【作者】 刘晓青； 陈思蓓； 何国清； 黎毅敏； 何为群； 陈荣昌； 钟南山；

【Author】 LIU Xiao-ging,CHEN Si-bei, HE Guo-qing, LI Yi-min, HE Wei-qun, CHEN Rong-chang, ZHONG Nan-shan, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical College, Guangzhou 510120, China

【机构】 广州呼吸疾病研究所；

【摘要】 目的探讨重症传染性非典型肺炎（又称严重急性呼吸综合征,SARS）的治疗方法以及预测死亡的可能危险因素。方法以2002年12月至2003年3月临床诊断重症SARS 37例患者为对象,通过回顾性分析,比较33例应用持续气道内正压的方式进行无创通气前后的呼吸频率和脉搏容积血氧饱和度（SpO₂）,并对其中18例吸氧5L/min、安静下SpO₂只有90%～93%的患者,进行无创通气前轻微活动、安静状态及无创通气1h后SpO₂的比较;对年龄、基础疾病、血小板减少、白细胞升高、淋巴细胞减少5个因素预测死亡的可能危险性采用Mantel-Haenszel x²检验进行统计学分析。结果33例患者无创通气1h后较通气前呼吸频率明显减慢（P<0.01）,分别为（29.6±10.0）次/min和（34.6土8.4）次/min;SpO₂明显提高（P<0.01）,分别为（96.1±2.4）%和（89.9±3.5）%。18例吸氧5 L/min、安静下SpO₂只有90%～93%的患者,轻微活动后SpO₂明显下降,无创通气1h后SpO₂明显提高,SpO₂分别为（91.7±0.9）%、（88.5±1.4）%和（96.9±1.8）%（P均<0.01）;以血小板减少、年龄>50岁、基础疾病、血白细胞升高、淋巴细胞减少5个因素预测死亡的可能危险性,其相对危险度（RR）分别为25.83、8.57、6.40、1.64及1.17;95%CI分别为3.64～183.59、1.94～37.83、1.75～23.33、0.38～7.05及0.16～8.48。糖皮质激素可明显减轻并抑制肺部浸润病灶的发展。结论重症SARS患者进行无创通气可改善呼吸困难,提高SpO₂;安静状态吸氧5 L/min、SpO₂只有90%～93%的患者,轻微活动时SpO₂明显下降,因此这类患者也应该进行无创通气;合并应用无创通气有可能减少糖皮质激素的用量和疗程;5个可能的因素中,与死亡有关的因素共3个,按危险性的大小依次为血小板减少、年龄>50岁及伴基础疾病。更多还原

【Abstract】 Objective To investigate the management of critical severe acute respiratory syndrome (SARS) and possible risk factors for death. Methods Thirty-three patients with SARS referred to Guangzhou Institute of Respiratory Disease ( GIRD) between December 2002 and March 2003 were studied retrospectively. Paired t-test using statistical software SPSS 10. 0 was employed to compare the respiratory frequency and pulse O2 saturation ( SpO2) before and after noninvasive ventilation with continuous positive airway pressure (CPAP) on the 33 patients. Among them, 18 patients who presented with SpO2 of 90% -93% at rest under O2 inhalation 5 L/min were further recorded for their SpO2 during slight physical movement and CPAP. The possible death-related risk factors including age, underlying diseases, leucocytosis, thrombocytopenia, and lymphopenia were analyzed by the Mantel-Haenszel x2 test Results The respiratory frequencies were significantly decreased and SpO2 was improved in the 33 patients after one hour of noninvasive ventilation. The SpO2 in the latter 18 patients fell during slight physical movement and improved one hour after CPAP ( P < 0.01 ) . The RRs of the five death predictors concerning thrombocytopenia, age ( > 50 yrs, underlying diseases, leucocytosis, and lymphopenia were 25. 83 , 8.57, 6.40, 1.64, and 1.17, respectively, with the 95% CI of 3. 64-183. 59, 1.94-37.83, 1.75-23.33,0.38-7.05 and 0. 16-8.48, respectively. Management with corticosteroids effectively ameliorated and suppressed the development of pulmonary fibrosis. Conclusions Noninvasive ventilation relieves dyspnea and SpO2 in patients with critical SARS, and should also be employed in those with SpO2 of 90%-93% at rest under O2 inhalation 5 L/min. Noninvasive as an add-on management may probably cut down on the dosage and duration of corticosteriod therapy. Among 5 possible risk factors, 3 were recognized as death-related, turning out to be thrombocytopenia, age ( > 50 yrs) and underlying diseases.更多还原