51例重症新型冠状病毒肺炎临床特征及预后分析

Clinical characteristics and prognosis in 51 severe cases of COVID-2019

摘要:

目的：探讨重症新型冠状病毒肺炎（coronavirus disease 2019，COVID-19）确诊病例临床特征、治疗及预后。方法：选取2020年1月21日至2月25日重庆三峡中心医院收治的确诊重症COVID-19患者51例。回顾性分析患者一般资料、临床表现、实验室指标、影像学资料、并发症、治疗及预后情况。结果：51例COVID-19患者中，重型35例（68.6%），危重型16例（31.4%）。51例患者首发症状主要以发热、咳嗽、咳痰、呼吸困难、乏力为主。危重型组呼吸频率快于重型组（P=0.027）；危重型组中性粒细胞比率高于重型组（P=0.012）；危重型组乳酸脱氢酶（lactate dehydrogenase，LDH）高于重型组（P=0.028）；危重型组D-二聚体高于重型组（P=0.013）；危重型组降钙素原（procalcitonin，PCT）高于重型组（P=0.013）；危重型组白蛋白低于重型组（P=0.004）；危重型组氧合指数（partial pressure of oxygen/fraction of inspired oxygen，PaO2/FiO2）低于重型组（P=0.040）。危重型组与重型组并发急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）、急性呼吸衰竭、脓毒血症、休克、急性心力衰竭比较，差异均有统计学意义（P=0.006、0.000、0.004、0.012、0.027）。危重型组接受利巴韦林比例、血液滤过治疗比例、无创机械通气比例、有创机械通气比例、俯卧位通气比例均高于重型组，差异均有统计学意义（P=0.008、0.012、0.001、0.000、0.027）。51例患者中，治愈出院24例（47.1%），继续住院17例（33.3%），因病情好转转入轻症肺炎病区6例（11.8%），死亡4例（7.8%）。结论：老年人及合并高血压、糖尿病等基础疾病者发生重型和危重型COVID-19的风险可能较高。危重型COVID-19可能较重型部分实验室指标异常更明显、更易并发ARDS、死亡率更高。

Abstract:

Objective：To investigate the clinical characteristics，treatment and prognosis of coronavirus disease 2019（COVID-19）. Methods：Totally of 51 patients with severe and critical COVID-19 in Chongqing Three Gorges Center Hospital from January 21，2020 to February 25，2020 were included. Cases were analyzed retrospectively for demographic，clinical manifestations，laboratory in－dexes，imaging data，comorbidity，treatment and prognosis. Results：Patients were divided into severe group（n=35，68.6%） and critical group（n=16，31.4%） according to the guideline for diagnosis and treatment of novel coronavirus infected pneumonia. The most com－mon symptoms at onset of illness were fever，cough，expectoration，dyspnea and fatigue. The rate of respiratory was faster in critical group than in severe group（P=0.027）. The ratio of neutrophils was significantly higher in critical group than in severe group（P=0.012）. The serum levels of lactate dehydrogenase was significantly higher in critical group than in severe group（P=0.028）. The serum D-dimer levels were significantly higher in critical group than in severe group（P=0.013）. The serum procalcitonin concentration was significantly higher in critical group than in severe group（P=0.013）. The serum levels of albumin was significantly lower in critical group than in severe group（P=0.004）. The oxygenation index（PO2/FiO2） was lower in critical group than in severe group（P=0.040）. The percentage of complications such as acute respiratory distress syndrome（ARDS），acute respiratory failure，sepsis，shock and acute heart failure occoured in critical group were higher than in severe group（P=0.006，0.000，0.004，0.012，0.027，respectively）. The per－centage of treatment such as ribavirin，hemofiltration，noninvasive mechanical ventilation，invasive mechanical ventilation and prone position ventilation accepted were higher in the critical group than in the severe group（P=0.008，0.012，0.001，0.000，0.027，respec－tively）. The 51 COVID-19 patients，24 cases（47.1%） were cured and discharged，17 cases（33.3%） were hospitalized，6 cases（11.8%） were transferred to the mild pneumonia area due to the improvement of their condition，and 4 cases（7.8%） died. Conclusion：Elderly patients and those with chronic medical illness may be more likely to develop into severe and critical COVID-19. The laboratory indexes are more abnormal in critical group than those in severe group. The critical COVID-19 patients are more likely have ARDS than se－vere COVID-19. The mortality of critical COVID-19 is higher than that of severe COVID-19.