69例传染性非典型肺炎患者出院后初步随访报告

A Follow-up Study on 69 Cases of Discharged SARS Patients

目的:报道广东省中医院出院后随访的传染性非典型肺炎(严重急性呼吸综合征,SARS)患者的健康状况及相关的检测指标结果,为制订该人群康复治疗的中西医结合措施提供科学依据。方法:采用随访问卷和血常规、肝肾功能、免疫功能、肺功能、胸部螺旋CT、心脏彩色B超检测,运用描述性分析及推断性分析进行处理。结果:69例随访对象中,5例有肝功能损害,18例显示免疫功能有一定程度降低;肺功能检测提示该病对患者的大气道通气功能影响不大,而15例小气道通气功能障碍,40例残气容积增加、14例轻度肺弥散功能障碍,24例患者遗留肺炎吸收不全、局灶或多发性间质病变、肺间质纤维化、胸膜粘连等,34例出现肺循环阻力升高,或轻度肺动脉高压,或左心室心肌节段性缺血。2例视力下降。中医证候分类:气阴两虚证24例,心脾两虚证8例,肝郁脾虚证37例;夹湿热证18例,夹血瘀证7例。部分患者存在精神心理影响。结论:部分SARS患者出院后仍见心、肺、肝功能损害,免疫功能降低,精神心理影响。随访结果提示对已治愈出院的SARS患者应结合中医证候类型进行必要的康复治疗。

Sixty-nine patients with severe acute respiratory syndrome (SARS) discharged from Guangdong Provincial TCM Hospital were followed up from January to April 2003 during which the patients were asked to fill the questionnaire form and at the same time received blood routine examination,hepatic,renal, pulmonary and immune function tests,and spiral computerized tomography (CT) of the chest,color B- ultrasonography of the heart with the collected data treated by descriptive analysis and deductive analysis. The results showed that in the 69 followed-up patients,impairment of the hepatic function was found in 5 cases,hypoimmune state in 18,impediment of ventilation in the distal air passages with normal major air passages in 15,increased residual volume in 40,mild disturbance of pulmonary diffusion function in 14, incomplete absorption of inflammatory exudates,focal or multiple interstitial lesions,pulmonary interstitial fibrosis and pleural adhesion in 24;increased resistance or mild systolic hypertension in the pulmonary circulation,and segmental ischemia of the left myocardium in 34;and decreased visual acuity in 2.According to TCM differentiation 24 cases belonged to the type of deficiency of both qi and yin,8 deficiency of both the heart and spleen,37 depression of the liver and deficiency of the spleen,18 intermingling with damp-heat,and 7 intermingling with stagnant blood.Some patients still had psychological problems.The study indicates that though clinically cured and discharged from hospital, some SARS patients have functional impairment of the heart,lung and liver,hypoimmune state as well as psychological problems,and need to be treated accordingly for a complete recovery.A rationale for suggested TCM treatment is expounded.