传染性非典型肺炎(IAP)临床诊断与治疗初步探讨——附186例临床资料分析

Clinical diagnosis and treatment of 186 patients with severe acute respiratory Syndrome

目的探讨广州地区传染性非典型肺炎临床诊断和治疗方法。方法对2003年1月～5月广州地区确诊为传染性非典型肺炎186例病人的临床资料和治疗效果进行回顾性分析。结果 186例患者多有近距离接触传染源史,潜伏期1～11天,163例以发热为首发症状,155例全身乏力,半数以上病人有咳嗽、气促,可伴有畏寒、头晕头痛,肌肉、关节酸痛,心悸。48例(占25.8％)白细胞计数减少,68例(占36.6％)血小板计数减少,177例(占95.2％)外周血淋巴细胞绝对值计数正常。T-淋巴细胞亚群检测显示CD_3^+,CD_4^+,CD_8^+细胞数量均明显减少。X线胸片全部病例均有不同程度渗出阴影。应用左氧氟沙星、阿奇霉素、美满霉素基础上,早期持续低流量鼻管吸氧和早期规律合理使用皮质激素治疗能有效地缩短发热时间,改善全身中毒症状,减少气促,减少肺纤维化,防止和控制急性呼吸窘迫综合征(ARDS)的发生。本组病人治疗(包括好转)率94.6％,死亡率5.4％。结论本病由变异冠状病毒引致,以呼吸道传播为主,传染性极强的呼吸道传染病。应用针对性综合治疗能有效提高治疗率。

Objective To study the diagnosis and treatment of severe acute respiratory syndrome. Methods Clinical data from 186 patients suffered from SARS in Guangzhou area during January and May were retrospective analyzed. Results All of 186 patients had history of close contact with diagnosed SARS patients.The incubation period range from 1 to 11 days. 163 of them have fever, 155 of them have malaise, more than 50 percent of them have cough, shortness of breath, headache, myalgia. Peripheral vein blood test showed leukopenia in 48 patients (25.8%), thrombopenia in 68 patients (36.6%), normal lymphocytes in 177 patients (95.2%) . CD3+,CD4+, CD8+ lymphocytes in peripheral blood decreased apparently.Infiltrates on chest radiography was seen in all the patients.Patients received levofloxadne, azithromycin or minocycline, Treatment of inspiring oxygen and using glucocorticoid early cna shorten the duration of fever, reduce incidence of acute respiratory distress syndrome (ARDS) and pulmonary fibrosis.Death - rate is 5.4% in toad 186 patients.Conclusions SARS is a severe communicable disease by variant coronavirus.General combination therapy can be effective.