%),psychiatric symptom(28.8%)and fungal infection(20.7%).ADR of SARS patients treated with glucocorticoid should be monitored strictly.To reduce the incidence of ADR in SARS patients,administration of glucocorticoid should be controlled strictly and carefully,especially the high dosage of drugs must be avoided.

Hormone Utilization and Glucose Metabolism Disturbance in SARS Treatment

Xu Datian;Wang Li;Wu Xiaoguang

2003, 24(4):  451-452. 

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The objective was to analyze the effect of hormone utilization on glucose metabolism in the patients with severe acute respiratory syndrome(SARS).Among all 220 patients,51patients with hyperglycemia was retrospectively analyzed.10(19.6%)of them with diabetes mellitus(DM),41(80.4%)without DM.The age of patients with hyperglycemia was 18～86 years old(52.35±16.64).There were male 24(47.1%),and female27(52.9%).All the patients were treated with insulin,and the glucose levels was compared before and after utilization of hormones.The number of patients complicated with hyperglycemia increased with the increase of hormone dosage(χ² =20.95,P<0.01).Conclusion:Hyperglycemia should be treated with hormone in the treatment on SARSpatients.

Effects of Platelete Counts on Prognosis in Patients with Severe Acute Respiratory Syndrome

Zhang Lianguo;Liu Mingfang;Nie Xiuhong;Zhang Lin;Wang Shuo;Li Xiaojing;Xiao Han;Yang Qiang

2003, 24(4):  453-456. 

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The objective was to investigate the relationship between platelet(plt)counts and prognosis in patients with severe acute respiratory syndrome(SARS).Parameters in 133 SARS patients admitted to Xuanwu Hospital in Beijing from May 2003 to June 2003 were analyzed retrospectively.Results:The inortality in the cases being treated in ICU remarkably increased in thrombocytopenia group,compared with those in normal group.The level of high bloodglucose and abnormal LDH、CPK、WBC and lymphopenia in thrombocytopenia group is much higher than that of normal platelet group(P< 0.01).The ratio of severe type patients and their average age in thrombocytopenia patients were much higher than that in the other group(P<0.01).These diferences were observed in platelet counts<150×10⁹/L group.Platelet counts may provide us with a good criteria for detecting disease severity and prognosis in patients with SARS.The changes of platelet counts in patients with SARS is an important predictor to prognosis.We should not only pay attention to patients whose platelet counts are lower than 100×10⁹/L,but also pay much attention to patients whose platelet counts are lower than 150×10⁹/L.

Anoxic Brain Damage and Oxygen Therapy of Severe SARS

Su Yingying;Chu Changbiao

2003, 24(4):  457-459. 

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The objective was to study anoxic brain damage of severe SARS and to investigate the effect of the oxygen therapy.All the 149 patients suffered from severe SARS were treated in Xuanwu Hospital from May 2003 to June 2003.The degree of Anoxic brain damage of84cases with severe hypoxemia were evaluated retrospectively.Result:54cases(64.3%)presented the manifestation of Anoxic brain damage.Among them bradypraxia and less verbal communication were the most common syndrome(92.6%),others included emotional disorder(46.3%),depression or anxiety(40.7%),conscious disturbance(22.2%),cognitive dysfunction(9.3%)and convulsion(1.9%).Through adjusting the model of oxygen supply,the Anoxic syndrome could be improved in a relatively short period(average5d).The patients'breath rate and heart rate decreased,SpO₂ increased and the Anoxic syndrome disappeared.Anoxic brain damage is a significant syndrome and should not be neglected,furthermore correct and reasonable oxygen therapy can increase the curability and decrease the mortality rate of SASR patient.

Analysis of Respiratory Infection in 15 Hospitalized Child Patients in May 2003

Han Mei;Liu Youqin;Wei Jiaping;Feng Ming;Jia Qiang;Yang Qiang;Nie Xiuhong;Li Kuncheng;Yin Jianguo;Wang Li;Xu Datian;Zhang Taichang;Wang Yuqin;Wang Kejie;Li Zongxin;Ding Xiujuan;Xu Ling

2003, 24(4):  460-463. 

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In May 2003,220 patients diagnosed as SARS in other hospitals were transferred to XUANWU hospital.Fifteen cases(female 5)were under of 18 years old.The youngest patient was7years old.Four patients were from8to14years old.Ten patiens were between the age of 15 and 18 years old.The average age was 15.1years old.Based on the Guanzhou diagnostic criteria of SARS,the epidemic history,clinical symptoms,laboratory tests,the results of chest X-ray,and their response to antibiotic administration points.The most important were reviewed for correct diagnosis of SARS in children were①close contact to SARSpatients;②family or group history.In order to avoid the over misdiagnosis of SARS,differentiation of the"epidemic area"from the"local region"must be made correctly.The shadow in chest X-ray examination is an important point.It is necessary for patiens to have an early CTscan for SARS diagnosis.Laboratory test and the response to antibiotics of these patients are also referential to make a correct diagnosis.These two aspects are similar to typical pneumonia.In order to reduce the adverse effects of corticosteroid,careful use of corticosteroid in the treatment of SARS are recommended.The condition of child patient with SARS is often stable,so it is not necessary to give expensive immunologic products.The reason why children are less infected by SAR Sshould be studied further using pathogenic methods.The antibody to SARS virus can be found in the serum of some babies and children.SARS virus shows some cross immuno-reaction to other viruses.Therefore,a golden criteria should be developed for the detection of pathogenic viruses.

Hospitalization Expenditures for Patients with Critical SARS in ICU

Li Xiaoying;Wang Lihong;Wang Xiangping

2003, 24(4):  464-467. 

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The objective was to understand the characteristics of hospitalization expenditures for patients with critical SARS in ICU and its influent factors and to discuss relevant controlling measures.The hospitalization expenditures and its influent factors for 41 patients with critical SARS in ICU were compared with the expenditures 179 patients with SARS from May 2003 to June 2003 in our hospital the hospitalization expenditures and its influent factors for 41 patients with critical SARS in group ICU₁ were compared with group ICU₂ .Results:In 41 patients with critical SARS,21 were male and 20 female,aged from 24 to 82 years[average(47.00±14.60)years].The total hospitalization expenditures were 1902 190 RMB with an average of 47117.51±33316.89 RMB per person,among them the medicine expenses were in the highest proportion(48.27%)and others were the cost of treatment,examinations,other expenses and ward charge.The difference in average total hospitalization expenditures and in five kinds of expenditures for the patients in group ICU₁ and group ICU₂ were not significant(P>0.05).The average age of 41 patients with critical SARS was significantly higher than that of179patients(P<0.05).The numbers of patients with complications(73.2%)were significantly more(P<0.01).More patients used non-invasive ventilation(58.3%)or invasive ventilation(17.1%)and the difference was significant(P<0.01).There were more patients using non-invasive ventilation(78.3%)in group ICU₁ than in group ICU₂ (P<0.01).The results suggest that the hospitalization expenditures of patients with critical SARS are very high;among them the medicine expenses are in the highest proportion,which is related to many factors.It is necessary to use non-invasive mechanical ventilation in time and take active and reasonable treatment measures combined with more effective drug treatment to improve curative rate and decrease mortality,and effectively control the hospitalization expenditures and reduce the proportion of medicine expenses.

Effect of Precautionary Means on Nought Infection of Medical Staff

Wang Lihong;Wang Xiangping;Zhang Jingli;Shi Haiou;Wang Guizhen

2003, 24(4):  468-471. 

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In order to protect the medical staff in SARS hospital from the infection of SARS virus,we review the sterilizing and isolating techniques and occupational protection in our hospital during SARS medication period.220SARSpatients,including 131 serious patients(59.55%),were treated in our hospital.More than 1200 medical workers were participated in the clinical work and none of them was infected by SARS virus.Therefore,we achieved our mission(nought infection of medical staff in our hospital)assigned by Beijing municipal government successfully.It has been proved that our means applied in sterilizing and isolating work and occupational protection are tremendously sufficient and effective.

Psychological Health Status in 500 Patients with SARS

Liu Lisong;Li Xuewen;Hua Qi;Yang Xin;Wu Hao;Xu Wuyi;Tian Jianhua;Chen Hong;Yang Fengchi;Liu Zhaohui;Ji Xunming;Zhang Jian

2003, 24(4):  472-474. 

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The study was to investigate the psychological health status in patients with SARS in Beijing.The questionnaire of emotional status(SARS psychological topic group,Shikan et al)and SDS were adopted to measure the personality depression in 500 patients with SARS and 500 compared healthy subjects.The results showed that mean grade of SARS patients was less than the control group.The mean grade of depression index in SARS patents was higher than the control group.66.8% SARS patients were in depression status,and significant differences existed between mild paitents and serious patients.It is suggested that psychological health level in patients with SARS is lower than that of the healthy people,mental intervention is a good way to patients with SARS in recovery period.

Psychological Health Status of 1806 Medical Works in SARS Period

Liu Zhaohui;Hua Qi;Yang Xin;Wu Hao;Xu Wuyi;Tian Jianhua;Chen Hong;Yang Fengchi;Huang Wei;Tang Zhe;Ji Xunming;Zhang Jian

2003, 24(4):  475-477. 

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The study was to discuss the variation of depressed psychical condition in first line medical staff during the time of treating SARS patients.First line and second line medical staff in SARS hospitals were set as the study group(1806 cases),the control group(Randomly selected people during SARS period,148cases)and the normal control group(1340 cases).SDS assessment was taken and results were compared in these 3 groups.no significant difference in SDS score was found between medical staff and control groups but gender difference was found in medical staff group.SDS in female was higher than male.The SDS core of medical staff from communicable diseases hospital(Youan and Ditan hospital)was higher than the normal and control groups.Psychiatry consultant is necessary for medical staff,and social support is needed as well.

Emotional and Depressive Differences between Doctors and Nurses Fighting Against SARS

Wan Yungao;Huang Wei;Hua Qi;Wu Hao;Xu Wuyi;Tian Jianhua;Ge Kanyi;Yang Fengchi;Yang Xin;Liu Zhaohui;Li Xuewen;Ji Xunming;Zhang Jian

2003, 24(4):  478-482. 

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The objective was to analyze the difference in mentation between doctors and nurses.In three months of SARS epedemic,altogether 1532 psychological questionnaires were collected from doctors and nurses who were working in many SARS-related hospitals.No watter in the firstline or the supparting line,doctors scored higher than nurses,and lower in SDSthan nurses.Compared with the normal persons nurse scored higher about SDS.SDSwas about"being short of support from the society","bad treating and living condition","being short of support from relatives",and so on.In addition was the score about SDS,reversely correlated with the degree of the exercise and the educational level.Compared with the nurses,doctors have better mentation.The psychological intervention should be based on the different causes.The related factors that cause the increase of the stress should be controlled.