重症SARS患者的临床特点与治疗经验

The clinical characteristic features and the experience of treatment of the critical SARS patients

目的 :探讨重症SARS患者的临床特点及治疗上的特殊性。方法 :回顾性分析我院SARS ICU收治的 36例重症SARS患者的临床资料。结果 :36例重症SARS患者中 ,18例 (5 0 % )年龄 >5 0岁 ,5 8.3%的患者有家庭聚集性发病倾向 ,6 1.1%的患者有明确的基础疾病 ,97.2 %的患者发病初期有明确的高热症状 (≥ 38℃ ) ,83.3%、72 .2 %、5 5 .6 %及 4 4 .4 %的患者分别存在淋巴细胞亚群、心肌酶、肝功及血糖的异常 ,77.8%的患者有X线胸片双肺同时受累的改变 ,86 .1%的患者治疗中使用了肾上腺糖皮质激素 ,30 .6 %及 13.9%的患者救治过程中分别使用了无创或有创通气方式 ,4 1.7%的患者治疗过程中出现了不同程度的合并症。结论 :重症SARS患者病情复杂 ,治疗难度大 ,及早联合治疗能收到很好的临床效果。

Objective:To explore the clinical characteristic features and the effective treatments of the critical SARS patients in ICU. Methods: To analyze the clinical documents of 36 SARS patients in ICU of our hospital by using Retrospective survey study. Results:In all of the 36 SARS patients in ICU, the age of 18 cases (50%) were over 50 years, 58.3% of the patients belong to family collective outbreak, 61.1% of the patients categorically had basic diseases, 97.2% of the patients began with obvious high fever (KT≥38℃). 83.3%, 72.2%, 55.6% and 44.4% of the patients were with abnormal T- lymphocyte subgroup, myocardial enzyme, liver function and blood glucose, respectively. 77.8% of the patients had showed pulmonary involvement on chest X-ray film. Different dosage of glucocorticosteroids had been used for 86.1% of the patients in the process of treatment. Non-invasive positive pressure ventilation (NIPPV) and the invasive ventilation (IV) were used for 30.6% and 13.9% of the SARS patients, respectively, in the process of treatment. Complications occurred in 41.7% of the patients during the process of the treatment. Conclusion: The condition of the critical SARS patients were complicated and their treatment was difficult. A good clinical result can be achieved if the combined treatment has been used early.