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目的 了解重症急性呼吸综合征 (SARS)的临床特点以及探索临床有效的治疗方法。方法 用前瞻性的方法对入院的 10 6例SARS病例临床资料进行总结。结果 10 6例患者男 5 6例 ,女5 0例 ;年龄 15～ 81岁 ,平均 (36± 10 )岁 ;多数病人都有发热 (98 1% )、畏寒 (75 5 % )、咳嗽 (71 7% )、头痛和胸闷憋气 (4 3 4 % )、腹泻 (2 4 5 % ) ,肺部有音者较少 (11 2 % )。WBC计数降低者占 34 0 % ,淋巴细胞计数减少者占 81 1% ,CD+ 4 T细胞减少者为 98 1% ,ALT增高者占 7 6 % ,血小板降低者少见(3 8% ) ;几乎所有病人在入院时或次日都有血氧分压下降 [<90mmHg(1mmHg =0 133kPa)者90 2 % ,<70mmHg者 2 8 6 % ];X线胸片表现为单侧局部肺部斑片状浸润者 34 0 % ,单侧多发肺部斑片状浸润者 11 3% ,双肺斑片状浸润者 4 6 2 %。临床治疗采取综合治疗的原则 ,包括以小剂量糖皮质激素 (甲泼尼龙 4 0～ 80mg,12h 1次 ) ,第二代头孢菌素、大环内酯类以及抗病毒药物为主 ,同时强调氧疗、对症及其基础病等的治疗。结论 SARS临床表现和实验室多样化 ,CD+ 4 T细胞测定有助于早期诊断 ,临床治疗以综合治疗为主 ,早期氧疗及小剂量激素治疗有较好的治疗效果。
Objective To understand the clinical features of Severe Acute Respiratory Syndrome (SARS) and to explore clinically effective treatments. Methods The prospective method was used to summarize the clinical data of 106 cases of SARS admitted to hospital. Results A total of 56 males and 50 females were enrolled in 106 patients, aged from 15 to 81 years (mean, 36 ± 10 years). Most patients had fever (98.1%), chills (75.5%) and cough 71 7%), headache and chest tightness (434%), diarrhea (24.5%), and lung less sound (112%). WBC count decreased 34 0%, lymphocyte count decreased 81 1%, CD 4 T cell decreased 98 1%, ALT increased 76%, thrombocytopenia rare (38%); almost all Patients on admission or the next day have a partial pressure of blood oxygen decreased [<90mmHg (1mmHg = 0 133kPa), 902%, <70mmHg, 286%]; X-ray showed unilateral local lung patch 34 0% infiltrated, unilateral multiple pulmonary patch infiltrated 11 3%, double lung patch infiltrated 462%. Clinical treatment to take the principle of comprehensive treatment, including low-dose glucocorticoid (methylprednisolone 40 ~ 80mg, 12h 1), second-generation cephalosporins, macrolides and antiviral drugs based, emphasizing Oxygen therapy, symptomatic and its underlying treatment. Conclusions The clinical manifestations of SARS and laboratory diversification, CD + 4 T cell assay are helpful for the early diagnosis. Clinical treatment is mainly based on comprehensive treatment, and early oxygen therapy and low dose hormone therapy have good therapeutic effect.