严重急性呼吸综合征患者多脏器损伤的观察

Study on severe acute respiratory syndrome patients with multiple organ injury

目的 了解严重急性呼吸综合征 (SARS)患者多脏器损伤表现及处理原则。方法 对 4 2 9例SARS患者中有多脏器损伤的 182例的临床资料进行回顾性分析。结果 95 .6 % (174 / 182 )患者有SARS的接触史 ,潜伏期 2～ 19d。临床表现 :发热 99.5 % (181/ 182 ) ,咳嗽 6 4.3% (117/ 182 ) ,全身酸痛 4 1.8% (76 / 182 ) ,呼吸困难和腹泻各 2 6 .9% (49/ 182 ) ,头痛占 19.8% (36 / 182 )。 182例患者均有不同程度的肺部损伤 ,一侧肺部病变 6 7例 (6 7/ 182、36 .8% ) ,双侧 115例 (115 / 182、6 3.2 % )。 15 2例 (15 2 / 182、83.5 % )患者有不同程度的肝脏损伤。 5 2例 (5 2 / 182、2 8.6 % )心脏损伤。心脏和肝脏同时受损的有 2 0例 (2 0 / 182 ,11% )。 1例 (1/ 182、0 .6 % )肝脏中度损害的患者有一过性的肾功能尿素氮轻度增高。结论 SARS对不同的脏器损伤发生率因脏器不同而有差异。肺脏损伤的发生率最高并且不同时期有不同表现 ;肝脏损伤以转氨酸中度增高为主 ,部分可能与药物有关 ;心脏的损伤早期为病毒的直接侵蚀 ,后期与病毒感染引起的继发免疫反应有关 ;对肾脏的影响发生率最低且程度轻 ,愈后良好。

Objective To study on multiple organ injury pres en tation and treatment principle of SARS patients.Methods To anal yze the clinical data of 182 SARS patients with multiple organ injury in 429 cas es retrospectively.Results 174(95.6%) of all 182 patients had e xposure to SARS,and the incubation period ranged from 2 to 19 days.The clinical features included fever (99.5%),cough (64.3%),body pain (41.8%),dyspnea (26.9%), diarrhea (26.9%),headache (19.8%).There were differential acute lung injury (ALI ) in 182 cases and differential hepatic lesion in 152 cases and heart injury in 52 cases.Conclusion The morbidity of differential organ injury in SARS patients are different.The highest morbidity was lung injury and it has differential presentation in every stage.Most of cases with hepatic injury with mid level increased transaminase an d it was related to drugs.The injury of heart was directily invasion by SARS-Co V in early stage and it was relating to secondary immune reaction in late stage. The morbidity of kidney injury was the lowest.