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目的 分析临床诊断传染性非典型肺炎患者的临床特点,并对其诊断和救治方法进行探讨。方法 对河北省11地市定点医院2003年4月19日～2003年5月31日收治的215例传染性非典型肺炎的流行病学资料,临床表现,实验室检查,胸部X线表现进行回顾性分析。结果 215例传染性非典型肺炎患者,男124例,女91例;年龄7～69岁;平均32.42岁;青壮年18～59岁 98例(92.1％),医务人员23例(10.7％)。流行病学资料显示,194例为输入病例,占90.23％。临床症状:发热(100％),咳嗽(73.95％),胸闷气短(58.8％),咳痰(36.28％),无力(23.72％),头痛(21.40％),咽痛(15.35％),肌痛(9.77％)等。血细胞检查:WBC>10.0×109/L 12例(5.58％),(10.0×10~9/L)～(4.07×10~9/L)140例(65.12％),<4.0×10~9/L 63例(29.32％),淋巴细胞计数<0.2×10~9/L者61例(28.37％)。胸部X线显示肺部斑片状阴影,短期内病变迅速增多,累计单侧132例(61.40％),双侧83例(38.40％)。死亡的12例患者中有基础疾病者9例。结论 流行病学接触史、发热、胸部X线显示肺部炎症,及白细胞计数正常或减少是诊断SARS的临床重要依据。综合支持治疗措施,糖皮质激素的合理应用及早期氧疗和无创持续正压通气治疗对降低重症SARS病死率有重要作用。
Objective To analyze the clinical features of SARS patients and to discuss the methods of diagnosis and treatment. Methods The epidemiological data, clinical manifestations, laboratory tests and chest X-ray findings of 215 cases of SARS admitted to the designated hospitals in 11 cities of Hebei Province from April 19, 2003 to May 31, 2003 were retrospectively reviewed Sexual analysis. Results Among 215 cases of SARS, 124 were male and 91 were female, ranging in age from 7 to 69 years with an average of 32.42 years. 98 (92.1%) were young adults aged 18 to 59, and 23 (10.7%) were medical workers. Epidemiological data show that 194 cases were imported cases, accounting for 90.23%. Clinical symptoms: fever (100%), cough (73.95%), chest tightness and shortness of breath (58.8%), expectoration (36.28%), weakness (23.72%), headache (21.40%), sore throat (15.35% (9.77%) and so on. Blood cells were detected in 140 cases (65.12%) of WBC> 10.0 × 109 / L in 12 cases (5.58%) and in the range of 10.0 × 10 ~ 9 / L to 4.07 × 10 ~ 9 / L 63 cases (29.32%), lymphocyte count <0.2 × 10 ~ 9 / L in 61 cases (28.37%). Chest X-ray showed patchy shadows of the lungs, and the number of lesions in the short term increased rapidly. There were 132 cases (61.40%) unilateral and 83 (38.40%) bilateral. Among the 12 deaths, 9 had underlying diseases. Conclusion Epidemiological history of exposure, fever, chest X-ray showed inflammation of the lungs, and normal or decreased white blood cell count is an important clinical basis for the diagnosis of SARS. Comprehensive support for treatment, rational use of glucocorticoids and early oxygen therapy and noninvasive continuous positive pressure ventilation reduce the critical SARS mortality has an important role.