重症新型冠状病毒肺炎患者的临床特征分析

Analysis of clinical features of the patients with severe coronavirus disease 2019

目的分析重症新型冠状病毒肺炎(COVID-19)患者的临床特征.方法收集广州市第八人民医院2020年1月至3月收治的52例重症COVID-19患者的临床资料,回顾性分析患者一般情况、临床症状、实验室检查、影像学资料、治疗及预后.结果本研究共纳入52例重症患者,重型组37例,危重型组15例,平均年龄(60.25±11.89)岁,其中男性33例(63.5%).既往有基础疾病患者34例(65.4%).临床症状为发热44例(84.6%),咳嗽27例(51.9%),气促6例(11.5%),乏力5例(9.6%),胸闷1例(1.9%),腹泻1例(1.9%).与重型组相比,危重型组患者降钙素原、白细胞计数、中性粒细胞计数、中性粒细胞计数/淋巴细胞计数、凝血酶原时间、D-二聚体、总胆红素、乳酸脱氢酶、尿素均明显升高,淋巴细胞计数、淋巴细胞百分比、血红蛋白、血小板计数、白蛋白均明显降低,差异有统计学意义(P<0.05).胸部影像结果显示双侧病变46例(88.5%),单侧病变6例(11.5%).截至3月31日,经积极治疗本研究中重型组患者均治愈出院,危重型组死亡1例,治愈出院患者1例,余13例仍在治疗中.结论重症COVID-19在老年人和存在基础病者中的发生风险更高.与重型组相比,危重型组更容易发生混合感染,同时凝血功能、营养状况、肝肾功能总体比重型组差,预后差.重症患者应及早开展积极的综合治疗,提高治愈率,降低死亡率.

Objective To analyze the clinical features of severe coronavirus disease 2019(COVID-19)patients.Methods The clinical data of 52 patients with severe COVID-19 were collected from January to March 2020 in the Eighth People's Hospital of Guangzhou.The general conditions,clinical symptoms,laboratory tests,imaging data,treatment and prognosis of the patients were retrospectively analyzed.Results A total of 52 severe COVID-19 patients were divided into 37 severe cases and 15 critical cases in this study,among them 33(63.5%)cases were male,34(65.4%)cases had previous underlying disease.The average age was(60.25±11.89)years.There were 44(84.6%)cases with fever,27(51.9%)cases with cough,6(11.5%)cases with shortness of breath,5(9.6%)cases with weakness,1(1.9%)case with chest tightness,and 1(1.9%)case with diarrhea in the 52 severe patients.Compared with the severe group,the procalcitonin,white blood cell count,neutrophil count,neutrophil count/lymphocyte count,prothrombin time,D-dimer,total bilirubin,lactate dehydrogenase and urea were significantly increased,and the lymphocyte count,lymphocyte percentage,hemoglobin,platelet count,and albumin were significantly reduced in the critical group(P<0.05).Chest imaging results showed 46(88.5%)cases had bilateral lesions and 6(11.5%)cases had unilateral lesions.With the active treatment,all the patients of severe group in this study were cured and discharged.But in the critical group,one patient died,one patient was cured and discharged,and the remaining 13 patients were still under treatment.Conclusion Severe COVID-19 easily occurs in the elderly and those with underlying disease.Compared with the severe group,the critical group is more likely to have mixed infections and poor prognosis.At the same time,the coagulation function,nutritional status,liver and kidney function are generally worse in the critical group than those in the severe group.Therefore,for the severe COVID-19 patients,active comprehensive treatment should be carried out early so as to improve cure rate and reduce the mortality.