SARS疑似病例早期临床特征分析

Analysis of the early clinical features in the patients with suspected SARS

  • 摘要: 目的: 本研究对我院发热门诊和隔离病房SARS疑似病例行临床特征的分析,以探讨其早期诊断、治疗、病程变化及临床预后。方法:对58例SARS疑似病例早期诊断依据、跟踪指定医院中临床观察结果进行回顾分析。按卫生部非典型肺炎临床诊断标准(试行)和WHO诊断标准,并将确诊或疑似病例分为轻、中、重三型。12例发热患者因普通胸部X线片不能确切判断,并行肺部CT检查确定炎症病变。治疗根据病情判断分层次给予抗病毒、抗菌、免疫增强剂、甲泼尼龙、中药方剂、无创正压通气等治疗。结果:58例疑似病例中最后确诊SARS 49例,确诊率84.5%。轻型:8例(16.3%);中度型:34例(69.3%);重型:7例(14.2%),其中2例(4%)转入指定专门医院后死亡。轻型患者入院后多无再发热,平均住院时间8.6d;中度型:可反复发热数日,经抗病毒、抗菌药治疗,并多数给甲泼尼龙治疗(92%)出院时胸片暗影基本吸收,平均住院时间21.3d;重型SARS患者以高热、乏力为首发症状,胸片均可见双肺多处病变,进展迅速。病情恶化期大剂量应用甲泼尼龙,应用无创正压通气,平均住院时间≥30d。重型SARS患者体温动态观察多持续2~3d,用解热或激素均可退热,应用激素期间仍于6~8d出现第二次发热,多数患者12~15d出现第三次发热。所有患者在发病早期(发病后1~2d)胸X线片未见明显异常,9例胸部X线片检查示正常或似见小片状影,其肺部CT影像显示6例病变表现为小渗出病变呈毛玻璃影(6/9,66.7%)。结论: SARS疑似病例需观察热型、血象和X线片变化,及进一步行CT检查对早期诊断有其临床意义。大剂量激素应用可控制重症病情恶化,但不适当使用可能导致不良反应。

     

    Abstract: Objective:To investigate the clinical features of 58 patients with suspected SARS,and discuss the clinical diagnosis ,evaluation,treatment and outcome.Methods:All the patients with suspected SARS were fulfilled the criteria for suspected SARS.The suspected cases were divided into three class such as the mild,moderate and severe case according to the different clinical features.12patients whose X-ray showed normal or simply has tiny exudation,the gracile layer CT scanning were took.All the patients were treated according to clinical evaluation consisting of antibacterials and a combination of ribavirin,Some moderate cases and all the critical SARS patients used methylprednisolone. immunointensifier and noninvasive ventilation.Results:All 58 cases have a history of exposure to a patient with SARS,fever and fatigue,WBC were normal or lower at first.49patients finally made diagnosis of probable SARS (84.5%),mild pattern were 8cases (16.3%),moderate 34 (69.3%),severe 7(14.2%),death 2 cases(4%).The patients with mild SARS didn’t have fever and lung shadow disappeared during mean 8.6 admission days.Moderate case had recurred fever for several days,but the shadow disappeared before discharge in 21.3 hospitalize day.In severe patients,Multifocal shadow were involvement and development on the radiographs,noninvasive ventilation were needed.such cases had three peak of high fever in the begin for 2-3 days,second fever during the 6-8 day,the third time was about the two week.The admission duration was more than 30days.The CT showed that there were shadows like clouded glass or consolidation change in 9 cases of 12 patients.Conclusion:As the important monitoring index,fever pattern,white-cell count and changes of radiographic shadow should be investigated in the patients with a novel infectious SARS.Even if the X ray shows normal or tiny exudation,the CT scanning should be taken to make early definite diagnose to the suspected SARS,in order to prevent the plague from exploring.The large dose of steroid can control the clinical development worse,but it may bring some side effect in using inadequately.

     

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