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《工程(英文)》 >> 2021年 第7卷 第10期 doi: 10.1016/j.eng.2020.09.009

起病时无呼吸道症状或发热的重型或危重型COVID-19患者的临床特征及转归

a Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
b Physical Examination Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
c Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
d Department of Pharmacology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

# These authors contributed equally to this work.

收稿日期: 2020-04-07 修回日期: 2020-09-19 录用日期: 2020-09-21 发布日期: 2020-10-29

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摘要

以不典型症状起病的新型冠状病毒肺炎(COVID-19)患者在早期容易漏诊,部分患者可发展为重症甚至危重症,目前尚缺乏相关的临床研究。本研究回顾了在起病时无典型症状(呼吸道症状或发热)的重型或危重型COVID-19患者的临床、实验室和影像学特征及治疗情况,并随访至患者死亡或治愈出院。2020年1月25日至2020年2月10日期间,武汉协和医院西院共收治943例COVID-19患者,其中909例(96.4%)重型或危重型COVID-19患者中有10例(1.1%)患者在起病时无呼吸系统症状或发热。10例患者的中位年龄为63岁[四分位区间(IQR):57~72],其中7例为男性。从出现症状到入院的中位时间为14 d(IQR:7~20)。10例患者中有8例患有慢性基础疾病。入院时,5例患者有乏力症状(n = 5)、4例有头痛或头晕(n = 4)、5例有腹泻(n = 5)、3例有厌食(n = 3)、3例有恶心或呕吐(n = 3)以及1例患者有眼部不适症状(n = 1)。4例患者外周血淋巴细胞减少。影像学检查显示9例患者有双侧肺炎,1例有单侧肺炎。最终2例患者死亡,8例患者治愈出院。8例患者从入院到出院的中位时间为24 d(IQR:13~43)。总的来说,部分重型或危重型COVID-19 患者在起病时无呼吸道症状或发热,此类不典型患者应尽早发现和隔离,否则可能延误病情,导致住院时间延长,甚至死亡。因此,对COVID-19患者密切接触者,即使无呼吸道症状或发热,也应及时进行核酸检测或胸部CT扫描以筛查不典型症状患者。

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