12例SARS患者死亡危险因素分析

Analysis of mortal risk factors in 12 patients with severe acute respiratorysyn drome

目的 :探讨严重急性呼吸综合征 (SARS)患者的死亡危险因素。方法 :采用回顾性调查方式 ,对 12例SARS死亡患者和 3 2例治愈病例 (对照组 )进行分析比较。结果 :12例 SARS死亡患者平均年龄为 67岁 ,治愈对照组平均年龄仅为 42岁 ,而且死亡组中有 5例患者存在 1～ 5种基础疾病。 SARS存活患者 CD+4 (4 16.6±2 3 5 .0 )个 /μl、CD+8(2 96.1± 181.5 )个 /μl;死亡患者的 CD+4 (14 3 .8± 78.1)个 /μl,CD+8(10 3 .6± 63 .2 )个 /μl;较正常参考值均有下降 ,但死亡组的 CD+4 、CD+8下降更为显著。死亡组 12例合并细菌感染 5例 ,其中真菌感染3例 ,败血症 2例 ,出现电解质紊乱和肾脏损害率为 41.67% ,明显高于治愈对照组 3 .12 %。应用有创呼吸机患者的病死率高达 80 .0 % ,且 5例患者继发肺部细菌性感染 ;而应用无创呼吸机者无一例死亡。结论 :年龄及基础疾病是 SARS患者死亡的最主要危险因素 ;患者机体免疫功能低下、继发感染。

Objective: To investigate the risk factors in the dead patients with se vere acute respiratory syndrome (SARS). Methods: The retrospective analyses were m ade on 12 dead cases and 32 recovered cases with SARS. Results: The mean age was 6 7 years old in 12 dead cases with SARS and was 42 in recovered control group . The re were 15 other basic diseases in 5 cases of death group. The state s of dead patients w ere severe and the deterioration of patients' condition was rapid. T he CD + 4 and CD + 8 T lymphocytes in p eripheral blood were (416 6±235 0) cells/μl and (296 1±181 5)ce lls/μl in survival patients and (143 8± 78 1) cells/μl, (103 6 ±6 3 2) cells/μl in dead patients, they often decreased compared to the norma l values, especially in dead cases. Five ca ses were infected with bacteria in 12 dead cases, among them 3 were infected wit h fungus and 2 were septicemia. In dead group, the occurrence rates of electroly te maladjustment and kidney injury were 41 67 percent. Invasive ventilation was used in 10 cases and death rate was 80 0 percent, among them 5 patients were infected with bac teria. None was dead in the patients with noninvasive ventilation . Conclusion: The age and basic diseases are the main mortal risk factors in SARS. Other risk factors include the decline of immune function, secondary infection, compli cations and use of invasive ventilation.