发热门诊治疗新冠肺炎患者康复时间影响因素分析

目的 了解新型冠状病毒肺炎(COVID-19)患者临床特征、实验室指标变化和治疗康复情况,分析影响患者康复时间的因素。方法 采用回顾性方法将2020年1月10日—2月10日在武汉市肺科医院发热门诊治疗的308例COVID-19患者纳入研究范围,分析其临床特征、实验室检测和治疗康复情况,并采用Logistic回归分析影响康复时间的因素。结果 308例新冠肺炎患者康复时间中位数（M）是35（26.00,44.75） d,48.05%的新冠肺炎患者治疗康复时间超过35 d。临床症状以发热（84.74%）和干咳（58.77%）为主,病灶范围≤2肺叶110例（35.71%）, 范围>2肺叶198例（64.29%）;核酸阳性177例（57.47%）,核酸阴性131例（42.53%）;基础疾病以高血压（12.99%）和糖尿病（6.82%）为主,实验室检查结果显示主要为白细胞正常或减少,可见淋巴细胞计数减少、C反应蛋白增高、乳酸脱氢酶增高等;单因素分析结果显示：年龄（P=0.003）、病灶部位（P=0.028）、病灶范围（P=0.035）、基础疾病包括高血压（P=0.003）、糖尿病（P=0.012）、慢性阻塞性肺炎（COPD）（P=0.045）和病情分型（P=0.013）与康复时间是否延长有关;多因素Logistic回归分析结果显示,高血压（OR=2.632,95%CI: 1.237~5.602）、糖尿病（OR=2.620,95%CI: 1.599~4.683）、慢阻肺（OR=5.632,95%CI: 2.372~23.906）和病情重型（OR=2.145,95%CI: 1.021~4.503）等因素可能与新冠患者康复时间延长有关。结论 新冠肺炎患者康复时间可能与病灶范围、基础疾病（高血压、糖尿病和COPD）、病情严重程度存在密切关联,在临床诊治和护理中应加以考虑。

Analysis on factors influencing the recovery time of fever outpatients with COVID-19

Objective To understand clinical characteristics , laboratory indicators and treatment rehabilitation of coronavirus disease 2019 (COVID-19), we analyze the factors that affect the recovery time of patients. Methods Totally 308 patients with COVID-19 from febrile clinic of Wuhan Pulmonary Hospital from January 10, 2020 to February 10, 2020 were included in the study by retrospective method, and their clinical characteristics, laboratory tests, treatment and rehabilitation were analyzed, and the factors influencing the rehabilitation time were analyzed by Logistic Regression. Results The median recovery time of 308 patients with viral pneumonia was 35 (26.00, 44.75) days, and 48.05% of patients with COVID-19 were treated for more than 35 days. The main clinical symptoms were fever (84.74%) and dry cough (58.77%). 110 cases (35.71%) had lesions less than 2 lobes and 198 cases (64.29%) had lesions more than 2 lobes; 177 cases (57.47%) were nucleic acid positive and 131 cases (42.53%) were nucleic acid negative; The underlying diseases were hypertension (12.99%) and diabetes (6.82%). Laboratory examination showed that white blood cells were mainly normal or decreased, and lymphocyte count decreased, C reactive protein increased and lactate dehydrogenase increased. Univariate analysis showed: age ( P=0.003) , the location of the lesion (P=0.028), the range of the lesion (P=0.035), the underlying diseases including hypertension ( P=0.003), diabetes mellitus (P=0.012), COPD (P=0.045) and disease classification (P=0.013) were related to the prolonged recovery time. Multivariate Logistic regression analysis showed that hypertension (OR=2.632, 95%CI: 1.237-5.602), diabetes (OR=2.620, 95%CI: 1.599-4.683), COPD (OR=5.632, 95%CI: 2.372-23.906) and critical illness (OR=2.145, 95%CI: 1.021-4.503) and other factors may be related to the prolonged recovery time of patients with COVID-19. Conclusion The recovery time of patients with COVID-19 may be closely related to range of lesion, the underlying diseases (hypertension, diabetes and COPD) and the severity of the disease, which should be considered in clinical diagnosis, treatment and nursing.