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目的 :了解严重急性呼吸道综合征 (SevereAcuteRespiratorySyndrome ,SARS ,即非典型肺炎 )早期临床特点 ,探讨早期诊断和治疗的方法。方法 :对 4 5例SARS患者进行回顾性分析。结果 :95 .6 % (43/ 4 5 )的患者有SARS的接触史 ,潜伏期 2～ 2 0d ,平均 (7.3± 4 .7)d。临床表现包括有发热 (44 / 4 5 ,97.8% )、干咳 (31/ 4 5 ,6 8.9% )、乏力(2 7/ 4 5 ,6 0 % )、胸闷及气短 (2 4 / 4 5 ,5 3.3% ) ,关节疼痛、腹泻 (各 12例 ,2 6 .7% ) ,4例患者出现咯血。 15例重型患者中 12例有明显呼吸困难 ,需无创呼吸机支持。约 1/ 3的患者出现血白细胞及血小板的减少 ,可有肝功能异常(2 4例 ,5 3.3% )及心肌酶谱升高 (2 6 .6 % )。胸片出现渗出影的平均时间为 (4.2± 2 .9)d ,CT出现异常的时间早于胸片 ;胸片进展及开始好转吸收的平均时间分别为 (9.3± 4 .1)d和 (14 .5± 5 .0 )d。初始糖皮质激素治疗时间平均在病后 (4.8± 3.5 )d ,一般在 (8.4± 3.9)d时激素加至最大剂量 ,重度组和普通组激素剂量分别为每天 (6 11± 2 12 )mg和 (2 6 8± 2 0 2 )mg ,P <0 .0 0 1。抗体阳性率为 6 4 .7% (2 2 / 34) ,出现阳性最早时间为第 9d ,平均 (18.2± 6 .4 )d。结论 :临床初期以发热为主要表现 ,胸片可表现为小片渗出影 ,此
Objective: To understand the early clinical features of Severe Acute Respiratory Syndrome (SARS) and to explore the methods of early diagnosis and treatment. Methods: A total of 45 cases of SARS were retrospectively analyzed. Results: 95.6% (43/45) of the patients had history of exposure to SARS with an incubation period of 2 ~ 20d with an average of (7.3 ± 4.7) days. The clinical manifestations included fever (44/45, 97.8%), dry cough (31/45, 69.9%), fatigue (27/45, 60%), chest tightness and shortness of breath (24/45, 5 3.3%), joint pain and diarrhea (12 cases each, 26.7%), and 4 patients had hemoptysis. Twelve of 15 severe cases had significant dyspnea requiring non-invasive ventilator support. Approximately one-third of patients showed a decrease in white blood cells and platelets with abnormal liver function (24 cases, 53.3%) and elevated myocardial enzymes (26.6%). The mean duration of exudation of the chest radiograph was (4.2 ± 2.9) d, the time of CT abnormality was earlier than that of the chest radiograph, and the average time of chest radiography and the beginning of recovery was (9.3 ± 4. 1) d and (14.5 ± 5 .0) d. The average initial glucocorticoid treatment time was (4.8 ± 3.5) d after the illness, and the hormone was added to the maximum dose at (8.4 ± 3.9) days. The dosage of hormone in the severe and common groups was (6 11 ± 2 12) mg And (26 8 ± 20 2) mg, P <0.001. The positive rate of antibody was 64.7% (2 2/34), the earliest positive time was 9 days, with an average of (18.2 ± 6.4) days. Conclusion: The main clinical manifestations of fever as the performance of chest X-ray can show small exudate, this