摘要
目的探讨新型冠状病毒肺炎(COVID-19)死亡病例的临床特点及死亡原因。方法回顾性分析2020年1月4日-2月24日解放军中部战区总医院收治的13例COVID-19死亡患者的一般资料、实验室检查、影像学资料及临床治疗方案。比较死亡患者在病程不同阶段(入院时、进展期、死亡前)的细胞免疫功能、炎性因子表达情况及乳酸水平等。结果13例中男10例,女3例,年龄(74±19)岁,其中≥70岁10例(76.9%)。9例合并慢性基础疾病,其中6例(46.2%)合并两种以上基础疾病。8例(61.5%)入院时肺部CT表现为双肺多发斑片状磨玻璃影,经(9±3)d进展为双肺弥漫性病变。患者入院时外周血淋巴细胞绝对数及CD3^+、CD4^+、CD8^+T淋巴细胞亚群计数均明显低于正常值,在疾病进展期及死亡前进一步降低,与入院时比较,差异均有统计学意义(P<0.01)。白介素(IL)-6、D-二聚体、C-反应蛋白(CRP)、乳酸水平等随着病情恶化逐渐升高,于死亡前达高峰(P<0.01)。死亡原因主要为严重急性呼吸窘迫综合征(ARDS)导致的Ⅰ型呼吸衰竭,其中3例出现多器官功能障碍综合征(MODS)。结论COVID-19患者死亡的主要危险因素包括男性、年龄≥70岁、合并多种基础疾病、细胞免疫功能低下、炎性因子过度表达。死亡原因主要为ARDS导致的Ⅰ型呼吸衰竭或MODS。
Objective To investigate the clinical features of 13 fatal cases of corona virus disease 2019 (COVID-19).Methods The clinical data of 13 patients who died of COVID-19 in Central Theater General Hospital,China,between January 4,2020,and February 24,2020,were analyzed retrospectively.The data reviewed included clinical manifestations,laboratory test results,radiographic features and dinical treatment plan.The cellular immune function,the expression of inflammatory factors,and lactate level in deceased patients at different stages of the disease were analyzed.Results Of those who died,the patients consisted of 10 men and 3 women.The age of those who died was (74±19) years,and 10(76.9%) patients were over 70 years old.For the patients who died,9 presented with underlying diseases,6(46.2%) of whom had more than 2 diseases.On admission,the chest computed tomography (CT) for 8 patients (61.5%) mainly showed multiple patchy ground-glass opacities.When the disease progressed,the ground-glass opacities rapidly developed into diffuse lesions in both lungs.The lymphocyte and CD3^+,CD4^+,and CD8^+ T lymphocyte counts in the peripheral blood of 13 patients were significantly lower than normal levels and decreased more substantially during the disease course based on the levels when admitted (P<0.01).Additionally,the interleukin (IL)-6,D-dimer,C-reactive protein (CRP),lactic acid levels gradually increased,and most peaked before death.The cause of death for most patients was acute respiratory distress syndrome (ARDS) with type I respiratory failure.Three patients eventually developed multiorgan deficiency syndrome (MODS).Conclusions The risk factors of death for COVID-19 patients included older men,more underlying diseases,poor cellular immune function and over-expression of inflammatory factors.The main cause of death in patients with COVID-19 was ARDS,which led to respiratory failure and MODS.
作者
刘海潮
李龙
毛从政
徐瑞娟
张方琪
胡振红
宋青
Liu Hai-Chao;Li Long;Mao Cong-Zheng;Xu Rui-Juan;Zhang Fang-Qi;Hu Zhen-Hong;Song Qing(Department of Respiratory Medicine,Central Theater General Hospital of Chinese PLA,Wuhan 430070,China;Department of Critical Care Medicine,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2020年第5期481-485,共5页
Medical Journal of Chinese People's Liberation Army
关键词
新型冠状病毒肺炎
死亡原因
临床分析
corona virus disease 2019
cause of death
clinical analysis
