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目的 认识老年SARS患者临床与治疗 (特别是糖皮质激素应用方面 )特点及其转归 ,以提高诊治率。 方法 对我院收治的 4 1例老年SARS患者的临床资料进行分析 ,并与同期住院的非老年SARS患者进行对比。 结果 老年组临床表现多以发热为首发症状 ,与非老年组相比 ,高热、畏寒和寒战的发生率低 ;实验室检查老年组胸部X线片表现双侧多发病变者明显多于非老年组 ;血清白蛋白、血淋巴细胞比率及血T淋巴细胞亚群 (CD3+、CD4 +、CD8+)的水平在老年组显著下降 ;老年组使用激素治疗精神异常和二重感染的发生率明显高于非老年组 ,其并存基础病和并发症的发生率明显的高于非老年组 ;病死率在老年组为 2 4 4 % ,显著高于非老年组的 5 5 % (P <0 0 1)。 结论 老年SARS患者临床重型和极重型比例高 ;发热等临床症状相对轻于病情严重程度 ;细胞免疫功能降低 ,病程进展快 ,预后差 ;治疗中老年人对糖皮质激素耐受性差 ,并发症发生率高 ,应合理、适量应用
Objective To understand the characteristics of elderly patients with SARS and treatment (especially glucocorticoid application) and its outcome in order to improve the diagnosis and treatment rate. Methods The clinical data of 41 elderly SARS patients admitted to our hospital were analyzed and compared with those of non-elderly SARS patients hospitalized in the same period. Results The clinical manifestations of senile patients were mostly fever. The incidence of fever, aversion to chills and chills was lower than that of non-senile patients. Laboratory tests of chest X-ray showed more frequent bilateral lesions than those of non-elderly The levels of serum albumin, blood lymphocytes and blood T lymphocyte subsets (CD3 +, CD4 +, CD8 +) were significantly decreased in the elderly group. The incidence of psychiatric abnormalities and double infections in the elderly group was significantly higher than that in the control group The incidence of underlying diseases and complication in non-elderly group was significantly higher than that in non-elderly group; the mortality rate was 24.4% in elderly group, which was significantly higher than 55% in non-elderly group (P <0.01) . Conclusions The elderly patients with severe acute respiratory syndrome (SARS) have a high proportion of patients with severe and severe clinical symptoms. The clinical symptoms such as fever are less severe than those with mild disease, the cellular immune function is reduced, the course of disease is rapidly progressed and the prognosis is poor. The treatment of elderly patients with poor glucocorticoid tolerance and complications High rate, should be reasonable, appropriate application