摘要
目的:分析危重型新型冠状病毒肺炎(COVID-19)患者的临床特征及相关危险因素。方法:回顾性分析15例危重型COVID-19患者的临床特征及预后。结果:15例危重型COVID-19患者平均年龄(61.73±9.58)岁,≥60岁12例(80%)。男性10例(66.7%),女性5例(33.3%)。9例(60%)合并基础疾病。主要临床表现有发热15例(100%),咳嗽12例(80%),气促12例(80%),咯血1例(6.7%),腹泻2例(13.3%)。起病至气促平均时间(4.2±3.0)d。所有患者的淋巴细胞绝对值都明显降低,(0.15~0.63)×10~9/L,血白蛋白降低者10例(66.7%),CRP水平升高者15例(100%),D-二聚体水平升高者8例(53.3%)。氧合指数平均(134.60±50.48)mm Hg。整个治疗过程中所有患者都出现并发症,其中急性呼吸窘迫综合征(ARDS)15例(100%),急性心肌损伤5例(33.3%),急性肾功能不全3例(20%),急性肝功能不全3例(20%),感染性休克8例(53.3%),消化道出血1例(6.7%)。15例患者中继发感染10例(66.7%),痰或肺泡灌洗液培养中找到多重耐药菌(MDR)者3例(20%),痰培养找到真菌者3例(20%),其中2例(13.3%)为白色假丝酵母菌,1例(6.7%)为烟曲霉。死亡6例(40%)。结论:年龄≥60岁、合并基础病、淋巴细胞绝对值降低、白蛋白减低、CRP及D-二聚体水平升高可能是COVID-19患者发展为危重型的重要因素。呼吸衰竭、继发感染可能是危重型COVID-19患者的主要死因。预防MDR和真菌感染对降低患者病死率有重要意义。
Objective:To analyze the clinical characteristics and risk factors of death in patients with critically ill coronavirus disease 2019(COVID-19).Methods:The clinical characteristics and prognosis of 15 patients with critically ill COVID-19 were analyzed retrospectively.Results:The mean age of 15 patients with critically ill COVID-19 was(61.73±9.58)years,and that of 12 patients(80%)was 60 years old or above.There were 10 males(66.7%)and 5 females(33.3%).Nine cases(60%)had chronic medical illness.The main clinical manifestations were fever(15 cases,100%),cough(12 cases,80%),shortness of breath(12 cases,80%),hemoptysis(1 case,6.7%)and diarrhea(2 cases,13.3%).The time from onset to shortness of breath was(4.2±3.03)days.The lymphocyte absolute values were significantly reduced in all patients(0.15~0.63)×109/L,albumin was significantly reduced in 10 patients(66.7%),CRP was significantly elevated in 15 patients(100%),and D dimer was significantly elevated in 8 patients(53.3%).Average oxygenation index was(134.60±50.48)mmHg.All patients had organ dysfunction,including 15(100%)with ARDS,5(33.3%)with cardiac injury,3(20%)with acute kidney injury,3(20%)with liver dysfunction,8(53.3%)with sepsis shock,1(6.7%)with gastrointestinal hemorrhage.Among 15 patients,10 cases(66.7%)suffered secondary infection.Multidrug resistant(MDR)bacteria were found in sputum or alveolar lavage culture of 3 cases(20%).Sputum cultures from 3 patients(20%)were positive for fungi,of which 2(13.3%)were positive for Candida Albicans and 1(6.7%)for aspergillus fumigatus.Six cases(40%)died.Conclusion:The age≥60 years,chronic medical illness,the decrease of lymphocyte absolute value or albumin,the elevation of CRP and D dimer level may be important factors for the development of critically ill cases of COVID-19.Respiratory failure and secondary infection may be the main causes of death in COVID-19.It is important to prevent MDR bacterial and fungi infection in order to reduce the mortality.
作者
邹小静
余姗姗
胡明
李树生
房明浩
ZOU Xiao-jing;YU Shan-shan;HU Ming;LI Shu-sheng;FANG Ming-hao(Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《内科急危重症杂志》
2020年第2期116-118,133,共4页
Journal of Critical Care In Internal Medicine
关键词
新型冠状病毒肺炎
危重型
多重耐药菌
Coronavirus disease 2019
Critically ill
Multidrug resistant bacterial
作者简介
通信作者:房明浩,E-mail:fangmh@tjh.tjmu.edu.cn
