20名医务人员重症急性呼吸综合征临床及随访分析

Analysis of Clinical Features and Follow-up of 20 Medical Workers with Severe Acute Respiratory Syndrome

目的 :探讨医务人员重症急性呼吸综合征 (SARS)患者的临床特点和预后。方法 :选择 2 0名患SARS的医务人员为研究对象 ,收集病例资料并进行 3个月随访。结果 :2 0名患者均有SARS患者接触史 ,90 %为未防护时受感染 ,其家人均未患病。潜伏期 3～ 8(4.2± 1.5 )d ,临床症状主要有发热、咳嗽、呼吸困难及腹泻、心悸、胸痛 ,3例出现ARDS ,无一例死亡。实验室检查示部分患者血白细胞及淋巴细胞计数降低 ,ALT、AST、CPK升高。影像学改变主要为双肺中下野多发斑片状阴影。病愈后 3个月随访发现患者常有易疲乏、多汗、气短、心悸、脱发及易患感染等症状 ,5例CT示肺纤维化 ,肺功能检查示约半数患者有弥散功能下降。结论 :SARS患者潜伏期可能无传染性 ,临床特点为以呼吸系统为主的多系统损害 ,病愈后部分患者可能有肺功能下降。

Objective:To investigate the clinical feat ure s and prognosis of medical workers with severe acute respiratory syndrome (SARS) . Methods: 20 medical workers of our hospital suffered from S ARS were analyzed. Clinical data were collected and all patients were followed u p for 3 months. Results: All of the 20 cases had the contact h istory with SARS patients. 90% of them were infected at the situation of unprote ction and their family members were not infected. The incubation period ranged f rom 3 to 8 days (4.2±1.5). Main clinical symptoms included fever, cough, dyspne a, diarrhea, palpitation and chest pain. 3 patients suffered from ARDS and no on e died. Laboratory test showed white blood cell and lymphocyte count decreased, and ALT, AST, CPK increased in some patients. Chest radiographic changes were ma inly bilateral multi-focal patchys in the middle and lower lung fields. Follow-u p after 3 months of onset showed there were fatigue, hidrosis, breathless, palpi tation, trichorrhea and susceptible to infection. CT showed pulmonary fibrosis i n 5 cases. Diffusion capacity were lowered in about half of the cases in pulmona ry function test. Conclusion: There may be no ability of i nf ection in the incubation period of SARS. The clinical features of cases with SAR S are multi-system lesions, but predominantly in respiratory system. There may be pulmonary function decreased in some cured patients.