新型冠状病毒肺炎疫情期间发热门诊重症患者的临床特征

Analysis of clinical characteristics of critically ill patients during prevention and control of new coronavirus pneumonia

目的分析新型冠状病毒肺炎防控期间发热门诊留观重症患者的临床特点,提高发热门诊重症患者的诊治水平。方法采用回顾性病例分析方法,采集2020年2-3月在解放军总医院第一医学中心发热门诊重症区收治的80例患者的临床资料,所有患者间隔24 h采集咽拭子标本行2次新型冠状病毒核酸检测。同时行甲、乙型流感病毒核酸联合测定,肺部计算机断层扫描(CT)检查。比较不同血白细胞计数组别患者的临床数据差异。结果所有患者新型冠状病毒核酸检测结果均为阴性,2例患者甲流病毒核酸检测为阳性。1例患者乙流病毒核酸检测为阳性。年龄>65岁患者有60例(75.00%),存在两种以上的基础性内科疾病患者47例(58.75%),肺部CT提示存在病变的患者70例(87.50%),出现急性肾损伤的患者30例(37.50%),与白细胞计数<10×109/L组的患者比较,白细胞计数≥10×109/L组的患者糖尿病比例升高(P=0.024),两组患者筛查留观时间、体温、氧合指数、急性肾损伤发生率差异无统计学意义。结论医院发热门诊的重症患者年龄大、基础疾病多、肺部普遍存在病变、留观筛查期间容易出现急性肾损伤,核酸检测是新型冠状病毒感染筛查最重要的鉴别诊断依据。

OBJECTIVE To analyze the clinical characteristics of critically ill patients during the prevention and control of new coronavirus pneumonia and to improve the diagnosis and treatment of critically ill patients with fever.METHODS A retrospective case analysis method was used to collect clinical data of 80 patients admitted to the critically ill area of fever clinic in the first medical center of PLA general hospital from February to March,2020.Pharyngeal swab specimens were collected from all patients at 24 h intervals and tested for new coronavirus nucleic acid twice.At the same time,a combination of influenza A and B virus nucleic acid were determined,and lung computer tomography scan examination were performed.The differences in clinical data of patients with different blood leukocyte count groups were compared.RESULTS All patients had negative results for new coronavirus nucleic acid tests,and 2 patients had a positive test for influnenza A virus nucleic acid.One patient was tested positive for hepatitis B virus nucleic acid.There were 60 patients(75.00%)with age over 65 years,47 patients(58.75%)with more than two basic medical diseases,70 patients(87.50%)with lung CT indicating lesions,30 patients(37.50%)with acute kidney injury.Compared with patients with while blood cell count<10×10~9/L,patients with WBC≥10×10~9/L had higher incidence of diabetes mellitus WBC(P=0.024).There was no significant difference in retention time,body temperature,oxygenation index,and incidence of acute kidney injury between two groups of patients.CONCLUSION The critically ill patients diagnosed in hospital had the characteristics of old age,many chronic diseases,widespread lung disease,and prone to acute kidney injury during screening.Nucleic acid detection is the most important differential diagnosis basis for the screening of new coronavirus infection.