41例医务人员严重急性呼吸综合征的临床特点分析

Clinical features of severe acute respiratory syndrome in forty-one confirmed health care workers

目的 探讨严重急性呼吸综合征 (SARS)的临床特点。方法 对我院 2 0 0 3年 3月中旬至 4月中旬收治的 4 1例医务人员SARS患者的临床资料进行回顾性分析。结果 患者年龄 2 3～ 5 5岁 ,平均 32岁。男 8例 ,女 33例 ;医生 13例 ,护理人员 2 8例。传播途径为近距离接触传播 ,过度劳累是发病诱因。以发热为首发症状者 30例 (73% ) ,乏力伴周身酸痛 10例 (2 4 % ) ,1例在体检时发现双下肺部炎症而整个病程无临床症状。 4 1例中危重型病例 2例 (5 % ) ,重型病例 4例 (10 % ) ,普通型35例 (85 % )。外周血白细胞计数 (× 10 9/L)在病程第 1周最低 ,为 4 4± 1 5 ,与第 2～ 4周的白细胞计数 (7 1± 5 2 ,11 0± 5 2 ,10 5± 4 5 )比较差异有显著性。血小板计数 (× 10 9/L)第 1周最低 ,为14 3± 37,与第 2～ 4周的血小板计数 (16 8± 85 ,2 5 4± 90 ,2 6 2± 10 9)比较差异有显著性。肝功能异常者 2 7例 (6 6 % ) ,以丙氨酸转氨酶升高为主 ,发生于病程第 3～ 4周者 19例 (70 % )。病程第 1天CT发现肺部病变者 30例 (73% ) ,累及双肺 15例 (37% )。应用糖皮质激素者 36例 ,31例 (86 % )用量为 80～ 2 4 0mg/d。使用人工通气者 2 7例 ,有创机械通气者 1例。死亡 2例 ,病死率为 5 %。结论 1/

Objective To investigate the clinical features of severe acute respiratory syndrome (SARS). Methods Forty-one medical care workers (aged 23-55 years, with a average of 32 years; men/women=8/32) who were admitted to our hospital and diagnosed with SARS during March and April, 2003 were retrospectively analyzed.Results Thirteen of all the patients were physicians and the rest were nurses.The disease was mainly transmitted through air droplet in a short distance, and overwork induced tiredness was involved in disease stimulation.Seventy-three percent of the patients presented fever as their first symptom.Ten patients complained inertia and myalgia.One patient showed no clinical symptoms, and bilateral infiltrates was found in his chest X-ray.Among the 41 cases, 6 (15%) were diagnosed as severe type.At the first week, the counts of white blood cells (WBCs), lymphocyte and platelets were (4.4±1.5)×10 9/L, 0.22±0.12 and (143±37)×10 9/L, which were significantly lower when compared with those at the 2nd to 4th week.Abnormal liver function was found in 27 cases (mostly with elevated serum ALT), with 70% occurred at the 3rd or 4th week.In terms of CT, 30 patients (73%) showed pathological changes in lungs, and bilateral lung involvement was found in 35.59 %.Of 36 cases treated with steroids, 86% received middle or low dosage (80-240 mg/d).Artificial ventilation was used for twenty-seven patients, and air pipe mechanical ventilation was used for 1 case.Mortality in this study was 5%.Conclusions Inertia and myalgia may be the earlier symptoms of health care workers with SARS include, which are parallel to CT manifestations.There is no objective index for the assessment of the severity of the disease at early stage.The medicine associated toxicities may be the main reason of liver lesions.damages.Middle or low dosage of steroid was reasonable to be used as early as possible.