SARS-CoV-2感染对高龄患者消化系统影响的临床分析

Clinical analysis of the effect of SARS-CoV-2 infection on digestive system in elderly patients

目的分析高龄患者感染SARS-CoV-2对消化系统功能的影响,为高龄COVID-19患者的临床诊治及降低病死率提供参考和思路。方法收集2022年4月17日至2022年5月30日我院收治的67例感染SARS-CoV-2高龄患者的临床资料,回顾性分析轻型、普通型、重型/危重型高龄患者的基本临床特征、消化道症状及实验室检查指标、治疗情况、预后等。结果共纳入67例高龄COVID-19患者,年龄(78.12±5.33)岁,男29例(43.28%),女38例(56.72%)。轻型13例(19.40%),普通型48例(71.64%),重型4例(5.97%)及危重型2例(2.99%)。所有患者均患有慢性基础疾病。疫苗接种完成1剂18例(26.87%),完成2剂13例(19.40%),未接种36例(53.73%)。未接种疫苗组患者轻型、普通型、重型/危重型发生率比较,差异有统计学意义(P<0.05)。57例(85.07%)有食欲减退表现,其中22例(32.84%)为首发症状。腹泻19例(28.36%)、恶心13例(19.40%)、呕吐11例(16.42%)、腹胀8例(11.94%)、反酸4例(5.97%)、腹痛2例(2.99%)、便血1例(1.49%)。各临床分型组消化道症状的发生率比较,差异无统计学意义(P>0.05)。轻型、普通型、重型/危重型患者肝功能比较,差异均无统计学意义(P>0.05)。三组患者的ALB、D-二聚体、IL-6比较,差异有统计学意义(P<0.05)。轻型、普通型、重型/危重型组的抗病毒药物治疗、抗凝治疗比较,差异无统计学意义(P>0.05)。其中肠内营养治疗各型比较,差异有统计学意义(χ^(2)=1.432,P=0.032)。核酸转阴时间(7.21±4.76)d,轻型、普通型、重型/危重型比较,差异有统计学意义(F=3.247,P=0.017)。结论高龄COVID-19患者合并慢性基础疾病,早期消化系统症状不典型,如食欲下降、腹泻等容易被忽视,重视高龄患者消化系统功能的评估和治疗有助于治疗效果的改善。

Objective To analyze the effect of SARS-CoV-2 infection on digestive system function in elderly patients,so as to provide reference and ideas for clinical treatment of elderly patients with COVID-19 and reducing mortality.Methods To collect the clinical data of 67 elderly patients with COVID-19 admitted in our hospital from Apr.17th,2022 to May 30th,2022.The basic clinical features,digestive system symptoms,laboratory indexes,treatment and prognosis of mild,common,severe and critical elderly patients were analyzed retrospectively.Results A total of 67 elderly patients with COVID-19 were included,with the age of(78.12±5.33)years old.There were 29 males(43.28%)and 38 females(56.72%).There were 13 light patients(19.40%),48 common patients(71.64%),4 severe patients(5.97%)and 2 critical patients(2.99%).All patients had chronic underlying diseases.18 cases(26.87%)completed one dose of vaccine,13 cases(19.40%)completed two doses,and 36 cases(53.73%)were not vaccinated.There was significant difference in the incidence of mild,common,severe and critical cases among the patients in the unvaccinated group(P<0.05).57 cases(85.07%)had anorexia,of which 22 cases(32.84%)were the first symptom.There were 19 cases(28.36%)of diarrhea,13 cases(19.40%)of nausea,11 cases(16.42%)of vomiting,8 cases(11.94%)of abdominal distension,4 cases(5.97%)of acid regurgitation,2 cases(2.99%)of abdominal pain,and 1 case(1.49%)of bloody stool.There was no significant difference in the incidence of gastrointestinal symptoms among the clinical classification groups(P>0.05).There was no significant difference in liver function among the three groups(P>0.05).There were significant differences in ALB,D-dimer and IL-6 among the three groups(P<0.05).There was no significant difference in antiviral and anticoagulant therapy among mild,common,severe and critical groups(P>0.05).There was significant difference among different types of enteral nutrition(χ^(2)=1.432,P=0.032).The time of nucleic acid turning negative was(7.21±4.76)days.There was significant difference among mild,common,severe and critical types(F=3.247,P=0.017).Conclusion The elderly patients with COVID-19 complicated with chronic basic diseases and atypical digestive system symptoms,such as decreased appetite and diarrhe-a,are easy to be ignored.Paying attention to the evaluation and treatment of digestive system function in elderly patients will help to improve the treatment effect.