成人重症新型冠状病毒肺炎患者临床特征及治疗分析

Clinical characteristics and treatment of adult critically ill patients with COVID-19

目的分析河北省成人重症新型冠状病毒肺炎(简称新冠肺炎)患者的临床特征与治疗措施.方法回顾性收集2020-01-22~2020-03-25河北省13家新冠肺炎定点医院收治的重症成人新冠肺炎患者的病例资料,分析患者的一般情况、流行病学、临床表现、实验室指标、胸部CT、并发症、治疗及预后.结果最终纳入51例患者,其中男性27例(52.9%),平均年龄(58.9±13.7)岁(25~85岁),以41~80岁多见.所有患者均无华南海鲜市场暴露史,其中40例(78.4%)有明确暴露史,以家庭聚集发病为主.33例(64.7%)合并基础疾病,以高血压病、冠心病及糖尿病为主.发热、干咳为主要临床表现,危重型多伴有咳痰、喘憋,其中48例(94.1%)出现发热,34例(66.7%)出现干咳,19例(37.3%)出现咳痰,18例(35.3%)出现喘憋.37例(72.5%)外周血白细胞正常或降低,42例(82.4%)中性粒细胞比率升高,42例(82.4%)淋巴细胞百分比降低,47例(92.2%)C-反应蛋白(C-reactive protein,CRP)升高,35例(68.6%)乳酸升高,42例(82.4%)血糖升高,80%以上的患者CD4^+、CD3^+及CD8^+T细胞计数下降.所有患者氧合指数均下降.重症患者肺部CT多表现为双侧磨玻璃影,危重型患者常出现肺部网格样变及下肺实变.所有的重症患者均给予抗病毒药物治疗,45例(88.2%)应用抗生素治疗,46例(90.2%)应用糖皮质激素治疗,20例(39.2%)接受呼吸机辅助通气.16例(31.4%)出现肺外并发症.最终46例(90.2%)好转出院.结论重症新冠肺炎患者以中老年为主,常合并基础疾病,以发热、干咳为常见症状,实验室检查多表现为白细胞正常或下降,淋巴细胞比率降低、免疫功能下降明显,肺部受损严重,均出现急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS),多数患者氧合指数<200 mm Hg.约三分之一患者出现肺外并发症,以心脏损伤、消化道出血和肾脏损伤为主,治疗方面以支持治疗为主,多数患者预后良好.

Objective To observe the clinical characteristics and treatment of severe patients with coronavirus disease 2019(COVID-19).Methods 51 critically ill patients with CO VID-19 from 13 designated hospitals of Hebei province between 2020-01-22 and 2020-03-25 were retrospectively reviewed.General conditions,epidemiology,symptoms,laboratory findings,chest computed tomography scan,complications,treatment and prognosis were analyzed.Results Among the 51 severe patients,27(52.9%)patients were males,the average age was(58.9±13.7)years old(ranging from 25 to 85),focused on 41-80 years old.No participant had a history of exposure to the Huanan seafood market,40(78.4%)patients could provide a history of contact,and the most of cases were familial clusters.There were 33(64.7%)patients with chronic underlying diseases,including mainly hypertension,coronary atherosclerotic heart disease and diabetes.The most common symptoms were fever and cough,expectoration and dyspnea were present in critically ill patients,48(94.1%)patients had fever,34(66.7%)patients had cough,19(37.3%)patients had expectoration and 18(35.3%)patients had dyspnea.White blood cell count was normal or decreased in 37(72.5%)patients,neutrophil rate was increased in 42(82.4%)patients,lymphocyte rate was decreased in 42(82.4%)patients,C-reactive protein(CRP),lactic acid and blood glucose were increased in 47(92.2%)patients,35(68.6%)patients and 42(82.4%)patients respectively.More than 80% of patients showed decreased CD4^+,CD3^+ and CD8^+ T cell counts.Oxygenation index was decreased in all patients.The most common chest CT imaging in critically ill patients was bilaterally ground glass opacities,and the severe patients had reticular change and consolidation of the lung.All the patients were treated with antiviral drugs,45(88.2%)patients with antibiotics,46(90.2%)patients with steroids,and 20(39.2%)patients with mechanical ventilation.Extra-pulmonary complications occurred in 16(31.4%)patients.Eventually,46(90.2%)patients were discharged.Conclusion The critically ill patients with COVID-19 are usually middle-aged and elderly,especially with underlying diseases.Fever and cough are the most common symptoms,and the lung is severely damaged.All the patients have acute respiratory distress syndrome(ARDS),and oxygenation index is less than 200 mm Hg in most patients.About one-third of the patients have extra-pulmonary complications such as heart injury,gastrointestinal bleeding and kidney injury.At present,supportive treatment is the main therapy,and most patients have a good prognosis.