摘要
目的描述成年重症COVID-19患者的临床特征及结局病探讨其院内死亡的危险因素。方法本研究纳入了来自湖北省荆州市洪湖市人民医院重症监护病房的确诊为COVID-19的20名成人患者,根据最后的结局分为生存组和死亡组,10人/组。从电子病历中获取人口学、临床表现及体征、实验室指标、治疗措施和临床结局等数据,总结ICU成年COVID-19患者的临床特征和结局分析。通过使用单因素Logistic分析两组与院内死亡相关的危险因素。结果COVID-19确诊患者的平均年龄为70±12岁,其中40%为男性,起病11±9 d后入住ICU。入院时最常见的症状分别是咳嗽(19例,95%)、乏力或肌痛(18例,90%)、发热(17例,85%)和呼吸困难(16例,80%)。11名(55%)患者有基础疾病,其中高血压最常见(11例,55%),其次是心血管疾病(4例,20%)和糖尿病(3例,15%)。6人(30%)接受了有创机械通气和持续肾脏替代治疗,并最终死亡。急性心脏损伤是最常见的并发症(19例,95%)。50%的患者(10人)在入住ICU后第2~19天之间死亡,相较于死亡患者,生存患者的平均体质量更低(61.70±2.36 vs 68.60±7.15,P=0.01),格拉斯哥昏迷评分更高(14.69±0.70 vs 12.70±2.45,P=0.03),更少并发休克(2 vs 10,P=0.001)和急性呼吸窘迫综合征(2 vs 10,P=0.001)。结论患有COVID-19的危重患者年龄较高,体质量较重、淋巴细胞计数减少可能是ICU中COVID-19患者死亡的潜在危险因素。
Objective To explore the clinical characteristics and outcomes of adult critically ill patients with COVID-19 and identify the risk factors correlated with in-hospital deaths.Methods This study was conducted among 20 confirmed adult cases of COVID-19 in the Intensive Care Unit(ICU)of Honghu People's Hospital in Jingzhou City,Hubei Province.According to the final outcome,the patients were divided into survivor group and death group with 10 patients each.The demographic data,clinical manifestations and signs,laboratory findings,treatment measures and clinical outcomes were obtained from electronic medical records to compare the clinical characteristics and outcomes between the two groups.Univariate logistic analysis was used to analyze the risk factors associated with in-hospital death.Results The mean age of patients with confirmed COVID-19 was 70±12 years,and 40%of them were male.The patients were admitted to ICU 11±9 days after symptom onset.The most common symptoms on admission were cough(19 cases),fatigue or myalgia(18 cases),fever(17 cases)and dyspnea(16 cases).Eleven(55%)of the patients had underlying diseases,among which hypertension was the most common(11 cases),followed by cardiovascular disease(4 cases)and diabetes(3 cases).Six(30%)of the patients received invasive mechanical ventilation and continued renal replacement therapy but eventually died.Acute cardiac injury was the most common complication(19 cases).Half of the patients died between the 2nd and 19th day after ICU admission.Compared with dead patients,the surviving patients had a lower average body weight(61.70±2.36 vs 68.60±7.15 kg,P=0.01)and a higher Glasgow Coma Index(14.69±0.70 vs 12.70±2.45,P=0.03),and were less likely to develop shock(2 vs 10,P=0.001)or acute respiratory distress syndrome(2 vs 10,P=0.001).Conclusion Critically ill patients with COVID-19 are generally older.A higher body weight and a lower lymphocyte count are potentially associated with a greater likeliness of fatality in ICU patients with COVID-19.
作者
陆嘉茵
章媛
程功
何劲
吴凤
胡鸿彬
沙桐
曾振华
陈仲清
LU Jiayin;ZHANG Yuan;CHENG Gong;HE Jin;WU Feng;HU Hongbin;SHA Tong;ZENG Zhenhua;CHEN Zhongqing(Department of Critical Care Medicine,Nanfang Hospital,Southern Medical University,Guangzhou510515,China;Department of Critical Care Medicine,Honghu People's Hospital of Jingzhou City,Jingzhou 433200,China)
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2020年第6期778-785,共8页
Journal of Southern Medical University
基金
国家自然科学基金(81871604)
广东省自然科学基金(2020A151501361,2017A030313590)。
