SARS第二峰的临床表现和处理

Clinical features and management of recurrence of severe acute respiratory syndrome

目的 :探讨严重急性呼吸综合征 (severeacuterespiratorysyndrome ,SARS)第二峰的临床特征及治疗反应。方法 :回顾性分析 2 0 0 3年 4月至 5月间我院收治的SARS患者出现第二峰的情况 ,了解其临床特征以及发生的相关因素。分析出现第二峰的患者对治疗的反应以及预后。结果 :从 2 0 0 3年 4月 8日到 2 0 0 3年 5月 14日期间共收治SARS患者 12 3例 (重症患者 5 1例 ) ,其中出现第二峰者 2 5例 ,占患者总数的 2 0 .3% ,重症患者中出现第二峰者16例 ,占重症患者的 31.4 %。临床特征包括发热、呼吸困难、肺部新出现浸润影和乳酸脱氢酶水平的异常。出现第二峰的患者均使用糖皮质激素治疗 ,使用机械通气治疗 11例。其中 2 1例患者痊愈 ,2例患者遗留明显肺纤维化 ,2例死亡。结论 :SARS第二峰是重症SARS的主要表现之一 ,发病机制不明。激素和无创通气治疗可以有效地控制病情。

Objective:To investigate the clinical features of recurrence of severe acute respiratory syndrome (SARS) and therapeutic response. Methods: Recurrence was analyzed retrospectively in SARS patients referred to our hospital from April to May this year to understand the clinical features, the recurrent related factors, the response of treatment and the outcomes. Results: One hundred and twenty three patients with SARS were referred to the First Hospital of Peking University from 8, April to 14, May this year and of whom 51 were the critical. Twenty five patients experienced recurrence, account for 20.3% of total patients (25/123) and 31.4% of critical patients. The clinical features included recurrent fever, worsened breathlessness, exacerbation in radiological lesions and elevated LDH, etc. . These patients were treated with glucocorticoids. Eleven of them were mechanical ventilated. Twenty one patients recovered. Pulmonary fibrosis were left in 2 patients and another 2 patients died. Conclusion: The recurrence of symptoms in SARS patients is one of the common clinical feature of critical patients with SARS. Mechanism of recurrence in SARS patient is unknown. Management with glucocorticoids and noninvasive ventilation can control the progression in these patients effectively.