【作者】 张复春； 尹炽标； 唐小平； 许敏； 刘晋新； 陈燕清； 王健； 陈谐捷； 陈伟烈； 陈万山； 贾卫东； 雷春亮；

【Author】 ZHANG Fu-chun, YIN Chi-biao, TANG Xiao-ping, et al. Guangzhou No. 8 People ’s Hospital, Guangzhou 510060, China

【机构】 广州市第八人民医院；

【摘要】 目的了解传染性非典型肺炎(AP)的流行病学、临床表现、实验室检查、X线表现等特点及治疗和预后。方法对我院于2003年2～4月上旬收治的260例传染性非典型肺炎的流行病学及临床资料进行回顾性分析。结果患者年龄从2岁到89岁,平均(41±18)岁,男123例,女137例。67.3%的患者有AP患者密切接触史或明确传染他人的证据,呈家庭及医务人员聚集现象。传播途径以近距离飞沫和密切接触为主。潜伏期为1～14 d,平均4.5 d。以发热为首发症状(100%),伴有干咳(7.7%),气促(31.2%)、急性呼吸窘迫综合征(ARDS,占13.8%),腹泻(24.2%),重症患者36例(13.8%)。外周血白细胞正常或降低占85%,血清丙氨酸转氨酶(ALT)升高66.9%,乳酸脱氢酶(LDH)升高46.5%。外周血CD3~+、CD4~+、CD8~+明显降低。全部患者都有肺部病变,累及双肺占73.8%,肺部体征与X线胸片表现不一致。治疗以综合治疗为主,经验性使用抗生素、抗病毒药物,糖皮质激素对改善中毒症状、阻止病情进展有一定疗效。需要人工通气36例(均出现ARDS),其中有创机械通气11例。死亡11例,病死率4.2%。结论非典型肺炎传染性强,有一定的病死率,虽无特效抗病原药物,但经综合治疗可取得较好疗效。更多还原

【Abstract】 Objective To study the epidemiological, clinical and laboratory characteristics, chest radiography, treatment and prognosis of patients with Severe Acute Respiratory Syndrome ( SARS). Methods Clinical data from 260 patients with SARS admitted during February and April were retrospectively analyzed. Results The patients ranged from 2 to 89 years old, with an average of 41 ±18. 47. 3 percent (123) were men and 67. 3 percent of the patients had a history of close contact with diagnosed SARS patients. The phenomenon of family and medical staff accumulation was observed. Infectious patterns suggested through air droplet or close contact transmission. The incubation period ranged from 1 to 14 days, with an average of 4. 5 days. The first and most common symptom was fever (in 100% ) , followed by dry cough (in 72.7% ) , shortness of breath (in 31.2% ) , Acute respiratory distress syndrome (in 13. 8% ) , diarrhea ( in 24. 2% ). 13. 8 percent (36) were diagnosed as severe type of SARS. 85 percent of patients had normal or decreased white blood cell counts. Serum ALT and LDH levels were elevated in 66. 9% and 46. 5% of the patients, respectively. CD3 + ,CD4+ ,CD8+ T lymphocytes in peripheral blood decreased apparently in patients with SARS. Infiltrates on chest radiography was seen in all the patients, with 73. 8% involved both lungs. Chest radiography was more obvious than the signs of lungs. General combination therapy was taken for treating the patients. Empirical therapy most commonly used included antibiotics and anti-viral reagents such as ribavirin. Glucocorticoid was useful for improving viremia and preventing disease progress and fibro-sis of the lungs. Artificial ventilation was used in 36 patients including 11 using air pipe mechanical ventilator. 11 patients (4. 2% ) died of ARDS. Conclusions SARS is a highly communicable condition with substantial mortality. Although there are still no specific anti-viral drugs for the treatment, general combination therapy can be very effective in most patients.更多还原