重症SARS的临床特点和胸部X线表现

Clinical characteristics and chest X-ray manifestations in SARS

目的 总结和观察重症SARS的临床特点和胸部X线表现。方法 对我院经临床诊断为重症SARS的 2 4例患者的临床和胸部X线资料进行回顾性分析。结果 2 4例重症SARS患者中高热 2 4例(10 0 % ) ,呼吸困难 2 3例 (95 8% ) ,干咳 19例 (79 2 % ) ,胸闷、胸痛 17例 (70 8% )。 2例合并肝炎 ,1例合并糖尿病 ,1例同时伴有妊娠。外周血白细胞均正常或降低、淋巴细胞明显降低、低氧血症。胸部X线表现呈斑片状或小片状阴影 15例 (6 2 5 % ) ,大片状阴影 5例 (2 0 8% )及磨玻璃影 9例 (37 5 % ) ,肺纹理增粗 11例 (4 5 8% ) ;肺部病灶位于两肺者 18例 (75 % ) ,其中病灶位于两中、下肺野者 15例(6 2 5 % ) ,2例 (8 3% )同时并发肺不张 ;肺部病灶位于一侧肺者 6例 (2 5 % )。病情未得到有效控制时 ,病灶 2 4～ 4 8h内进展 >5 0 %者 14例 (5 8 3% ) ,且具有游走性。所有患者病灶吸收时间相对于非重症SARS明显延长 ,平均吸收时间为 19d。 8例 (33 3% )肺部渗出性病灶吸收后肺内有不同程度的纤维化改变。结论 重症SARS具有发热、咳嗽和呼吸困难以及外周白细胞正常和降低 ,CD4T淋巴细胞明显降低和低氧血症等特点。肺部X线表现以两中下肺野多叶多段、大小片状影为主 ;

Objective To summarize and observe clinical special characterstics and chest X ray manifestations in severe cases of SARS.Methods A retrospective analysis was done on clinical and chest X ray data of 24 patients proved by clinical diagnosis to be suffering form SARS.Results Among 24 severe cases with SARS,24(100%)had high fever,23(95 8%)suffered from dyspnea,19(79 2%)developed nonproductive cough,17(70 8%)complained of dullness and pain over the chest region.2 were complicated with hepatitis,1 was complicated with diabetes,while another one with pregnancy.Lab examinations revealed normal or slightly lowered white cell count in peripheral blood with significant decrease of lymphocytes and hypoxemia. Chest X ray manifestations included small patchy shadows in 15(62 5%)cases,large patchy shadows in 5 cases(20 8%)and 9 cases (37 5%)ground glass like foci and, coparse lung markings in 11(45 8%).18(75%)cases had both lungs involved,among whom 15(62 5%)showed involvement of middle and lower part of lungs on both sides 2(8 3%)among whom complicated simultaneously by pulmonary atelectasis.6(25%)cases had unilaterally located foci in one lung.Before the disease was controlled,there had been 14(58 3%) cases who had foci progress>50% within 24～48 hours,and lesions were migratory.Mean resolution time of foci in all cases was 19 days,apparently prolonged in relation of that for non severe cases.After resolution of infiltrative foci in the lungs,changes of fibrosis in 8 patients were still present to various extent.Conclusion Severe cases of SARS have fever,cough and dyspnea with either normal or slightly decrease of white cell count in peripheral blood;there are several special features such as an apparent fall of CD4T lymphocytes accompanied by hypoxemia.Manifestations of chest X ray examinations mainly show patchy shdows of various sizes, multiple migratory,and ground glass like foci.