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目的 探讨重症急性呼吸综合征 (SARS)的临床特点和综合防治方法。方法 对 2 0 0 3年 2月至 5月我院收治的 2 2例SARS病人的临床表现、X线特征、实验室资料、综合防治方法等进行分析。结果 发病 2周内有密切接触SARS病人的 16例 ;宰杀过动物的 2例 ;潜伏期 3～ 12d。所有病人均以发热为首发症状 ,其中有高热 (39℃ )以上者占 91%。伴呼吸困难的 6 8% ,咳嗽 86 4 % ,乏力 72 7% ,全身酸痛 2 7% ,头痛 5 0 % ,头晕 2 2 7% ,胸痛 31 8% ,呼吸道卡他症状 13 6 % ,心悸 36 4 % ,腹泻 18 2 % ,血丝痰 9% ,畏寒18 2 % ,咽痛 9%。 77%的病人肺部无明显体征。X线胸片及肺部CT :单侧病灶 36 4 % ,双侧 6 3 6 % ,双肺弥漫性渗出 2 2 7%。ARDS 2例 ;死亡 1例 ,死亡率 4 5 %。规律应用皮质类固醇治疗的占 72 7%。应用无创正压通气 (NIPPV)的 5例 ;应用有创机械通气的 2例。通过规范的防护措施 ,一线医务人员感染率为零 ;医务人员家属感染率为零 ;院内交叉感染率为零。结论 综合治疗方案中 ,合理应用糖皮质激素是重要措施。重症病人应及早使用机械通气。规范的防护措施可预防感染
Objective To investigate the clinical features and comprehensive prevention and treatment of severe acute respiratory syndrome (SARS). Methods The clinical manifestations, X-ray features, laboratory data and integrated prevention and treatment of 22 SARS patients admitted to our hospital from February to May in 2003 were analyzed. Results There were 16 cases of close contact with SARS patients within 2 weeks of onset; 2 cases of animals were killed; the incubation period was 3 to 12 days. All patients with fever as the first symptom, including high fever (39 ℃) above 91%. 68% with dyspnea, 86.4% with cough, 72.7% with weakness, 27% with body aches and pains, 50% with headache, 22.7% with dizziness, 31.8% with chest pain, 136% with respiratory catarrhal symptoms and 36 with palpitations 4%, diarrhea 18 2%, blood phlegm 9%, chills 18 2%, sore throat 9%. 77% of patients with no obvious lung signs. X-ray and pulmonary CT: unilateral lesions 36 4%, bilateral 6 3 6%, pulmonary diffuse exudation 2 2 7%. ARDS 2 cases; 1 death, mortality 45%. Regular application of corticosteroids accounted for 72 7%. Five cases were treated with noninvasive positive pressure ventilation (NIPPV) and two cases with invasive mechanical ventilation. Through the standard protective measures, front-line medical staff infection rate was zero; family members of medical staff infection rate was zero; nosocomial cross-infection rate was zero. Conclusion Comprehensive treatment options, rational use of glucocorticoid is an important measure. Severe patients should use mechanical ventilation early. Precautionary measures prevent infection