武汉市71例新型冠状病毒肺炎死亡病例临床分析

Clinical analysis of 71 COVID-19 death cases in Wuhan

目的研究武汉市71例新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)死亡病例的临床特征,分析COVID-19病例死亡的可能影响因素。方法对武汉市第三医院收治的71例COVID-19死亡病例临床资料进行回顾性分析,使用SPSS 22.0软件进行统计学分析,比较疾病不同时期的实验室检测结果。结果武汉市71例COVID-19死亡病例中,男性居多(64.79%,46/71)。中位年龄为70.0岁,60岁以上者占81.69%(58/71)。有基础疾病者占76.06%(54/71),最常见的基础疾病为高血压(53.52%,38/71),最常见的临床症状为发热(85.91%,61/71)。入院时病型主要为重型(56.34%,40/71)。实验室检测结果显示:疾病终末期乳酸脱氢酶(LDH)[469.50(454.50~552.75)U/L]、血糖[9.95(6.83~13.95)mmol/L]较入院时LDH[144.00(123.75~273.25)U/L]、血糖[6.60(5.20~10.70)mmol/L]升高,差异有统计学意义(Z=-3.298、-2.542,P均<0.05)。终末期血气分析中的pH值[7.31(7.27~7.34)]、氧分压(PaO2)[45.00(35.00~56.00)mm Hg]较入院时pH值[7.38(7.34~7.41)]、PaO2[82.50(77.50~88.50)mm Hg]下降,二氧化碳分压(PaCO2)[59.00(48.75~60.75)mm Hg]较入院时[42.00(37.25~48.75)mm Hg]升高,差异有统计学意义(Z=-2.906、-3.296、-3.206,P均<0.05)。结论高龄和合并基础疾病在COVID-19死亡患者中占较高比例,疾病导致的肺损伤、低氧血症、心肌损伤、糖代谢异常均是COVID-19患者死亡的主要原因。监测实验室指标有助于COVID-19患者的预后判断。

Objective To study the factors influencing the death of the novel coronavirus disease 2019(COVID-19) patients in Wuhan city of China. Methods The clinical data of 71 COVID-19 death cases admitted and treated in the Third Hospital of Wuhan were retrospectively analyzed, and SPSS 22.0 software was used for statistical analysis to compare the laboratory results in different periods of the disease. Results Males(64.79%, 46/71) accounted for a large proportion of the 71 cases of COVID-19 deaths in Wuhan city of China.The median age was 70.0 years old, 81.69%(58/71) were over 60 years old.People with underlying diseases accounted for 76.06%(54/71), the most common underlying disease was hypertension(53.52%, 38/71), and the most common clinical symptom was fever(85.91%, 61/71).The majority of the patients were severe type(56.34%, 40/71) at the time when they were admitted to the hospital.According to the laboratory results, their lactate dehydrogenase(LDH) [469.50(454.50~552.75) U/L], blood glucose [9.95(6.83~13.95) mmol/L] at the end stage were higher than that at admission with LDH [144.00(123.75~273.25) U/L] and blood glucose [6.60(5.20~10.70)mmol/L](Z=-3.298,-2.542, both P<0.05).Blood gas analysis at the end stage showed that their pH value [7.31(7.27~7.34)], oxygen partial pressure(PaO2) [45.00(35.00~56.00) mm Hg] were lower than that at admission with the pH value [7.38(7.34~7.41)] and PaO2 [82.50(77.50~88.50)mm Hg].Meanwhile, their partial pressure of carbon dioxide(PaCO2) [59.00(48.75~60.75)mm Hg]was higher than that at admission[42.00(37.25~48.75)mm Hg](Z=-2.906,-3.296,-3.206,all P<0.05). Conclusions Elder age and combined underlying diseases account for a higher proportion of deaths.Lung injury,hypoxemia,myocardial injury,and abnormal glucose metabolism caused by the disease are the major causes of death in COVID-19 patients in Wuhan city of China.