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目的 探讨严重急性呼吸综合征 (SARS)死亡病例的临床特点及死亡原因。方法 回顾性分析广州市三家医院收治SARS病人中的 2 5例死亡病例临床资料。结果 死亡病例年龄在 6 0岁以上者 16例 (占 6 4 % ) ,平均 (6 1± 18)岁。 16例 (6 4 % )合并有基础疾病。随着病情的进展 ,病人外周血白细胞计数逐渐升高 ,而淋巴细胞和血小板逐渐下降 ,与疾病初期相比有显著差异 (P <0 0 5 )。外周血T淋巴细胞计数明显降低 ,磷酸肌酶 (CK)、乳酸脱氢酶 (LDH)及尿素氮 (BUN)与入院时相比升高 2倍以上 ,提示有多器官、多系统功能损害。 19例 (76 % )继发感染 ,主要为肺部细菌和 /或真菌感染。所有病例均有肺部弥漫病变 ,2 0例 (80 % )累及双肺 ,其中 19例出现肺内广泛的磨玻璃样病变 ,内含分枝状支气管气像的“白肺”改变。病理检查肺组织呈间质性炎症、急性渗出性炎症、双肺实变、肺泡内广泛性透明膜形成。死亡原因均为严重急性呼吸窘迫综合征 (ARDS)导致Ⅰ型呼吸衰竭 ,其中 9例出现多脏器功能衰竭综合征 (MODS)。结论 SARS患者死亡的主要危险因素有 :(1)年龄 >6 0岁 ;(2 )存在基础疾病 ;(3)继发严重感染 ;(4 )X线胸片进展迅速。死亡原因主要为ARDS导致Ⅰ型呼吸衰竭或MODS。
Objective To investigate the clinical characteristics and causes of death in patients with severe acute respiratory syndrome (SARS). Methods The clinical data of 25 deaths from SARS patients admitted to three hospitals in Guangzhou were retrospectively analyzed. Results There were 16 death cases (64%) and 6 (18 ± 18) years old over 60 years old. 16 cases (64%) with underlying diseases. As the disease progressed, the number of peripheral blood leukocytes increased, while the number of lymphocytes and platelets decreased gradually, which was significantly different from the initial stage of disease (P <0.05). Peripheral blood T lymphocyte count was significantly lower, and CK, LDH and BUN were more than 2 times higher than those on admission, suggesting multiple organ and multiple system dysfunction. Nineteen (76%) had secondary infections, mainly pulmonary bacterial and / or fungal infections. All cases had diffuse lung lesions, 20 cases (80%) involving the lungs, of which 19 cases appeared extensive intraglular glassy lesions, bronchial branches containing bronchial “white lung” changes. Pathological examination was interstitial lung tissue inflammation, acute exudative inflammation, lung consolidation, alveolar widespread transparent membrane formation. Causes of death were all severe acute respiratory distress syndrome (ARDS) leading to type I respiratory failure, of which 9 cases showed multiple organ failure syndrome (MODS). Conclusions The main risk factors for SARS death are: (1) age> 60 years; (2) underlying disease; (3) secondary serious infection; (4) rapid progress of X-ray. The main cause of death ARDS lead to type Ⅰ respiratory failure or MODS.