30例医务人员新型冠状病毒肺炎的临床特征分析

Clinical characteristics of 30 medical workers infected with new coronavirus pneumonia

目的 探讨医务人员新型冠状病毒肺炎(简称新冠肺炎)的临床特征。方法 对江汉大学附属医院2020年1月10-3l日收治的感染新冠肺炎的30例该院医务人员的临床表现、实验室、影像学资料进行分析。结果 30例医务人员感染者分别是医生22例, 护士8例;男10例,女20例,年龄21~59岁,平均(35±8)岁;普通型26例,重症4例,均有近距离(1m内)接触新冠肺炎患者的直接接触史,平均接触次数12(7,16)次,平均累计接触时间2(1.5,2.7)h。30例患者临床症状包括发热23例(76.67%),头痛16例(53.33%),乏力或全身酸痛21例(70%),恶心、呕吐或腹泻9例(30%),咳嗽25例(83.33%),呼吸困难14例(46.67%)。血白细胞(WBC)<4.0×109/L者8例(26.67%),(4~10)×109/L者22例(73.33%),病程中出现WBC>4.0×109/L的患者4例(13.33%);淋巴细胞计数<1.0×109/L者12例(40%);肝功能异常者7例(23.33%);心肌受损者5例(16.67%),D-二聚体>0.5 mg/L者5例(16.67%)。与普通型患者相比,重症患者平均接触次数、累计接触时间、BMI值、平均热程、白细胞计数、肝酶、LDH、肌酶及D-二聚体显著升高,外周血淋巴细胞计数及白蛋白水平显著降低。胸部CT主要表现为多发小斑片影及间质改变,累及单肺者11例(36.67%),累及双肺者19例(63.33%),其中4例(13.33%)表现为典型的双肺弥漫性磨玻璃样改变。与防护期感染者相比,未防护期感染者重症比例增加,病灶累及双肺者增多。结论 医务人员具有感染新冠肺炎的高风险,感染几率与接触患者时间、吸入病毒量相关,重症患者的BMI增高、平均热程长、白细胞计数、淋巴细胞计数、D-二聚体、白蛋白水平明显改变,更易并发肝功能异常、心肌受损,加强防护是预防医务人员感染的重要措施。

Objective To investigate the clinical characteristics of medical staff with novel coronavirus pneumonia(NCP).Methods 30 patients infected with novel coronavirus referred to jianghan university hospital between January 11,2020 and January 3,2020 were studied.The data reviewed included those of clinical manifestations,laboratory investigation and Radiographic features.Results The patients consisted of 10 men and 20 women,including 22 doctors and 8 nurses,aged 21~59 years(mean 35±8 years).They were divided to 26 common type and 4 severe cases,all of whom had close(within 1m)contact with patients infected of novel coronavirus pneumonia.The average contact times were 12(7,16)and the average cumulative contact time was 2(1.5,2.7)h.Clinical symptoms of these patients were fever in 23 patients(76.67%),headache in 16 petients(53.33%),fatigue or myalgia in 21patients(70%),nausea,vomiting or diarrhea in 9 petients(30%),cough in 25 petients(83.33%),and dyspnea in 14 petients(46.67%).Routine blood test revealed WBC<4.0×109/L in 8 petients(26.67%),(4-10)×109/L in 22 petients(73.33%),and WBC>4.0×109/L in 4 petients(13.33%)during the disease.Lymphocyte count<1.0×109/L occurred in 12 petients(40%),abnormal liver function in 7 petients(23.33%),myocardial damage in 5 petients(16.67%),elevated D-dimer(>0.5mg/l)in 5 patients(16.67%).Compared with normal patients,the average exposure times,cumulative exposure time,BMI,Fever time,white blood cell count,liver enzyme,LDH,myoenzyme and D-dimer were significantly increased in severe patients,while the lymphocyte count and albumin levels in peripheral blood were significantly decreased.Chest CT mainly showed patchy shadows and interstitial changes.According to imaging examination,11 patients(36.67%)showed Unilateral pneumonia and 19 patients(63.33%)showed bilateral pneumonia,4 patients(13.33%)showed bilateral multiple mottling and ground-glass opacity.Compared with the patients infected in the protected period,the proportion of severe infection and bilateral pneumonia were both increased in the patients infected in unprotected period.Conclusion Medical staffs are at higher risk of infection.Infection rates are associated with contact time,the amount of suction virus.Severe patients had BMI increased,heating time prolonged,white blood cell count,lymphocyte count,D-dimer and albumin level significantly changed and were prone to be complicated with liver damage and myocardial damage.Strict protection measures is important to prevent infection for medical workers.