北京地区250例严重急性呼吸综合征患者临床分析

Clinical analysis of patients with severe acute respiratory syndrome in Beijing area

目的 探讨严重急性呼吸综合征 (SARS)的流行病学特征、临床表现、实验室检查、治疗及预后等特点。方法 回顾性分析北京地坛医院 2 50例SARS患者的临床资料。结果 2 50例患者的平均年龄 (3 6± 16)岁 ,男 110例 (44 0 % ) ,女 14 0例 (56 0 % )。潜伏期平均 (8± 7)天。主要临床表现 :发热 (10 0 0 % )、咳嗽 (72 8% )、乏力 (70 0 % )。外周血白细胞计数降低者占 2 7 2 % ,淋巴细胞比例降低者占 64 2 %。CD+ 4和CD+ 8计数降低者分别占 91 4%、80 6%。动脉血氧饱和度 (SaO2 )低于 97%者162例 (64 8% )。血清丙氨酸转氨酶 (ALT)升高者 45 2 % ,天冬氨酸转氨酶 (AST)升高者 2 9 4% ,乳酸脱氢酶 (LDH)升高者 42 1% ,肌酸激酶 (CK)升高者 18 3 %。恢复期血清SARS病毒特异性抗体IgG阳性率 69 9%。采用综合治疗 ,使用抗生素、抗病毒药物、激素及免疫增强剂。需要呼吸支持者 196例 ,气管插管或切开机械通气支持治疗者 8例 ,重症患者 81例 (3 2 4% ) ,死亡 2 5例。结论 SARS传染性较强 ,中青年人群患病为主 ,有特征性临床表现 ,采用综合治疗 。

ObjectiveTo study the epidemiological,clinical and laboratory characteristics,treatment and prognosis of patients with severe acute respiratory syndrome(SARS).Methods Clinical data from 250 patients with SARS were retrospectively analyzed. Results The age of the patients were 36±16,44.0%( n=110) were male,and 56.0%( n=140) were female. The incubation period was 8±7 days.The most common symptom were fever(100. 0%),cough(72.8%),and fatigue(70.0%).27.2% of the patients had decreased white blood cell counts.64.2% of the patients had decreased lymphocytes.91.4 % and 80.6% of the patients had decreased CD + 4 and CD + 8 cell counts,respectively. 162 patients(64.8%)had decreased SaO 2. Serum ALT,AST,LDH and CK were elevated in 45.2%,29.4%,42.1%,and 18.3% of the patients respectively. Serum IgG to SARS virus was positive in 69.9% of the patients at recovery stage.General combination therapy including antibiotics ,anti-viral agents,glucocorticoids and immunity-enhancing agents,was used.Artificial ventilation was used in 196 patients including 8 for whom invasive mechanical ventilation was used Eighty-one(32.4%) were diagnosed as having severe type of SARS. 25 patients died of SARS. Conclusions SARS is a highly communicable disease and mostly affects youth and people in their prime of life. It has characteristic clinical manifestations.Combination therapy can be very effective for most patients.