严重急性呼吸综合征的后期并发症及其处理策略

Complications at the anaphase of the critical severe acute respiratory syndrome and its treating strategies

目的 总结严重急性呼吸综合征 (SARS)患者后期出现的并发症 ,分析其发生并发症的原因 ,并探讨其处理策略。方法 回顾性分析 10例重症SARS患者的基础疾病状况、并发症、治疗经过和预后。结果 5例患者合并有慢性基础疾病 ,10例患者均长期使用糖皮质激素和广谱抗生素 ,所有患者都出现了急性呼吸功能衰竭 ;经抗感染、呼吸支持和其他综合治疗 1个月左右 ,有 4例患者仍然存在着急性呼吸功能衰竭 ,8例患者血清CD4和CD8水平低于正常范围 ,7例有继发高血糖表现 ,2例继发高血压 ;出现重度营养不良和严重电解质紊乱 1例 ,精神行为异常者 1例 ,气胸 3例 ;8例患者发生了院内获得性肺炎 (HAP) ,其中 3例发展为多器官功能障碍综合征 ;总的死亡率为 30 % (3/10 )。结论 重症SARS患者后期并发症多 ;合并慢性基础疾病、机体免疫力受损、长期大剂量使用激素和广谱抗生素是SARS后期出现并发症的主要原因 ;合理使用糖皮质激素和抗生素、提高机体的免疫力、积极地处理合并症和并发症是治疗重症SARS后期患者的关键。

ObjectiveTo analyse the causes and to evaluate treating strategies of the patients occurring at the anaphase of the critical severe acute respiratory syndrome (SARS) by summarizing their complications.MethodsTo analyse retrospectively the underlying condition,complications,treating process and prognosis of 10 critical SARS patients.Results5 had the underlying condition, 10 cases had used high doses of glucocorticoid and broad-spectrum antibiotics for a long time,all of them had acute respiratory function failure.After anti-infection ,ventilation support and other colligating therapies for about a month,4 cases had still acute respiratory function failure, CD4 and CD8 serum level of 8 cases was lower than the normal, 7 had secondary hyperglycemia ,2 had secondary hypertension,1 had severe malnutrition and electrolyte disturbance,1 had psyche and behaviour disorder,3 had pneumothorax; 8 had hospital acquired pneumonia, 3 of 8 developed to be mutiple organ dysfunction syndrome;total mortality was 30%(3/10). ConclusionThere were many complications at the anaphase of the critical SARS patients; The major causes that induced complication included chronic underlying condition ,defected immunity,long use of high doses of glucocorticoid and broad-spectrum antibiotics;the key to treat patients at the anaphase of the critical SARS were to treat actively the underlying diseases and complications,to improve immunity, and to use reasonable antibiotics and glucocorticoid.