【作者】 赵春惠； 郭雁宾； 吴昊； 李秀惠； 郭新会； 金荣华； 丁惠国； 孟庆华； 郎振为； 王薇； 闫惠平； 黄春； 刘德恭；

【Author】 ZHAO Chun-hui, GUO Yan-bin, WU Hao, LI Xiu-hui, GUO Xin-hui, JIN Rong-hua, DING Hui-guo, MENG Qing-hua, LANG Zhen-wei, WANG Wei, YAN Hui-ping, HUANG Chun, LIU De-gong. SARS Task Force, You’an Hospital, Capital Medical University, Beijing 100054 , China

【机构】 首都医科大学北京佑安医院SARS攻关组；

【摘要】 目的分析北京地区SARS的临床特征及转归。方法分析2003年3月11日至4月15日收治的108例SARS患者的临床资料。结果男性35例（32.4%）,女性73例（67.6%）。年龄13～83（37±19）岁。医务人员31例（28.7%）。94例（87.0%）有明确接触史。22例（20.4%）并存其他内科疾病。主要临床表现为发热、咳嗽、胸痛、胸闷、头痛等。多脏器受累多见。潜伏期2～14 d。有隐性感染者。轻型5例（4.6%）,普通型43例（39.8%）,重型22例（20.4%）,极重型38例（35.2%）。典型病程临床呈早期、进展期、极期、恢复期四期经过。发病早期白细胞总数、淋巴细胞总数和比值、前白蛋白、转铁蛋白明显下降,C反应蛋白、α酸性糖蛋白和α₂球蛋白明显升高,CD₃⁺、CD₄⁺、CD₈⁺细胞下降。X线胸片早期见肺内单发或多发局灶性渗出改变,多位于肺下野;进展期磨玻璃影或实变影增大。高分辨率CT表现为单发或多发“棉花团”样磨玻璃影或实变影。低氧血症较多。在疾病的进展期、极期合理使用激素和早期使用无创机械通气可阻止病情进展。抗生素可预防继发感染。4例（3.7%）遗留肺间质纤维化。94例好转恢复出院,14例死亡。中医认为SARS属于温病,中西医结合治疗能减轻中毒症状,有助于恢复期患者体力恢复。结论SARS多见于青壮年,有特征性临床表现。临床五型四期分类法有助于更准确地判断病情,指导临床治疗。中西医结合治疗有效。更多还原

【Abstract】 Objective To investigate the clinical manifestations, treatment, and outcome of severe acute respiratory syndrome (SARS). Methods The clinical data of 108 SARS in-patients were analyzed. Results Among the 108 cases, 35 males (32.4% ) and 73 females (67. 6% ) , aged 37 ±9 (range 13 - 83 years) , most were white-collar workers, medical workers accounting for 28. 7% . 87. 0% had a definite contact history. 20. 4% were complicated by other internal diseases. The main clinical manifestations included fever, cough, pectoralgia, chest distress, headache, etc. Involvement of multiple organs was often. The incubation period was 2 - 14 days. The course included early stage, progressive stage, climax, and convalescence. Mild type accounted for 4. 6% , common type 39. 8% , severe type 20. 4% , and extremely severe type 35. 2% . At the early stage, white blood cell count, lymphocyte count and ratio of lymphocyte, proalbu-min, transferring, CD3+ ,CD4+ , and CD8+ cell count were remarkably decreased, and C-reactive protein, a-acid glycoprotein, and a2 -globulin were remarkably increased. X-ray chest film showed solitary or multiple local exudative changes, mostly in pulmonary lower field. During the progressive stage the hyaline or consolidation images were enlarged. High solution CT showed solitary or multiple cotton wadding like images and ground glass-like or consolidation images. Hypoxemia was common. At the progressive stage application of adrenocortical hormones and non-invasive mechanical ventilation helped stop the progress of disease. Ninety-four cases were discharged, 14 cases died. Traditional Chinese medicine (TCM) regards SARS as one of epidemic febrile diseases. Treatment by combination of TCM and Western medicine was effective. Conclusion SARS mainly affects youth and people in their prime of life. It has its own characteristic clinical manifestations. The classification system of 5 types and 4 stages helps judge the condition. Treatment by combination of TCM and Western medicine is encouraged.更多还原