作者：杨静1 ，解超英 2 ，阳成英 1

单位：

1.410005 湖南省长沙市第一医院妇产科　2.410005 湖南省长沙市第一医院护理部；通信作者：解超英，E-mail：306984603@qq.com

Units：

1.Department of Obstetrics and Gynecology，the First Hospital of Changsha，Changsha 410005，China；2.Department of Nursing，the First Hospital of Changsha，Changsha 410005，China；Corresponding author: XIE Chaoying，E-mail：306984603@qq.com

关键词：

冠状病毒感染；新型冠状病毒；体征和症状

Keywords：

Coronavirus infections；Severe acute respiratory syndrome coronavirus；Signs and symptoms

CLC：

R 512.99

DOI：

DOI：10.3969/j.issn.1008-5971.2020.02.001

Funds：

摘要：

背景　新型冠状病毒肺炎自 2019 年 12 月开始暴发流行，面对这一疫情，防控及诊治方面的措施还在摸索中。长沙市第一医院是湖南省及长沙市新型冠状病毒肺炎患者定点收治单位，回顾性分析患者的临床资料对新型冠状病毒肺炎的进一步认识具有重要意义。目的　总结分析长沙市第一医院感染隔离病房收治的新型冠状病毒肺炎普通型患者 40 例的临床资料。方法　选取 2020-01-17 至 2020-02-05 长沙市第一医院感染隔离病房收治的新型冠状病毒肺炎普通型患者 40 例，分析总结其一般资料、流行病学史、发病情况、临床表现、实验室检查、影像学检查及治疗情况。结果　本组 40 例患者年龄为 1~77 岁，中位年龄为 45 岁；男 23 例（57.5%），女 17 例（42.5%）；有基础疾病患者 10 例（25.0%）；有家族聚集史者 8 例（20.0%）；疫情时期路过武汉及周边地区 5 例（12.5%）；居住在武汉地区来长沙探亲患者 4 例（10.0%）；无流行病学史 3 例（7.5%）。2 例多次行新型冠状病毒（2019-nCoV）核酸检测均为阴性，5~7 d 后行 2019-nCoV 核酸检测阳性。40 例患者中发热 32 例（80.0%），咳嗽、咳痰 20 例（50.0%）；主要体征包括肺部听诊呼吸音粗 36 例（90.0%），肺部闻及干湿性啰音 20 例（50.0%）。CT 影像学检查特点为：磨玻璃影与实变影或条索影共存，一般为节段性，可累及多个肺叶。主要行抗病毒 + 支持治疗，合并细菌感染者加用抗生素。结论　新型冠状病毒肺炎人群普遍易感，多发生在中老年，以男性居多。家族聚集性发病占 20%。临床上以发热、咳嗽、乏力为主要表现，血化验提示白细胞计数正常或降低，淋巴细胞计数降低为主，C 反应蛋白早期升高，影像学表现对发病判断及治疗效果具有指导性意义。对于 2019-nCoV 核酸检测为阴性的情况，需要特别关注患者临床表现，结合肺部 CT 分析，可采取单独隔离以避免漏诊。一旦确诊就应该收住入院并尽早治疗。治疗上以抗病毒治疗为主，注意营养支持及胃肠道功能保护，联合中药治疗，必要时在疾病进展期加用短期甲泼尼龙治疗，避免细胞因子炎性损伤，进展为重症或危重症。

Abstract：

Background　The exploration of measures for controlling，preventing，diagnosing and treatingCOVID-19 epidemic broke out in December 2019 is still underway.We conducted a retrospective analysis of clinical data ofsuch patients in the First Hospital of Changsha，a designated hospital for COVID-19 treatment，hoping to give aid to furtherunderstand the disease.Objective　To summarize and analyze the clinical data of 40 cases of common type of COVID-19 fromthe isolation ward in the First Hospital of Changsha.Methods　We collected and analyzed demographic data，epidemiologicalhistory，morbidity，clinical manifestations，laboratory examination，imaging and treatment data of 40 patients with commontype of COVID-19 admitted to the isolation ward in the First Hospital of Changsha from January 17 to February 5，2020.Results　Our subjects contained 40 patients（age range:1-77；median age:45），including 23 males（57.5%） and 17 females（42.5%）.There were 10 （25.0%） with underlying disease，8 （20.0%） with a history of gathering with a family memberwith COVID-19 infection，5 （12.5%） with a history of passing Wuhan and/or its surrounding areas，4 （10.0%） Wuhanresidents coming to Changsha for visiting relatives，and 3 （7.5%） without epidemiological history.The 2019-CoV nucleic testwas negative repeatedly in 2 cases but turned positive 5 to 7 days later.There are 32 （80.0%） complained of fever and 20（50.0%） complained of cough and phlegm.The main signs included coarse lung sounds〔36 （90.0%）〕 and rhonchi andmoist rales〔20.0（50%）〕 heard during lung auscultation.CT imaging features: ground-glass opacification with occasionalconsolidation and irregular line，and segmental foci involving multiple lung lobes in general.Antiviral and supportive therapywas mainly treatment.Antibiotics were added to treat those also with bacterial infection.Conclusion　People are very susceptibleto COVID-19，especially in middle-aged and elderly adults，and males.The cases of familial aggregation occupy 20%.Thysymptoms mainly consist of fever，cough and fatigue.Blood tests mainly show normal or slightly decreased white blood cell countsand decreased lymphocytes counts，and increased C-reactive protein at an early stage.Imaging findings are instructive to judgeonset and curative effects.As to RT-PCR negative patients，in order to avoid missed diagnosis，particular attentions should beput to their clinical manifestations and CT findings，and they should be quarantined and admitted to hospital once confirmed toget timely treatment.The therapies entail antiviral drugs，nutritional support，gastrointestinal function protection and traditionalChinese medicine treatment.Short-term methylprednisolone treatment can be used necessarily to avoid cytokine storm andinflammatory injuries which could lead patients to severe or critical situations.

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