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目的 分析严重急性呼吸综合征 (SARS)病例的临床特征和预后转归。方法 对该院自 2 0 0 3- 0 4～0 6收治的 2 33例临床诊断为SARS的临床症状、体征、实验室检查以及预后转归和死亡病例进行回顾性分析。结果 2 33例患者中男性 115例 ,女性 118例 ,平均年龄为 ( 4 2 8± 18 5 )岁 ,其中 2 0～ 4 9岁占 5 7 9%。 4 3 3%的患者伴有一种或两种基础疾病。 73 0 %的患者在发病前有明确或可疑SARS患者接触史。潜伏期为 1～ 2 1d ,平均( 4 9± 4 1)d。首发症状中发热占 86 .3% ,发病 1～ 2周出现呼吸道症状。 5 6 7%的患者病程中出现外周血白细胞计数的下降 ,78 5 %的患者外周血淋巴细胞计数下降。 6 9 5 %的患者接受了糖皮质激素治疗。 87例 ( 37 3% )患者出现呼吸窘迫 ,10例死亡 ,病死率为 4 3% ,重症抢救成功率为 88 5 %。伴发糖尿病与预后转归显著相关 ,外周血淋巴细胞数下降、血小板减少、血清LDH和CPK升高与预后均有相关性。高龄、伴发基础疾病、持续高热( >38 5℃ ,>2周 )、外周血白细胞增高和血小板降低以及多肺叶病变是SARS死亡的高危因素。结论 SARS多见于青壮年 ,传染性强 ,具有特征性临床表现 ,发热常为首发症状。高龄和伴发基础疾病的重症患者病死率高。伴发糖尿病 ,外周血白细胞增高、淋?
Objective To analyze the clinical characteristics and prognosis of severe acute respiratory syndrome (SARS). Methods The clinical symptoms, signs, laboratory tests, prognosis and death of 233 cases clinically diagnosed as SARS from 2000 to 2004 were retrospectively analyzed. Results There were 115 males and 118 females, with an average age of (428 ± 18 5) years, of which 33.9% were 20 to 49 years old. 43.3% of patients had one or two underlying diseases. 73 0% of patients had a history of exposure to patients with clear or suspected SARS before onset. The incubation period was 1-21 days, with an average of (49 ± 4 1) days. The first symptom of fever accounted for 86.3%, 1 to 2 weeks of onset of respiratory symptoms. Peripheral blood leukocyte counts decreased in 56.7% of the patients, and peripheral blood lymphocyte counts decreased in 78% of the patients. Sixty-five percent of patients received glucocorticoid therapy. Eighty-seven patients (37.3%) had respiratory distress, 10 died, the case fatality rate was 43%, and the critical rescue success rate was 88.5%. Concomitant diabetes was significantly associated with the outcome of the prognosis, peripheral blood lymphocytes decreased thrombocytopenia, elevated serum LDH and CPK and prognosis are related. Elderly patients with concomitant underlying diseases, persistent high fever (> 38 5 ℃,> 2 weeks), peripheral leukocytopenia and thrombocytopenia, and multilobar lesions are risk factors for death from SARS. Conclusion SARS more common in young adults, highly contagious, with a characteristic clinical manifestations, fever is often the first symptom. Elderly and associated with basic diseases of critically ill patients with high mortality. Accompanied by diabetes, peripheral white blood cells increased, leaching?