严重急性呼吸道综合征24例死亡危险因素分析

Riskfactoranalysison24 dead cases of severe acute respiratory syndrome

目的 回顾性分析严重急性呼吸道综合征 (SARS)病人的死亡危险因素 ,为降低 SARS病死率提供可借鉴经验。方法 对来自本省太原市及各地区收治 SARS7家医院所提供的死亡 SARS病历资料进行回顾性分析。包括 :年龄、基础疾病、实验室数据、影像学检查及治疗措施等。结果 2 4例死亡 SARS病人中 ,男性 14例和女性 10例。平均年龄 5 7.4岁。其中≥ 5 0岁 2 1例 (88% )。有基础疾病者 2 0例 (83% )。其中心血管疾病 12例占居首位 ,糖尿病 9例居次席 ,脑血管疾病 8例位居第三 ,慢性阻塞性肺疾患 (COPD) 5例占第四位和消化道疾病占末位。有并发症者 13例 (5 4 % ) ,依次为急性呼吸窘迫综合征 (ARDS)、休克、多器官功能障碍综合征 (MODS)和继发感染等。部分资料齐全的病人在入院时的生命体征都平稳。血液学和动脉血气检测与分析均显示在疾病晚期与入院时相比 :白细胞计数增多 ,血糖升高和乳酸脱氢酶 (L DH)值升高 (P均 <0 .0 0 1) ,而淋巴细胞计数显著减少 (P<0 .0 0 5 ) ,动脉血氧分压 (Pa O2 )和氧合指数 (Pa O2 / Fi O2 )均呈进行性降低 (P<0 .0 0 5 ,P<0 .0 0 1)。近半数SARS病人血液生化指标异常。结论 年龄、基础疾病、低氧血症和 L DH值升高 ,皮质类固醇和抗生素的滥用所致的继发感染等都是 SARS病人死?

Objective To make a restrospective analysis on the dead risk factors of patients with severe acute respiratpry syndrome (SARS),so as to provide experience for decreasing mortality of SARS patients in clinic.Methods A retrospective analysis of 24 dead cases of SARS for their ages,basic diseases,laboratory data,imageological examinations,and treatments was made.Results The 24 dead cases were 14 males and 10 females,aged averagely 57 4,21 cases aged 50 or over (88%);20 had basic diseases (83%),of which 12 had cardiovascular diseases (first of all!),9 had diabtes (second of all!),8 had cerebrovascular diseases (third of all!),5 had chronic obstructive pulmonary disease (COPD;fourth of all!),and the others had digestive tract diseases (last of all!).Thirteen cases (54%) had complications,in proper order:acute respiratory distress syndrome (ARDS),shock,multiple organ dysfunctional syndrome (MODS),and secondary infections.Parts of cases with complete clinical data had stable vital signs.Hemological and arterial blood gas checks showed a comparison between the advanced stage and admission dates,as follows:WBC counts increased,blood sugar level and LDH value became heightened (P<0 001);lymphocyte count dropped markedly (P<0 005),both PaO 2 and PaO 2/FiO 2 decreased progressively (P<0 005,P<0 001).Nearly half of the SARS cases had an abnormal biochemical index.Conclusion Ageing,basic disease,hypoxemia,and LDH elevation,as well as misused corticosteroids and/or antibiotics-induced secondary infections all are the main risk factors to the death of SARS patients.