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目的 分析传染性非典型肺炎 (世界卫生组织又称严重急性呼吸综合征 ,SARS)患者的临床特点 ,并对其诊断标准和治疗方法进行探讨。方法 对广州呼吸疾病研究所 2 0 0 2年 12月 2 2日至 2 0 0 3年 3月 31日收治的 78例SARS患者的临床、实验室、影像学资料进行回顾性分析。结果78例SARS患者 :男 4 2例 ,女 36例 ;年龄 2 0～ 75岁 ,平均 (37 5± 11 6 )岁 ;医务人员 4 4例 (5 6 % )。临床症状包括 :发热 (10 0 % )、咽痛 (17% )、咳嗽 (88% )、气促 (80 % )、畏寒 (5 9% )、肌肉酸痛 (41% )。血常规 :白细胞 (WBC) <4 0× 10 9/L 12例 (15 % ) ,WBC(4 0～ 10 0 )× 10 9/L 4 9例 (6 3% ) ,WBC >10 0× 10 9/L 17例 (2 2 % ) ,平均为 (7 6± 5 0 )× 10 9/L ;中性粒细胞为 0 75± 0 14 ,淋巴细胞 0 18±0 11。胸部X线和CT显示肺部斑片状阴影 ,短期内病灶增多 ,累计单侧 2 3例 (30 % )、双侧 5 2例(6 7% )。分析医护人员被感染途径 ,提示本病具有较强的飞沫近距离传染特性。出现急性肺损伤(ALI) 37例 (47% ) ,其中发展为急性呼吸窘迫综合征 (ARDS) 2 1例。 7例死亡患者均为ARDS合并有多器官功能衰竭综合征 (MODS)。结论 流行病接触史、发热、X线肺炎征及白细胞计数正常或减少是诊断本病的临床依据。?
Objective To analyze the clinical features of patients with SARS (SARS) and to discuss their diagnostic criteria and treatment methods. Methods The clinical, laboratory and imaging data of 78 SARS patients admitted to Guangzhou Respiratory Disease Institute from December 22, 2002 to March 31, 2003 were retrospectively analyzed. Results 78 cases of SARS patients: 42 males and 36 females; aged 20 to 75 years, with an average of (37 5 ± 11 6) years; and medical staff 44 (56%). Clinical symptoms include fever (10%), sore throat (17%), cough (88%), shortness of breath (80%), chills (59%) and muscle soreness (41%). Blood routine: white blood cells (WBC) <4 0 × 10 9 / L in 12 cases (15%), WBC (40 0 ~ 10 0) × 10 9 / 9 / L in 17 cases (22%) with an average of (7 6 ± 5 0) × 10 9 / L; neutrophils in 0 75 ± 0 14 and 0 18 ± 0 11 in lymphocytes. Chest X-ray and CT showed patchy shadows of the lungs. The number of lesions increased in the short term, with a total of 23 cases (30%) unilateral and 52 (67%) bilateral. Analysis of health care workers were infected ways, suggesting that the disease has a strong infectious properties of droplets close. Acute lung injury (ALI) occurred in 37 cases (47%), of which 21 developed acute respiratory distress syndrome (ARDS). All 7 patients died of ARDS complicated with multiple organ failure syndrome (MODS). Conclusion Epidemic contact history, fever, signs of X-ray pneumonia and white blood cell count is normal or reduce the clinical basis for the diagnosis of the disease. ?