广州地区33例儿童严重急性呼吸综合征临床特点和治疗转归

Clinical characteristics and prognosis of 33 children with severe acute respiratory syndrome in Guangzhou area

目的 分析儿童严重急性呼吸综合征 (SARS)的临床特点及治疗转归。方法 分析2 0 0 3年春广州地区 33例SARS的临床症状、体征、实验室检查、治疗、病情经过及转归。结果 33例中有明确SARS接触史者 5例 (1 5 % ) ,5例 (1 5 % )患儿患病后其密切接触者出现发热和 (或 )咳嗽。SARS病例 3～ 1 2岁儿童占 82 %。主要表现为发热 (1 0 0 % )和咳嗽 (91 % ) ,多为高热、干咳。外周血白细胞总数 (2 5～ 9 7)× 1 0 9/L ,以淋巴细胞为主者 1 8例。外周血白细胞总数 <5 0× 1 0 9/L者 2 2例 (67% ) ;外周血白细胞总数 (5 0～ 7 0 )× 1 0 9/L者 1 0例 (30 % )。肺部细湿 1 9例 (58% ) ,肺部无音者 1 4例 (42 % ) ,胸X线片均表现为斑片状局灶性浸润性阴影 ,单侧病变者 1 5例 ,双侧病变者 1 8例。肺部病灶变化快 ,随病程进展而加重 ,部分患儿由单侧发展为双侧 ;肺部阴影消退较慢 ,明显吸收好转平均需 2周时间。ALT升高者 3例 ,CK MB升高者 2例。给予隔离、通风、充分休息、加强营养、低流量吸氧、中药清热解毒、预防细菌感染、抗炎症因子等综合治疗。住院天数 (1 0 0± 3 8)d。全部病例临床治愈出院。结论 儿童SARS有其自身临床特点 。

Objective Since the outbreak of a highly contagious new pneumonia, atypical pneumonia or severe acute respiratory syndrome (SARS) occurred in Guangzhou area, 33 children with this syndrome were treated in the authors′ hospital The present study aimed to understand clinical characteristics and prognosis of pediatric SARS patients in Guangzhou area Methods Clinical manifestations, laboratory and radiologic findings, therapeutic approaches and prognosis of the 33 children with SARS in Guangzhou area were analyzed Results Of the 33 cases, 17 were males and 16 were females The age was between 3 months to 13 years, and 3～12 years old patients accounted for 82% Five (15%) cases had an evident history of contacting SARS patient before the symptoms occurred Another 5 (15%) cases had a history that contacts of these patients (family members or friends) developed fever and/or cough later The most common symptoms in this cohort were fever (100%) and cough (91%) Most of the cases had high fever, higher than 39℃ Near half of the cases had nonproductive cough The initial blood cells count showed that total white blood cell (WBC) count was (2 5～9 7)×10 9/L In 22 (67%) cases the WBC count was <5 0×10 9/L, and in 10 (30%) WBC was (5 0～7 0)×10 9/L, in 18 cases most of the WBC were lymphocyte count Chest radiograph showed patchy infiltrates, in 15 cases the changes were unilateral, and in 18 were bilateral The radiologic changes developed fast, in some cases the changes progressed from one side to both sides The opacity was absorbed slowly, significant absorption took in average two weeks Elevated ALT was found in 3 cases and elevated CK MB in 2 cases Treatment included isolation, good ventilation of the ward, bed rest, supportive regimens, low volume oxygen inhalation, use of Chinese traditional medicine, antibiotics to prevent bacterial infection, and anti inflammation therapy All the patients recovered and discharged from hospital after a mean period of 10 0±3 8 days Conclusion SARS in children may have its own characteristics The main clinical manifestations were high fever and cough while no severe toxic symptoms, nor respiratory failure was seen; few symptoms or signs suggesting involvement of systems other than respiratory system were seen Chest radiograph showed uni or bilateral asymmetric air space infiltrates which could worsen quickly and were absorbed slowly Though there were severe changes in the lung, the patients might not have corresponding symptoms or signs The total white blood cell count in peripheral blood did not increase All the patients studied had a favorable outcome after the combined treatment