41例老年人SARS的临床与综合治疗分析

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

The clinical characteristics and general therapeutics of elderly SARS from 41 cases analysis

Objective To improve the diagnosis and the treatment of SARS by analyzing medical records of elderly SARS patients, which includes clinical characteristics, therapeutic methods (especially using cortical hormone) and outcomes. Methods Clinical records of 41 elderly SARS patients were analyzed, and who were compared with those of 164 non elderly SARS patients who were admitted to the same hospital in the same period. Results During the period, it was found that moderate fever was more frequently happened in the elderly SARS patients (P<0 05), while the main manifestations of SARS, such as high fever, sense of chillness and shivering occurred less commonly than those of the non elderly ones (P<0 05). The results of X ray showed that the incidence rates of bilateral lungs occurring multi pathological changes were obviously higher than those in the non elderly group (P<0 01). The total blood lymphocytes and T lymphocyte subgroups (CD3 , CD4 , CD8 ) were obviously lower than the non elderly ones (P<0 05). The serum albumin level of elderly SARS patients was also evidently lower than the non elderly ones (P<0 01). In the elderly SARS patients, the incidence rates of complicated mental disturbance and dual infection was higher than those of the non elderly ones (P<0 01). The death rate of the elderly SARS patients was 24 4% which was remarkably higher than that of the non elderly group(5 5%, P<0 01). The incidence rates of simultaneously occurred fundamental diseases and complications were also evidently higher than those of the non elderly ones (P<0 01). Conclusions The clinical characteristics of SARS suggest a higher rate of severe and extremely severe type in the elderly patients. The cellular immunity is obviously decreased. All these characteristics make more difficulties for the treatment of SARS and cause the increases in mortality. Careful use of cortical hormone should be emphasized since it caused remarkable side effects in elderly SARS patients.