严重急性呼吸综合征临床分型分期初步探讨

Initial study of clincial typing and staging in severe acute respiratory syndrome

目的 探讨严重急性呼吸综合征 (SARS)诊断的临床分型分期。方法 采用回顾性研究的方法 ,根据我院 16 2例SARS患者的主要临床特点提出分型分期 ,并与肺部X线影像学资料、淋巴细胞亚型的变化、血氧代谢及预后情况作对比参照。结果 将SARS临床诊断分为 4型 4期 ,即轻型、普通型、重型、极重型 ,典型的SARS病程经过又可分为早期 (前驱期 )、进展期、极期、恢复期。 16 2例中轻型 8例 (4.9% )、普通型 6 9例 (42 .6 % )、重型 4 1例 (2 5 .3% )、极重型 4 4例 (2 7.2 % )。肺部X线检查及淋巴细胞亚型和血气分析的变化情况与临床分型作对比参照 ,结果显示出较好的相关性 ,肺部病变越广泛、淋巴细胞总数及各亚群数越低下临床分型越严重 ,预后越差。结论 SARS的 4型 4期临床诊断基本概括了该病的临床特征 ,符合SARS病程发生、发展及转归的一般规律 ,将方便和规范临床诊断 ,有助于指导治疗和判断预后。

Objective To investigate the clinical typing and staging in diagnosis of Severe Acute Respiratory Syndrome (SARS). Methods Retrospective study was designed to analysis the principal clinical characteristic of SARS and the standard of clinical typing and staging was raised. Comparisons with X-ray in lung, change of lymphocyte subset, PaO_2, SaO_2,and prognosis of disease were performed. Results The standard of SARS clinical typing and staging is four types (light type, ordinary type, heavy type, serious type)and four phases (prodromal period, progres phase, fastigium, recovery phase). The light type is 8/162(4.9%), ordinary type is 69/162 (42.6%), heavy type is 41/162 (25.3%), serious type is (27.2%). Comparisons SARS clinical typing and staging with X-ray in lung, change of lymphocyte subset were found that the more lesion in lung, the lower lymphocyte and its subset, and more serious in clinical typing. Conclusions The standard of clinical typing and staging summarized basic clinical characteristic in SARS, and coincided with progress of SARS. The standard will be help of clinical diagnosis, treatment and judging the prognosis of SARS.