| 武阳丰,张林峰,谢高强,陈博文,肖峰,王月香,韩德民,北京市SARS医疗救治指挥中心科技攻关组.SARS患者入院时间与病情、病程及病死率的关系[J].Chinese journal of Epidemiology,2004,25(4):308-311 |
| SARS患者入院时间与病情、病程及病死率的关系 |
| Relationship between the severity,course,fatality of severe acute respiratory syndrome patients and the timing of hospitalization |
| Received:December 25, 2003 |
| DOI： |
| KeyWord: 严重急性呼吸综合征 入院时间 病情 病程 病死率 |
| English Key Word: Severe acute respiratory syndrome Hospitalization Disease condition Disease course Fatality rate |
| FundProject:国家SARS科技攻关重大项目;国家“863”课题(2003AA208107);北京市卫生局基金 |
| Author Name | Affiliation | E-mail | | WU Yang-feng | Department of Epidemiology,Fu Wai Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100037,China | handemin@trhos.com | | ZHANG Lin-feng | Department of Epidemiology,Fu Wai Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100037,China | | | XIE Gao-qiang | Department of Epidemiology,Fu Wai Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100037,China | | | CHEN Bo-wen | 首都儿科研究所卫生发展研究室 | | | XIAO Feng | 首都儿科研究所卫生发展研究室 | | | WANG Yue-xiang | 北京市卫生局 | | | HAN De-min | 北京市卫生局 | | | The Beijing Commanding Center for SARS Treatment and Cure Scientific Research Group. |
1. Department of Epidemiology,Fu Wai Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100037,China
2.HAN De-min. BeiJing Tong Ren Hospital BeiJing 100730, China
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| Abstract: |
| 目的探讨严重急性呼吸综合征(SARS)患者发病后的入院时间与患者病情、病程以及病死率的关系.方法将2003年"北京市SARS临床病历资料数据库"的1291例资料完整、符合卫生部2003年5月3日诊断标准的SARS临床诊断病例,按照发病后至收入院治疗时间的长短分为 1～3天、4～7天、8～14天和15天以后入院4组进行分析.结果 4组之间年龄、性别和基础病构成差异无显著性,职业构成差异有显著性.入院越早,医务人员所占比例越高.在入院当日上述4组患者具有胸闷、胸痛的比例分别为 9.7%、 16.5%、 23.1%和 24.0%( P<0.001),气短憋气分别为 7.4%、 13.7%、 19.2%和 22.0%( P<0.001),咳嗽为 32.8%、 44.8%、 59.9%和 48.0%( P<0.001),呼吸次数≥24次/min者所占比例依次为 11.1%、 15.5%、 22.8%和 25.5%( P<0.001),胸片异常率依次为 80.3%、 89.0%、 92.3%和 88.9%( P= 0.002),平均异常肺野数依次为 1.7、 1.9、 2.5和 2.6( P<0.001),接受持续吸氧治疗者分别为 33.6%、 50.0%、 53.7%和 74.0%( P<0.001),接受激素治疗者分别为 28.2%、 35.9%、 53.7%和 62.0%( P<0.001).有基础病者的年龄标化病死率为 14.9%、 11.7%、 50.0%和 33.9%( P<0.001),平均病程为 30.3天、 34.2天、 42.9天和 47.5天( P<0.001);无基础病者的年龄标化病死率为 5.3%、 9.8%、 9.2%和 8.3%( P= 0.101),平均病程为 32.4天、 35.3天、 40.9天和 47.6天( P<0.001).结论 SARS患者发病后如不及时住院治疗会导致病情加重,延误治疗时机,甚至影响病死率. |
| English Abstract: |
| Objective To study the relationship of timing of hospitalization and the severity, course, fatality of severe acute respiratory syndrome (SARS) patients. Method 1291 hospital records of clinically diagnosed SARS patients with complete data gathered from "2003 Beijing SARS Clinical Database" were analyzed. Results SARS cases were categorized into four groups, according to the time of hospitalization after onset of the disease: within 3 days, during day 4 to day 7, during day 8 to day 14 and after day 14. The numbers of cases for each group were 568,496, 177 and 50 respectively. Data showed that from group 1 to 4, the prevalence rates of major symptoms on the first day of hospitalization were: (1)9. 7 %, 16. 5 %, 23. 1 % and 24.0 % for "feeling chest pain" (P <0.001), (2) 7.4%, 13. 7%, 19.2% and 22.0% for "suffering from breathing obstruction" (P <0. 001), (3) 32. 8%, 44. 8%, 59. 9% and 48.0%, for "coughing"(P< 0. 001) and (4) 14. 1 %, 22. 4%, 27. 1 % and 18. 0 % for "coughing up phlegm" (P = 0. 0002), respectively. The rates of high respiratory frequency (≥24 bits/min.) were 11. 1 %, 15. 5 %, 22. 8 % and 25. 5 % (P< 0. 001). The rates of abnormal chest X--ray were 80. 3%, 89. 0 %, 92. 3 % and 88. 9 %, respectively (P = 0. 002). The average numbers of abnormal lung field (the lung were divided into 6 fields) were 1. 7, 1. 9, 2. 5 and 2. 6 (P< 0. 001); The numbers of cases receiving continuous oxygen supply treatment were 33. 6%, 50. 0%, 53. 7% and 74. 0 % (P <0. 001), and the numbers of cases receiving glucocorticosteroids treatment were 28. 2 %, 35. 9%, 53. 7% and 62. 0 % (P 0. 001), respectively. With cases having had chronic baseline diseases prior to SARS infection, the age--standardized fatality rates were 14. 9%, 11. 7%, 50. 0% and 33. 9% (P< 0. 001), and the average courses of the disease were 30. 3, 34. 2, 42. 9 and 47. 5 days (P< 0. 001), respectively. In cases without chronic baseline diseases, the age- standardized fatality rates were 5. 3%, 9. 8%, 9. 2% and 8. 3% (P = 0. 101), and the average courses for each group were 32. 4, 35. 3, 40. 9 and 47. 6 days (P< 0. 001), respectively. ConclusionDelayed hospitalization would cause the situation of SARS patient to deteriorate, losing the best chance for treatment and increase case fatality. In terms of control program on SARS, emphasize should be paid on decreasing the panic of patients to the disease so as to get early hospitalization. |
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