SARS: experience at Prince of Wales Hospital, Hong Kong.
SARS: experience at Prince of Wales Hospital, Hong Kong.
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DOI：
10.1016/s0140-6736(03)13218-7
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发表时间：
2003-05-03
期刊：
影响因子：
--
通讯作者：
Cockram C
中科院分区：
文献类型：
--
作者：
Tomlinson B;Cockram C
供个人使用。只有在获得柳叶刀出版集团许可的情况下才能复制。免疫系统，例如与淘大花园暴发有关的终末期肾功能衰竭患者和新加坡暴发中心肾功能衰竭患者。亚临床感染也可能发生，除非有可靠的诊断测试，否则无法识别。对医务人员造成高风险的程序包括鼻咽抽吸、支气管镜检查、气管插管、呼吸道抽吸、心肺复苏和无创呼吸机程序。大便失禁后清洁患者和床上用品似乎也是一种高风险的操作。治疗一直是经验性的。最初的患者服用了广谱抗生素，但在两天没有反应后，又服用了利巴韦林和皮质类固醇。随着胸部X线改变和/或氧减饱和的进展而继续恶化的患者，给予甲基强的松龙脉冲治疗。1使用类固醇的理由是，肺部疾病的进展可能由宿主炎症反应介导，类似于急性呼吸窘迫综合征，并由细胞因子或趋化因子“风暴”产生。临床印象是，脉冲类固醇有时会产生戏剧性的反应。然而，类固醇治疗的明显益处以前已被证明是不正确的，就像感染呼吸道合胞病毒一样。对SARS自然病史知识的缺乏增加了确定治疗效果的难度。一些患者的临床病程很长，有可能在第二周或第三周或更长时间内复发。即使是病情较轻的患者，也需要长期住院，需要长期重症监护的患者比例很高，无论是否进行通风(PWH1的138例患者中有23%)，以及卫生保健人员的敏感性，这对卫生保健系统的应对能力来说是个不祥的预兆。即使这种急性疾病已经结束，未知因素依然存在。持续的病毒脱落和可能出现的长期后遗症，如肺纤维化或晚期病毒后并发症，意味着患者将需要仔细监测。
For personal use. Only reproduce with permission from The Lancet Publishing Group. immune system, as could be the case in the patient with end-stage renal failure implicated in the Amoy Gardens outbreak and another with renal failure at the centre of an outbreak in Singapore. Subclinical infections may also occur and will not be recognisable until reliable diagnostic tests are available. Procedures causing high risk to medical personnel include nasopharyngeal aspiration, bronchoscopy, endotracheal intubation, airway suction, cardiopulmonary resuscitation, and non-invasive ventilation procedures. Cleaning the patient and the bedding after faecal incontinence also appears to be a high-risk procedure. Treatments have been empirical. Initial patients were given broad-spectrum antibiotics but, after failing to respond for 2 days, were given ribavirin and corticosteroids. Patients who continued to deteriorate with progression of chest radiographic changes or oxygen desaturation, or both, were given pulsed methylprednisolone. 1 Steroids were used on the rationale that progression of the pulmonary disease may be mediated by the host inflammatory response, similar to that seen in acute respiratory distress syndrome, and produced by a cytokine or chemokine “storm”. The clinical impression is that pulsed steroids sometimes produce a dramatic response. However, apparent benefits of steroid treatment have proven to be incorrect before, as in infection with respiratory syncytial virus. 12Lack of knowledge of SARS’natural history adds to the difficulty of determining the effectiveness of therapy. Some patients have a protracted clinical course with potential for relapses continuing into the second or third week, or beyond. Long hospital stays, even in less ill patients, are required, and the high proportion of patients requiring lengthy intensive care, with or without ventilation (23% in the 138 cases from PWH1), and the susceptibility of health-care workers bodes ill for the ability of health-care systems to cope. Even when the acute illness has run its course, unknowns remain. Continued viral shedding and the possible development of long-term sequelae, such as pulmonary fibrosis or late post-viral complications, means that patients will require careful surveillance.