【摘要】 目的分析新型冠状病毒肺炎(COVID-19)危重型患者的临床特征及早期肺外器官功能损伤特点,总结临床诊疗经验。方法对我院2020年1月21日至3月15日收治的15例COVID-19危重型患者的临床资料,实验室检查及胸部影像学资料进行回顾性。结果分析15例COVID-19危重型患者平均年龄(64±13)岁,男性12例占80%,7例(47%)有高血压病史,14例有明确流行病学史,6例为家庭聚集性病例。患者以发热、干咳、乏力为主要症状,15例危重型患者入院时病情判定均为非危重型病例,从起病进展至危重型平均时间为(12.3±5.9)d,其中血新型冠状病毒核酸检测阳性率占63%(5/8),入院时胸部CT有10例(67%)为双肺多发病灶,多为不规则形或片状磨玻璃密度增高影,病情进展至危重型48 h内的部分生化指标值较入院48 h内明显升高,包括降钙素原[(0.139(0.144,1.310)ng/mL与0.138(0.110,1.098)ng/mL]、C反应蛋白[(82±38)mg/L和(45±34)mg/L]、白细胞[(11.6±3.5)×109/L和(6.6±2.5)×109/L]、中性粒细胞[(10.7±3.4)%和(5.1±2.6)%]、乳酸脱氢酶[521(291,649)U/L和255(151,463)U/L]、肌钙蛋白[0.033(0.013,0.109)μg/L和0.011(0.005,0.210)μg/L]、尿素[(11.0±7.1)g/L和(7.8±4.7)g/L]、D-二聚体[5 890 (3 060,16 880)ng和1 270 (850,1 740)ng];而淋巴细胞[(0.53±0.20)%和(1.05±0.72)%]、氧合指数[(100±12)mmHg和(268±82)mmHg]等指标相较于入院48 h内明显下降,差异均有统计学意义(P<0.05)。心肌酶[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)],肝功能[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)]及肾功能[肌酐、肾小球滤过率(eGFR)]检测结果较入院48 h内检测结果差异无统计学意义。治疗主要以氧疗、抗病毒、抗继发感染、调节免疫和肠道微生态等综合治疗,最终有13例好转出院,1例维持透析,1例死亡。结论合并有高血压病的高龄男性患者为COVID-19危重症患者的高危群体,危重型患者早期以肺部病变为主,肺外器官功能损伤多不严重,临床医师不可因肺外器官损伤轻而掉以轻心。更多还原

【Abstract】 Objective To analyze the clinical features and early damage of extra-pulmonary organ in patients with new corona virus pneumonia(COVID-19),and to summarize clinical diagnosis and treatment experience. Methods The clinical data,laboratory tests and chest imaging data of 15 patients with COVID-19 critically ill treated in our hospital from January 21 to March 15,2020 were retrospectively analyzed. Results The average age of 15 critically ill patients with COVID-19 was(64 ±13) years,12 were males,the male to female ratio was 4 ∶1,46.7% have a history of hypertension,14 had a clear epidemiological history,and 6 were family cluster cases. Patients with fever,dry cough,and fatigue are the main symptoms,and some may have symptoms such as shortness of breath,muscle aches,and diarrhea.15 critically ill patients were admitted to the hospital as non-critical cases. The average time from onset to critical illness was(12.3± 5.9)days. Of these,the positive rate of new corona virus acid detection in blood accounted for 62.5%(5/8),66.7%(10/15) of chest CT were multiple lung lesions,mostly irregular or flaky ground glass density. The biochemical index value within 48 hours after the disease progressed to critical illness was significantly higher than that within 48 hours after admission,including procalcitonin[(0.139(0.144,1.310) ng/mL vs 0.138(0.110,1.098) ng/mL],C-reactive protein[(82±38)mg/L vs(45±34)mg/L],white blood cells[(11.6±3.5)×109/L vs(6.6±2.5)×109/L],neutral Granulo-cytes[(10.7±3.4)% vs(5.1±2.6)%],lactate dehydrogenase 521(291,649)U/L vs 255(151,463)U/L],troponin[0.033(0.013,0.109) μg/L vs 0.011(0.005,0.210) μg/L],urea [(11.0 ±7.1) g/L vs(7.8 ±4.7) g/L],D-dimer[5 890(3 060,16 880)ng vs 1 270(850,1 740)ng];and lymphocytes[(0.53±0.20)%和(1.05±0.72)%],oxygenation index[(100±12) mmHg vs(268±82) mmHg]and other indicators decreased significantly within 48 hours after admission,the differences were statistically significant(P<0.05). The treatment mainly consisted of oxygen therapy,anti-virus,antisecondary infection,immune regulation,and intestinal microecology. 13 patients were eventually discharged,1 patient maintained dialysis,and 1 died. Conclusion Elderly male patients with hypertension are a high-risk group of COVID-19 critically ill patients. In the early stage of critically ill patients are mainly lung lesions,and extra-pulmonary organ damage is mostly not serious. Clinicians should not be taken lightly because of the damage to the extra-pulmonary organ.更多还原