摘要
目的分析24例新型冠状病毒肺炎(COVID-19)死亡患者的临床特征及救治经验,为COVID-19临床诊疗提供参考。方法收集2020年2月13日至3月15日该单位援助武汉期间,在武汉市某医院重症病区收治的24例COVID-19死亡患者的临床资料。回顾性分析患者的临床表现、实验室检查、影像学检查、首次出现症状至呼吸衰竭时间、首次出现症状至死亡时间、并发症及治疗方案等。结果24例COVID-19死亡患者中,男17例,女7例,年龄56~95岁。入院临床表现主要以发热、气促为主。患者从首次出现症状至出现呼吸衰竭的平均时间为(14.25±4.87)d,患者从首次出现症状至死亡的平均时间为(20.42±6.39)d。采用有创呼吸支持患者的平均生存时间为(24.89±4.81)d,而仅采用无创呼吸支持患者的平均生存时间为(17.73±5.76)d,两者比较差异有统计学意义(P=0.007)。并发症以呼吸衰竭(24例)、心力衰竭(8例)、消化道出血(6例)为主。救治期间死亡患者血小板、淋巴细胞绝对值(LYM)均值呈明显下降趋势。结论危重型COVID-19早期症状不典型,病情进展迅速,病程1周是监测关键时间,2~3周是救治关键期;需密切关注多器官功能、凝血功能,以及血小板、LYM等变化;积极采用有创通气利于危重型患者生存。
Objective To analyze the clinical characteristics and treatment experience of 24 dead patients with corona virus disease 2019(COVID-19),and provide reference for clinical diagnosis and treatment of COVID-19.Methods The clinical data of 24 patients who died of COVID-19 in the intensive care ward of certain Hospital of Wuhan during the period from February 13 to March 15,2020 were collected.The clinical manifestations,laboratory examination,imaging examination,time from the first symptom to respiratory failure,time from onset to death,complications and treatment were analyzed retrospectively.Results Among the 24 patients died of COVID-19,there were 17 males and 7 females.The age ranged from 56 to 95 years old.The main clinical manifestations of admission were fever and shortness of breath.The average time from the first symptom to the respiratory failure was(14.25±4.87)d,and the average time from the first symptom to death was(20.42±6.39)d.The average survival time of the patients with invasive respiratory support was(24.89±4.81)d,while that of patients with the non-invasive respiratory support was(17.73±5.76)d,there was significant difference between the two groups(P=0.007).The main complications were respiratory failure(24 cases),heart failure(8 cases)and gastrointestinal bleeding(6 cases).During the treatment period,the average absolute value of the platelets(LYM)and lymphocytes in the dead patients showed a significant downward trend.Conclusion The early symptoms of the severe COVID-19 were atypical and the disease progressed rapidly.The first week of the disease course is the critical time for the monitoring,and the second to third week is the critical period for treatment.It is necessary to pay close attention to the changes of multiple organ function,blood coagulation function,platelet,LYM and so on.The active use of the invasive ventilation is beneficial to the survival of critically ill patients.
作者
李林峻
王小文
杨楠兰
郭建强
徐昉
米洁
汪志红
王璞
周发春
肖明朝
LI Linjun;WANG Xiaowen;YANG Nanlan;GUO Jianqiang;XU Fang;MI Jie;WANG Zhihong;WANG Pu;ZHOU Fachun;XIAO Mingzhao(the Eighth Batch of Medical Assistance Teams to Aid Hubei from Chongqing/the Fourth Batch of Hubei Medical Team of the First Affiliated Hospital of Chongqing Medical University/the National Medical Team Dispatched to Wuhan of the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Cardiothoracic Surgery ICU,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Cardiothoracic Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Ultrasonic Medicine,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Critical Care Medicine,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Endocrinology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Pulmonology,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China;Department of Urology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《重庆医学》
CAS
2021年第20期3509-3513,3517,共6页
Chongqing medicine
