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目的 分析北京地区SARS的临床特征及转归。方法 分析 2 0 0 3年 3月 1 1日至 4月1 5日收治的 1 0 8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1 3～ 83(37± 9)岁。医务人员 31例 (2 8 7% )。 94例 (87 0 % )有明确接触史。 2 2例 (2 0 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～ 1 4d。有隐性感染者。轻型 5例 (4 6 % ) ,普通型 43例 (39 8% ) ,重型 2 2例 (2 0 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 ,CD+ 3、CD+ 4、CD+ 8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 ,1 4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?
Objective To analyze the clinical characteristics and prognosis of SARS in Beijing. Methods Clinical data of 108 SARS patients admitted between March 1 and April 15, 2003, were analyzed. Results 35 males (32 4%) and 73 females (67 6%). Age 13 ~ 83 (37 ± 9) years old. 31 medical staff (28.7%). 94 cases (87 0%) have a clear history of exposure. Twenty-two patients (20%) had other medical problems. The main clinical manifestations of fever, cough, chest pain, chest tightness, headache and so on. Multiple organ involvement more common. The incubation period of 2 ~ 14d. Invisible infection. There were 5 (46%) cases of mild, 43 (39.8%) cases of common type, 22 (22%) cases of heavy type and 38 (35.2%) of extremely severe type. The typical course of clinical early, advanced, extremely, convalescent period after four. In the early stage of the disease, the total number of leukocytes, the total number of lymphocytes, the ratio of pre-albumin and transferrin were significantly decreased, and C-reactive protein, α-acid glycoprotein and α2-globulin were significantly increased while the numbers of CD + 3, CD + 4 and CD + 8 cells were decreased. X-ray chest early see single or multiple focal lung changes in exudate, and more in the lungs; progressive glass shadow or real shadow increases. High-resolution CT showed single or multiple “cotton bolus” ground glass shadow or solid shadow. Hypoxemia more. In the advanced stages of the disease, extreme rational use of hormones and early use of non-invasive mechanical ventilation can prevent the progression of the disease. Antibiotics prevent secondary infection. Four cases (37%) left pulmonary fibrosis. 94 cases recovered and discharged, 14 died. Chinese medicine believes that SARS is a warm disease, Integrative Medicine can reduce the symptoms of poisoning, help patients recover?