106例重症急性呼吸综合征患者的临床特征与治疗总结

Clinical features and therapy of 106 cases of severe acute respiratory syndrome

目的 了解重症急性呼吸综合征 (SARS)的临床特点以及探索临床有效的治疗方法。方法 用前瞻性的方法对入院的 10 6例SARS病例临床资料进行总结。结果 10 6例患者男 5 6例 ,女5 0例 ;年龄 15～ 81岁 ,平均 (36± 10 )岁 ;多数病人都有发热 (98 1% )、畏寒 (75 5 % )、咳嗽 (71 7% )、头痛和胸闷憋气 (4 3 4 % )、腹泻 (2 4 5 % ) ,肺部有音者较少 (11 2 % )。WBC计数降低者占 34 0 % ,淋巴细胞计数减少者占 81 1% ,CD+ 4 T细胞减少者为 98 1% ,ALT增高者占 7 6 % ,血小板降低者少见(3 8% ) ;几乎所有病人在入院时或次日都有血氧分压下降 [<90mmHg(1mmHg =0 133kPa)者90 2 % ,<70mmHg者 2 8 6 % ];X线胸片表现为单侧局部肺部斑片状浸润者 34 0 % ,单侧多发肺部斑片状浸润者 11 3% ,双肺斑片状浸润者 4 6 2 %。临床治疗采取综合治疗的原则 ,包括以小剂量糖皮质激素 (甲泼尼龙 4 0～ 80mg,12h 1次 ) ,第二代头孢菌素、大环内酯类以及抗病毒药物为主 ,同时强调氧疗、对症及其基础病等的治疗。结论 SARS临床表现和实验室多样化 ,CD+ 4 T细胞测定有助于早期诊断 ,临床治疗以综合治疗为主 ,早期氧疗及小剂量激素治疗有较好的治疗效果。

Objective To investigate the clinical characteristics of severe acute respiratory syndrome(SARS) and find out its effective treatment. Methods A total of 106 cases of SARS were analyzed prospectively. Results In this group, 56 were male and 50 female , aged from 15 to 81 years [average (36±10)years]. Common symptoms included fever (98.1%), chills(75.5%), cough(71.7%), headache and breathless(both 43.4%), diarrhea(24.5%) and rare rales in the lungs(11.2%). Laboratory test showed leukopenia (34.0%), lymphopenia(81.1%) and an extraordinary decrease of CD +_4 T cells (98.1%) . Other rare abnormalities included liver injury(elevated alanine aminotransferase in 7.6%) and thrombocytopenia(3.8%). Almost all patients suffered from hypoxemia(PaO_2 less than 90mm Hg in 90.2%, less than 70mm Hg in 28.6 %). Chest radiographs showed that unilateral focal patchy involvement in 34.0% of the patients, and unilateral multifocal or bilateral involvement were 11.3 % and 46.2 % respectively. Treatment regimens included small doses of steriods(methylprednisolone 40～80 mg, q12 h recommended) accompanied with broad-spectrum antibiotics such as the second generation of cephalosporins and macrolides and some other antiviral drugs. Meanwhile, emphasis was placed on oxygen support and coping with their underlying diseases. Conclusions SARS has various presentations of clinical features and laboratory tests. Detection of CD +_4 T cell count is beneficial to diagnose SARS in early stage. Effective treatment includes various regimens, oxygen support and small doses of steroids .