120例传染性非典型肺炎临床分析

Clinical analysis of 120 cases of patients with severe acute respiratory syndrome

目的了解传染性非典型肺炎(SARS)的临床特点,探索其有效的诊治方法.方法回顾分析了120例住院SARS病人临床资料,总结其临床规律和特点.结果通过10例有单次接触明确时间SARS病例观察到潜伏期为2～14d;120例病人均以发热为首发症状,且111例(92.5%)为中、高热,多伴随有畏寒、周身酸痛、乏力、胸闷、气急,查体多数无肺部阳性体征;发热持续时间为(9.2±6.7)d;发病时血常规检查95例正常(79.2%);X光所见肺部病变可以晚于发热出现,以肺部炎性实变为多,可表现多样;胸部X光检查肺部病变完全吸收时间为4～56d,平均为(26.1±10.8)d;治疗为抗病毒、预防感染、吸氧及对症、支持治疗的综合治疗,必要时予以激素冲击治疗及呼吸机呼吸支持.结论 SARS具有病情进展快,临床和放射学表现多样的特点.早期诊断、早期积极综合治疗可能改善预后,降低病死率.

Objective To study the epidemiological, clinical characteristics and treatment of patients with severe acute respiratory syndrome （SARS）. Mehtods Clinical data from 120 patients with SARS were retrospectively analyzed. Results The incubation period of SARS ranged 2 14d by observing 10 cases of patients with single directly contacted history with SARS patients in a clear date. The first symptom was fever in all 120 cases of patients. 92.5% of the patients had middle or high fever. The most common symptom were chill, myalgia, fatigue, malaise, shortness of breath and dyspnoea. Most patients didn＇t have moist rales. The mean time of fever were （9.2±6. 7）d. 79. 2% of the patients had normal white blood cell counts. Initial chest radiographs could show abnormalities after the appearing of fever. Eighty-three patients （69. 2%） had air-space consolidation, ten （8. 3%） had ground-glass attenuation, four （3%） had nodules, seven （5.8%） had mixed consolidation and nodules, five（4.2%） had streak opacifies, eleven（9.2%） had mixed consolidation and streak opacities. The mean time of recover of lung consolidation were （26.1 ± 10.8）d. General combination therapy included anti-viral agents, prevention of infection, inspiring oxygen, etc. Some patients need mechanical ventilatory support and high dose glucocorticoid therapy. Conclusion SARS has a rapid deterioration with respiratory distress, characteristic clinical manifestations and different radiographic changes. Early diagnosis and early combination therapy may be effective for improving prognosis and decreasing fatality.