80例新型冠状病毒肺炎患者的消化道症状分析

来源 :中华危重病急救医学 | 被引量 : 0次 | 上传用户:Xinigami
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目的:探讨新型冠状病毒肺炎(简称新冠肺炎)患者在整个疾病过程中消化道症状发生的临床特征,为病因诊断及治疗提供参考依据。方法:回顾性分析2020年1月22日至3月8日中国科学技术大学附属第一医院传染病分院集中收治的新冠肺炎确诊患者的临床资料,按是否发生纳差、恶心呕吐和腹泻等消化道症状进行分组,观察患者纳差、恶心呕吐及腹泻等症状出现的特征,分析性别、年龄、基础疾病、疾病严重程度、实验室检查以及药物治疗与消化道症状发生的关系。结果:共纳入80例新冠肺炎患者,43例(53.8%)在整个疾病过程中出现了纳差,17例(21.3%)出现恶心呕吐,33例(41.3%)出现腹泻。仅有5例(6.3%)、1例(1.3%)和4例(5.0%)患者的纳差、恶心呕吐和腹泻症状发生于入院前,其余患者的消化道症状大多发生在入院后48 h内。所有患者纳差、恶心呕吐和腹泻症状的持续时间(d)分别为5.3±2.1、2.2±1.0和1.4±0.9。出现纳差症状的患者较无纳差症状者年龄更大(岁:48.2±17.6比39.3±15.1),白蛋白(Alb)水平及淋巴细胞比例更低〔Alb(g/L):39.8(35.7,45.1)比46.1(42.6,49.4),淋巴细胞比例:0.19(0.09,0.28)比0.28(0.17,0.35)〕,中性粒细胞比例、C -反应蛋白(CRP)、D -二聚体、乳酸脱氢酶(LDH)等实验室指标更高〔中性粒细胞比例:0.74(0.61,0.85)比0.64(0.52,0.76),CRP(mg/L):21.4(3.9,52.9)比5.6(2.4,14.0),D -二聚体(mg/L):0.2(0.2,0.5)比0.2(0.1,0.3),LDH(μmol·sn -1·Ln -1):4.49(3.59,5.19)比3.12(2.77,4.90)〕,同时也更多地使用了中药〔65.1%(28/43)比40.5%(15/37),均n P<0.05〕。此外,18例合并心血管疾病的患者中,有14例出现了纳差症状,7例出现了恶心呕吐的症状。3例既往有慢性肾脏疾病的患者全部出现了纳差和恶心呕吐,其中有2例出现腹泻。n 结论:新冠肺炎患者在治疗过程中伴随的消化道症状并不少见,无论是病毒本身引起,还是与药物、饮食、精神有关,临床医师都应及时进行病因分析,从而为新冠肺炎患者提供更好的治疗方案。“,”Objective:To investigate the clinical characteristics of gastrointestinal symptoms in patients with coronavirus disease 2019 (COVID-19) during the whole disease process, and provide reference for etiological diagnosis and treatment.Methods:The clinical data of patients with COVID-19 admitted in the Infectious Diseases Branch of the First Affiliated Hospital of University of Science and Technology of China from January 22nd, 2020 to March 8th, 2020 were analyzed retrospectively. According to whether there were gastrointestinal symptoms (poor appetite, nausea/vomiting and diarrhea), all patients were divided into gastrointestinal symptom group and asymptomatic group. The characteristics of gastrointestinal symptoms, such as poor appetite, nausea, vomiting and diarrhea were counted and analyzed, and the correlation between gastrointestinal symptoms and gender, age, basic diseases, disease severity, laboratory examination and drug treatment were analyzed.Results:A total of 80 COVID-19 patients were involved, 43 cases (53.8%) presented with poor appetite, 17 cases (21.3%) had nausea and vomiting, and 33 cases (41.3%) had diarrhea. Among them, 5 cases, 1 case and 4 cases respectively preformed poor appetite, nausea/vomiting and diarrhea before admission, while the others experienced gastrointestinal symptoms within 48 hours after admission. Duration of poor appetite, nausea/vomiting and diarrhea (days) of all patients were 5.3±2.1, 2.2±1.0 and 1.4±0.9, respectively. The patients with poor appetite were older than those without symptoms (years old: 48.2±17.6 vs. 39.3±15.1), albumin (Alb) level and the lymphocytes ratio were lower than those in asymptomatic group [Alb (g/L): 39.8 (35.7, 45.1) vs. 46.1 (42.6, 49.4), lymphocytes ratio: 0.19 (0.09, 0.28) vs. 0.28 (0.17, 0.35)], while the neutrophil ratio, the levels of C-reactive protein (CRP), D-dimer, and lactate dehydrogenase (LDH) were higher than those in asymptomatic group [the neutrophil ratio: 0.74 (0.61, 0.85) vs. 0.64 (0.52, 0.76), CRP (mg/L): 21.4 (3.9, 52.9) vs. 5.6 (2.4, 14.0), D-dimer (mg/L): 0.2 (0.2, 0.5) vs. 0.2 (0.1, 0.3), LDH (μmol·sn -1·Ln -1): 4.49 (3.59, 5.19) vs. 3.12 (2.77, 4.90)]; at the same time, more traditional Chinese medicine was used in the patients with gastrointestinal symptoms [65.1% (28/43) vs. 40.5% (15/37), all n P < 0.05]. In addition, 14 cases of 18 patients with cardiovascular diseases presented with poor appetite, 7 patients had nausea and vomiting symptoms. All of the 3 patients with chronic kidney disease presented with poor appetite, nausea and vomiting, and 2 of them had diarrhea.n Conclusions:The gastrointestinal symptoms in patients with COVID-19 are common. Whether it is caused by the virus or related drugs, diet and mental conditions, clinicians should analyze the causes of these symptoms timely, and then provide a better treatment for patients with COVID-19.
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