摘要
背景:传染性非典型性肺炎(severe acute respiratory syndrome,SARS)是一种新型冠状病毒所致的急性传染病,临床表现以肺脏的急性炎症性损伤为主,可合并心、脑、肾等多脏器损害,除躯体症状外,情感障碍是SARS患者的另一显著神经精神症状。目的:对SARS 合并神经精神损害的临床特点进行分析总结。设计:以患者为观察对象,回顾性病例分析。单位:中山大学第二附属医院的神经科,呼吸科和放射科。对象:2003-02/05中山大学第二附属医院及广州市第八人民医院住院确诊SARS 病例325例,其中出现神经精神症状者173例。方法:回顾分析325例SARS 病例,其中173例出现神经精神症状,总结分析其临床资料。主要观察指标:神经精神损害的临床表现,眼底检查结果,部分死亡病例尸检病理结果。结果:①SARS 神经精神症状发生率为53.2%,主要有以下几类:头痛116例(67.1%),头晕50例(28.9%),意识障碍18例(10.4%),精神障碍8例(4.6%),伴神经系统局灶定位体征者1例(0.6%),抽搐2例(1.2%),情感障碍53例(30.6%),其中焦虑35例(20.2%),抑郁11例(6.4%),自杀倾向2例(1.2%),恐惧13例(7.5%)。②325例中,重症SARS 56例,伴发神经精神损害者47例,其发生率明显高于轻症(P<0.01)。③4例病例眼底检查显示视乳头边缘欠清晰,生理凹陷存在,静脉充盈。④2例死亡病例尸体解剖脑组织病理显示:脑组织出现不同程度的水肿,局部神经纤维出现脱髓鞘现象。结论:SARS 神经精神损害症状多样,与病情轻重显著相关。病理检查可见脑水肿及神经元脱髓鞘等损害。
BACKGROUND：Severe acute respiratory syndrome （SARS）,an acute infection with a mutant coronavirus,is characterized by acute pulmonary infltunmatory injury accompanied by possible multiple organ injuries. Bedsides somatic symptoms,affective disorder constitutes an obvious neuropsychiatric symptom in SARS patients. OBJECTIVE：To analyze the clinical features of SARS with neuropsychiattic involvement. DESIGN：A retrospective case analysis. SETTING：Department of Neurology,Department of Respiratory Diseases and Department of Radiology of Affiliated Hospital of Sun Yat-sen University. PARTICIPANTS：Totally 325 SARS patients treated in the Second Affiliated Hospital of Sun Yat-sen University and the 8^th People＇s Hospital of Guangzhou from February 2003 to May 2003 were involved,including 173 cases who developed neuropsychiatric symptoms. METHODS：The clinical data of 325 of SARS including 173 cases with neuropsychiatric symptoms were retrospectively analyzed. MAIN OUTCOME MEASURES：Clinical neuropsychiatric symptoms, ophthalmoscopic examination,and pathological findings in autopsy. RESULTS： ①The incidence of neuropsychiatric involvement was about 53.2% in SARS patients.The manifestations consisted mostly of headache （67.1%）,dizziness（28.9%）,conscious-ness disturbance（10.4%）,mental disorder（4.6%）, local orientational disorder（0.6%）,seizures（1.2%）,and affective disorders （30.6%）;anxiety occurred in 20.2%,depression in 6.4%,suicidal tendency in 1.2%,and phobia in 7.5% of the patients with neuropsychiattic involvement. ②Among the 325 patients,56 were in critical condition of whom 47 had accompanying neuropsychiatric impairment,with significantly greater incidence than that in mild cases （P〈 0.01）. ③Ophthalmoscopic examination performed in 4 patients showed blurred margin of the optic disc with retinal venous congestion. ④Autopsy in 2 cases identified edema of the perivascular tissue and vascular wall of the small veins with mononuclear cell and lymphocyte infiltration,neuron degeneration and demyelination in focal brain tissues. CONCLUSION：The manifestations of neuropsychiatric involement can vary in association with the severity of SARS,and the typical pathological changes include edema,neuronal demyelination etc.in the brain.
出处
《中国临床康复》
CSCD
北大核心
2005年第24期208-209,共2页
Chinese Journal of Clinical Rehabilitation
基金
广东省卫生厅科研基金资助项目(E002003021)~~
