四川省20例重症新型冠状病毒肺炎的流行病学和临床特征分析

Epidemiological and clinical characteristics of 20 severe cases of coronavirus disease 2019 in Sichuan Province

目的分析重症新型冠状病毒肺炎确诊病例的流行病学和临床特征,为临床诊治提供参考依据。方法回顾性分析2020年1月16日-2月5日成都市公共卫生临床医疗中心收治的20例重症新型冠状病毒肺炎患者的流行病学、临床表现、实验室检查、胸部影像学及治疗转归。结果20例重症新型冠状病毒肺炎患者中,男12例,女8例;年龄34~84岁,平均(57.4±16.5)岁;13例(65.0%)患者有1种或多种并存疾病,包括高血压(9例)、糖尿病(6例)及冠状动脉粥样硬化性心脏病(4例)等。11例患者(55.0%)有武汉居住或旅行史,4例患者(20.0%)有湖北省非武汉地区居住史,3例患者(15.0%)有确诊患者接触史,2例患者无上述流行病学史但均有非疫区旅游史。患者以发热(100.0%)、咳嗽(100.0%)、气促(75.0%)及乏力(65.0)为主要症状,部分患者在发病后第3~10天进展为急性呼吸窘迫综合征。患者的白细胞计数正常或者降低,超敏C反应蛋白和血清淀粉样蛋白明显升高,而CD4+T淋巴细胞计数和自然杀伤细胞(CD56+)计数明显下降。胸部影像学检查提示患者双肺感染病灶广泛,进展迅速。16例(80.0%)采用经鼻高流量吸氧[其中6例(30.0%)经鼻高流量吸氧病情无改善后转为无创呼吸机支持呼吸],3例(15.0%)行气管插管呼吸机辅助通气,1例(5.0%)行气管插管呼吸机辅助通气联合体外膜肺氧合。截至2020年4月8日,死亡3例,余17例均已治愈出院,平均住院日为21.4 d。3例死亡患者均为老年并合并心脏病、肺病等基础疾病。结论重症新型冠状病毒肺炎多合并高血压、糖尿病、心脏病等基础疾病,部分患者进展为急性呼吸窘迫综合征,呼吸支持有利于改善预后。

Objective To analyze the epidemiological and clinical characteristics of severe cases of coronavirus disease 2019(COVID-19)in order to provide reference for clinical diagnosis and treatment.Method The epidemiological histories,clinical characteristics,laboratory examinations,chest images,and treatment outcomes of 20 confirmed cases of severe COVID-19 admitted to Public Health Clinical Center of Chengdu from January 16 th to February 5 th,2020 were retrospectively analyzed.Results Among the 20 patients with severe COVID-19,12 were male and 8 were female.The age ranged from 34 to 84 years old,with an average of(57.4±16.5)years old.Thirteen patients(65.0%)had one or more co-existing diseases,such as hypertension(9 cases),diabetes(6 cases),and coronary atherosclerotic heart disease(4 cases).Eleven cases(55.0%)had a history of living or traveling in Wuhan,4 cases(20.0%)had a history of living in non-Wuhan areas of Hubei Province,3 cases(15.0%)had a history of contact with confirmed COVID-19 patients,while 2 cases had no above-mentioned epidemiological history,but had a history of traveling in nonepidemic areas.The main symptoms were fever(100.0%),cough(100.0%),shortness of breath(75.0%),and fatigue(65.0).Some patients developed into acute respiratory distress syndrome in 3-10 d after onset.The white blood cell count of the patients was normal or decreased,the hypersensitive C-reactive protein and serum amyloid protein significantly increased,while the CD4+T lymphocyte count and CD56+natural killer cell count significantly decreased.Sixteen patients(80.0%)were given transnasal hyperbaric oxygenation[among whom 6 patients(30.0%)were transferred to non-invasive ventilator after no improvement],3 patients(15.0%)were given tracheal intubated ventilator,and 1 patient(5.0%)was treated by tracheal intubated ventilator combined with extracorporeal membrane oxygenation to support breathing.By April 8 th,2020,3 patients died and the remaining 17 had been cured and discharged,with an average length of hospital stay of 21.4 d.The 3 death cases were all elderly with underlying diseases such as heart disease and pulmonary disease.Conclusions Severe COVID-19 is associated with hypertension,diabetes,heart disease,and other basic diseases,and some patients develope acute respiratory distress syndrome.Respiratory support may help to improve prognosis.