2019NIAN12YUE30RISHOUZHI 1 LIYINJIXINGYIYANGHUATANZHONGDUZHIYOUXIAOTUIGUJINMOSHIZONGHEZHENGDE 49 SUINANXINGHUANZHE,GAIHUANZHEYOUMANXINGSHENYANBINGSHI 10 NIAN,1 GEYUEQIANYINSHENGONGNENGSHUAIJIEKAISHITOUXIZHILIAO,RUYUANHOUJIZHENXINGGUJINMOSHIZONGHEZHENGQIEKAIJIANYASHU。RUYUAN 2 ZHOUBINGFAYIN 2019 XINXINGGUANZHUANGBINGDU(2019-nCoV)GANRANYINQIDEXINXINGGUANZHUANGBINGDUFEIYAN,JIANCHENG“XINGUANFEIYAN”,SUIJIZHUANRUGELIBINGFANG,JIYUKANGGANRAN、KANGBINGDU、QUTAN、QINGREJIEDU、CHUANGBIANYIDONGTOUXIJICHUANGBIANTOUXIJIQUANSHENYINGYANG、DUIZHENGZHICHIZHILIAO。JINGGUO 2 ZHOUZHILIAO,HUANZHEHUIFULIANGHAO,JINGSHENZHUANGTAIKE,WUFARE、KESOU、CHUANQIDENGBUSHI,SHIYUKE;YOUXIAZHISHANGKOUGANZAO,WUMINGXIANSHENCHU,YOUXIAZHIJIYOUZUGANJUE、YUNDONGGONGNENGZHUJIANHUIFU。GAIBINGLISHAOJIAN、ZHENGZHUANGZHONG、ZHENZHIKUNNAN,SHIMUQIANBAODAODESHOULIGUKESHOUSHUHOUBINGFAXINGUANFEIYANDEBINGLI。
引用本文: 杨平, 段祥林, 伍振威, 周青山, 吴星火. 骨筋膜室综合征并发新型冠状病毒肺炎救治一例. 中国修复重建外科杂志, 2020, 34(8): 1041-1043. doi: 10.7507/1002-1892.202002044 复制
2019 NIAN 12 YUEYILAI,HUBEISHENGWUHANSHILUXUFAXIANDUOLIYIN 2019 XINXINGGUANZHUANGBINGDU(2019-nCoV)GANRANYINQIDEXINXINGGUANZHUANGBINGDUFEIYAN,JIANCHENG“XINGUANFEIYAN”。HUAZHONGKEJIDAXUETONGJIYIXUEYUANFUSHUXIEHEYIYUANYU2019NIAN12YUE30RISHOUZHI 1 LIYIYANGHUATANZHONGDUZHIGUJINMOSHIZONGHEZHENGHUANZHE,GAIHUANZHEYUZHILIAOQIJIANBINGFAXINGUANFEIYAN,JINGGUODUOXUEKEQUANLIJIUZHIHOUHUIFULIANGHAO。BAOGAORUXIA。
1 病例介绍
HUANZHE NAN,49 SUI。YIN“YOUXIAZHIZHONGZHANG 1 d”RUYUAN。RUYUANJIANCHA:HUANZHESHENZHIQINGCHU,SHENGMINGTIZHENGPINGWEN,JIXINGBINGRONG,YOUXIAOTUIZHONGZHANGMINGXIAN,JIAOZUOCEMINGXIANZENGCU,PIFUZHANGLIJIAOGAO。1 d QIANYINMEIQIXIELOUZHIYISHIBUQING,YUDANGDIYIYUANJIUZHEN,ZHENDUANWEIJIXINGYIYANGHUATANZHONGDU;JINGGUOSHUYE、TUOSHUI、YINGYANGNAOSHENJINGJIGAOLIULIANGYANGLIAOCHULIHOU,HUANZHEQUANSHENZHENGZHUANGMINGXIANHUANJIE,DANYOUXIAOTUIZHONGZHANGCHIXUJIAZHONG,SUIZHUANRUHUAZHONGKEJIDAXUETONGJIYIXUEYUANFUSHUXIEHEYIYUANJINYIBUZHILIAO。JIWANGBINGSHI:MANXINGSHENYANBINGSHI 10 NIAN,WUGANYAN、JIEHEJIQITACHUANRANBINGBINGSHI;1 GEYUEQIANYINSHENGONGNENGSHUAIJIEKAISHITOUXIZHILIAO。
RUYUANHOUZHUANKETIJIAN:YOUXIAOTUIPIWENDI、GANJUEJIANTUI;ZHONGZHANGMINGXIAN,CHUZHENZHANGLIJIAOGAO;HUAIGUANJIE、ZUZHICHENGQUQUZHUANGTAI,JILI 1~2 JI;ZUBEIDONGMAIBODONGWEIRUO。XIONGBU X XIANPIANSHISHUANGFEIYEQINGXI,WEIJIANMINGXIANSHIZHIXINGBINGBIAN。SHENGHUAJIANCHA:XUEQINGJISUANJIMEI 8 450 U/L、RUSUANTUOQINGMEI 3 580 U/L、JISUANJIMEITONGGONGMEI MB 1 001.2 ng/L,JUNMINGXIANSHENGGAO;SHENGONGNENGBUQUAN,JIGAN、NIAOSUDANSHENGGAO,SHENXIAOQIULVGUOLVJIANGDI。JIZHEN B CHAOSHIYOUDATUIZHONGXIADUAN、XIAOTUIJICENGZENGHOU,HUISHENGZENGQIANG,JIWENLIMOHU。ZONGHEHUANZHEDEBINGSHI、ZHENGZHUANG、TIZHENGJIFUZHUJIANCHAJIEGUO,ZHENDUANWEIYOUXIAOTUIGUJINMOSHIZONGHEZHENG、YIYANGHUATANZHONGDU。
ZHENDUANMINGQUEHOU,JIZHENXINGGUJINMOSHIQIEKAIJIANYASHU。SHUZHONGYUYOUXIAOTUINEICEHEWAICEFENBIEZUOZONGXINGQIEKAI,ZHANGYUE 20 cm,TANCHAJIANGUJINMOSHINEIZHANGLIJIAOGAO,QIZHONGFEICHANGJI、BIMUYUJISHUIZHONGYANZHONG,CHENGHUIHONGSE,DIANCIJIHOUQINGWEISHOUSUO;XIAOTUIWAICEJIQUNJIQIANCEJIQUNHUOLISHAOHAO,CHENGSHENHONGSE,DIANCIJIJIROUKESHOUSUO。CHEDIJIANYAHOU,FENGBISHIFUYAYINLIU(vaccum sealing drainage,VSD)FULIAOFUGAICHUANGMIAN。SHUHOUJIAQIANGKANGYAN、XIAOZHONGZHITONG、YINGYANGNAOSHENJING、MIANZHAOGAOLIULIANGCHIXUXICHUNYANGJIDUIZHENGZHICHIZHILIAO。SHUHOU 2 ZHOUHUANZHIZHONGZHANGZHUBUJIANTUI,GANJUE、YUNDONGGONGNENGMINGXIANHUIFU,JILIHUIFUZHI 3 JI;CHAICHU VSD FULIAO,QINGXIQIEKOU,FANSHILINSHABUFUGAI,DAIQIEKOUGANZAOHOU,ERQIZHIPIXIUFUCHUANGMIAN。
入院 2 周后患者出现发热、咳嗽、胸闷、喘气,以午后发热多见,体温不超过 38.5℃,伴咳嗽、咳痰,痰少。1 周后病情恶化,肺部 CT 检查示:双肺多发斑片状实变影及磨玻璃影,上叶为甚,沿支气管周围分布,部分位于胸膜下;中至大量胸腔积液,双下肺叶节段性不张(图 1)。生化检查示:白细胞 11.8×109/L,增高;淋巴细胞 0.7×109/L,淋巴细胞百分比 5.9%,明显下降;甲流/乙流(—),9 种呼吸道感染病原体(肺炎支原体、肺炎衣原体、嗜肺军团菌血清 1 型、腺病毒、Q 热立克次体、呼吸道合胞病毒、流感病毒 A、流感病毒 B 和副流感病毒 1、2、3)IgM 检测均为阴性。新冠肺炎核酸 PCR 检测阳性,经专家组确诊为新冠肺炎。患者随即转入协和武汉红十字会医院隔离病房治疗,给予抗感染(莫西沙星针+头孢他啶针)、抗病毒(阿比多尔、更昔洛韦针等)、祛痰(氨溴索)、清热解毒(喜炎平注射液)、床边移动透析机床边透析及其全身营养、对症支持治疗。经过 2 周治疗,患者恢复良好,精神状态可,无发热、咳嗽、喘气等不适,食欲可,伤口干燥,无明显渗出,右下肢及右足感觉、运动功能逐渐恢复(肌力 4 级)。

2 讨论
骨筋膜室综合征是指骨筋膜室内的肌肉和神经因急性缺血、缺氧而产生的一系列早期症候群,是临床常见的急症,多见于前臂和小腿。骨筋膜室综合征的致病原因分为创伤性和非创伤性,前者多见,后者临床上少见。其治疗关键在于早发现、早诊断、早治疗,早期彻底切开筋膜减压是治疗骨筋膜室综合征的有效方法;一旦 5P 征同时出现,提示神经肌肉已发生不可逆性损伤,发展为缺血性肌挛缩和坏疽[1-3]。切开减压要彻底敞开受累骨筋膜室,解除室内高压,阻断缺血-水肿-缺血恶性循环。切开减压后,血循环得到改善,大量坏死组织、分泌物、代谢产物和毒素等进入血液循环,可导致休克、心率不齐和急性肾功能衰竭等并发症。血液透析可清除进入血液循环中的毒素,清除体内的代谢废物,纠正体内代谢紊乱,改善肾功能。此外,术后配合适度的功能锻炼,可以促进肢体功能早日恢复。
一氧化碳中毒的主要临床表现为头痛头昏、四肢无力、恶心呕吐等症状,严重者可出现意识障碍,甚至危及生命。对一氧化碳中毒的患者,首诊医生在做好急救的同时,要重点关注患者四肢感觉、运动功能及末梢血液循环、肢体疼痛、肿胀等情况,及时排查处理骨筋膜室综合征。本例患者发生骨筋膜室综合征的可能机制:① 一氧化碳中毒,导致横纹肌溶解,筋膜间室内压力增加,循环受阻,造成室内肌肉及神经缺血、缺氧;② 一氧化碳与血液中红细胞的血红蛋白结合形成稳定的 COHb,既不能携带氧,又使血氧不易释放,加重了组织缺氧;③ 压迫性肌肉坏死,右下肢长时间受压会使肌肉缺血、肿胀,使筋膜室内压力升高,形成缺血-水肿恶性循环,导致骨筋膜室综合征的发生与进展;④ 该患者有肾功能衰竭病史,体内代谢产物和毒素的潴留,水、电解质酸碱紊乱,致使红细胞被破坏或寿命缩短,加重组织细胞缺血、缺氧[4-5]。
新冠肺炎临床上以发热、乏力、干咳为主要表现,少数患者伴腹泻症状。肺部 CT 和呼吸道标本实时荧光定量 PCR 检测新型冠状病毒核酸,是目前此病的主要辅助检查方法。新冠肺炎尚无针对性有效治疗方法,其基础治疗包括对症支持治疗,维持氧、水、电解质等内环境的稳定;抗生素只对细菌有效,对病毒无效,建议慎用,只有考虑合并细菌感染时才使用抗生素;抗病毒治疗主要包括 α-干扰素、洛匹那韦/利托那韦等抗病毒药物,目前没有特效抗病毒药物。此外,氧疗也是一个很重要的手段,包括鼻导管、面罩给氧和经鼻高流量氧疗等措施。从目前临床报道来看,老年人和有慢性基础疾病者预后较差。Huang 等[6]通过对 59 例可疑患者进行临床、影像及病原学检查,其中 41 例确诊为新冠肺炎;通过进一步分析发现,32% 患者伴有慢性基础性疾病,且伴发合并症的中老年患者更易感染 2019-nCoV。
DANGQIAN,XINGUANFEIYANMANYANSINVE,GUANGDASHIMINJUJIABUNENGWAICHU,MIBIHUANJINGZHONGYIYANGHUATANNONGDUSHENGGAO,ZHONGDUHUIGENGZHONG,GUYINGCHANGKAICHUANGTONGFENG,BAOCHISHINEIKONGQILIUTONG。BENLIHUANZHEQINGKUANGSHAOJIAN,ZHENGZHUANGZHONG、ZHENZHIKUNNAN,SHIMUQIANBAODAODESHOULIGUKESHOUSHUHOUBINGFAXINGUANFEIYANDEBINGLI,JINGGUOJIJIJIUZHIHUODELEJIAOHAOLINCHUANGLIAOXIAO。YOUYUXINGUANFEIYANCHUANRANXINGBIJIAOQIANG,ZAILINCHUANGGONGZUOZHONGYIWURENYUANWUBIZUOHAOYIXIAJIDIAN:① HUANZHERUYUANQIAN,BIXUJIANCETIWEN、FEIBU CT、XUECHANGGUI(HAN C FANYINGDANBAI),BIYAOSHIHESUANJIANCHA,SHAICHAXINGUANFEIYAN;② ZHIDUOYUNXU 1 MINGJIASHUPEITONG,JIASHUYEBIXUSHAICHAXINGUANFEIYAN;③ WULUNDUIQUEZHENHAISHIYISIHUANZHEDOUBIXUYISHITONGREN,YANGEZUNSHOUXIAODUGELIZHIDU,ZAIDULIZHUANYONGGELISHOUSHUSHILIJINXINGSHOUSHU(CANZHAOGUKEQIXINGHUAIJUSHOUSHUGUICHENG);④ SHOUSHURENYUANBIXUANYANMIGELIYAOQIUCHUANDAIFANGHUYONGPIN,ZAIQUANMIANFANGHUTIAOJIANXIAWEIHUANZHESHISHISHOUSHU;⑤ SHUHOUTUOSHANGELIHUANZHE,ANGUICHENGYANGECHULISHOUSHUQIXIEJIWUPIN,DUIZHUANYONGSHOUSHUJIANJINXINGQUANMIANXIAOSHA;⑥ DUICHUYUBINGDUQIANFUQIDEHUANZHE,SHUHOUYIDANQUEZHEN,YINGLIJIZHUANRUGELIBINGFANG,YUANBINGFANGXUZUOHAOXIAODUGELI,SUOYOUSHOUSHURENYUANJIMIQIEJIECHUZHEJUNXUGELIGUANCHA,BINGJINXINGXINGUANFEIYANPAICHAXIANGGUANJIANCHA。
ZUOZHEGONGXIAN:YANGPINGFUZEWENZHANGZHUANXIE;DUANXIANGLINFUZEGUANDIANXINGCHENG;WUZHENWEIFUZESHIYANSHEJI、ZILIAOSHOUJI;ZHOUQINGSHANCANYUZILIAOSHOUJI;WUXINGHUOFUZEKETISHEJIGOUSI、GUANDIANXINGCHENG、LUNWENXIUGAI。
LIYICHONGTU:SUOYOUZUOZHESHENGMING,ZAIKETIYANJIUHEWENZHANGZHUANXIEGUOCHENGZHONGBUCUNZAILIYICHONGTU。
2019 NIAN 12 YUEYILAI,HUBEISHENGWUHANSHILUXUFAXIANDUOLIYIN 2019 XINXINGGUANZHUANGBINGDU(2019-nCoV)GANRANYINQIDEXINXINGGUANZHUANGBINGDUFEIYAN,JIANCHENG“XINGUANFEIYAN”。HUAZHONGKEJIDAXUETONGJIYIXUEYUANFUSHUXIEHEYIYUANYU2019NIAN12YUE30RISHOUZHI 1 LIYIYANGHUATANZHONGDUZHIGUJINMOSHIZONGHEZHENGHUANZHE,GAIHUANZHEYUZHILIAOQIJIANBINGFAXINGUANFEIYAN,JINGGUODUOXUEKEQUANLIJIUZHIHOUHUIFULIANGHAO。BAOGAORUXIA。
1 病例介绍
HUANZHE NAN,49 SUI。YIN“YOUXIAZHIZHONGZHANG 1 d”RUYUAN。RUYUANJIANCHA:HUANZHESHENZHIQINGCHU,SHENGMINGTIZHENGPINGWEN,JIXINGBINGRONG,YOUXIAOTUIZHONGZHANGMINGXIAN,JIAOZUOCEMINGXIANZENGCU,PIFUZHANGLIJIAOGAO。1 d QIANYINMEIQIXIELOUZHIYISHIBUQING,YUDANGDIYIYUANJIUZHEN,ZHENDUANWEIJIXINGYIYANGHUATANZHONGDU;JINGGUOSHUYE、TUOSHUI、YINGYANGNAOSHENJINGJIGAOLIULIANGYANGLIAOCHULIHOU,HUANZHEQUANSHENZHENGZHUANGMINGXIANHUANJIE,DANYOUXIAOTUIZHONGZHANGCHIXUJIAZHONG,SUIZHUANRUHUAZHONGKEJIDAXUETONGJIYIXUEYUANFUSHUXIEHEYIYUANJINYIBUZHILIAO。JIWANGBINGSHI:MANXINGSHENYANBINGSHI 10 NIAN,WUGANYAN、JIEHEJIQITACHUANRANBINGBINGSHI;1 GEYUEQIANYINSHENGONGNENGSHUAIJIEKAISHITOUXIZHILIAO。
RUYUANHOUZHUANKETIJIAN:YOUXIAOTUIPIWENDI、GANJUEJIANTUI;ZHONGZHANGMINGXIAN,CHUZHENZHANGLIJIAOGAO;HUAIGUANJIE、ZUZHICHENGQUQUZHUANGTAI,JILI 1~2 JI;ZUBEIDONGMAIBODONGWEIRUO。XIONGBU X XIANPIANSHISHUANGFEIYEQINGXI,WEIJIANMINGXIANSHIZHIXINGBINGBIAN。SHENGHUAJIANCHA:XUEQINGJISUANJIMEI 8 450 U/L、RUSUANTUOQINGMEI 3 580 U/L、JISUANJIMEITONGGONGMEI MB 1 001.2 ng/L,JUNMINGXIANSHENGGAO;SHENGONGNENGBUQUAN,JIGAN、NIAOSUDANSHENGGAO,SHENXIAOQIULVGUOLVJIANGDI。JIZHEN B CHAOSHIYOUDATUIZHONGXIADUAN、XIAOTUIJICENGZENGHOU,HUISHENGZENGQIANG,JIWENLIMOHU。ZONGHEHUANZHEDEBINGSHI、ZHENGZHUANG、TIZHENGJIFUZHUJIANCHAJIEGUO,ZHENDUANWEIYOUXIAOTUIGUJINMOSHIZONGHEZHENG、YIYANGHUATANZHONGDU。
ZHENDUANMINGQUEHOU,JIZHENXINGGUJINMOSHIQIEKAIJIANYASHU。SHUZHONGYUYOUXIAOTUINEICEHEWAICEFENBIEZUOZONGXINGQIEKAI,ZHANGYUE 20 cm,TANCHAJIANGUJINMOSHINEIZHANGLIJIAOGAO,QIZHONGFEICHANGJI、BIMUYUJISHUIZHONGYANZHONG,CHENGHUIHONGSE,DIANCIJIHOUQINGWEISHOUSUO;XIAOTUIWAICEJIQUNJIQIANCEJIQUNHUOLISHAOHAO,CHENGSHENHONGSE,DIANCIJIJIROUKESHOUSUO。CHEDIJIANYAHOU,FENGBISHIFUYAYINLIU(vaccum sealing drainage,VSD)FULIAOFUGAICHUANGMIAN。SHUHOUJIAQIANGKANGYAN、XIAOZHONGZHITONG、YINGYANGNAOSHENJING、MIANZHAOGAOLIULIANGCHIXUXICHUNYANGJIDUIZHENGZHICHIZHILIAO。SHUHOU 2 ZHOUHUANZHIZHONGZHANGZHUBUJIANTUI,GANJUE、YUNDONGGONGNENGMINGXIANHUIFU,JILIHUIFUZHI 3 JI;CHAICHU VSD FULIAO,QINGXIQIEKOU,FANSHILINSHABUFUGAI,DAIQIEKOUGANZAOHOU,ERQIZHIPIXIUFUCHUANGMIAN。
入院 2 周后患者出现发热、咳嗽、胸闷、喘气,以午后发热多见,体温不超过 38.5℃,伴咳嗽、咳痰,痰少。1 周后病情恶化,肺部 CT 检查示:双肺多发斑片状实变影及磨玻璃影,上叶为甚,沿支气管周围分布,部分位于胸膜下;中至大量胸腔积液,双下肺叶节段性不张(图 1)。生化检查示:白细胞 11.8×109/L,增高;淋巴细胞 0.7×109/L,淋巴细胞百分比 5.9%,明显下降;甲流/乙流(—),9 种呼吸道感染病原体(肺炎支原体、肺炎衣原体、嗜肺军团菌血清 1 型、腺病毒、Q 热立克次体、呼吸道合胞病毒、流感病毒 A、流感病毒 B 和副流感病毒 1、2、3)IgM 检测均为阴性。新冠肺炎核酸 PCR 检测阳性,经专家组确诊为新冠肺炎。患者随即转入协和武汉红十字会医院隔离病房治疗,给予抗感染(莫西沙星针+头孢他啶针)、抗病毒(阿比多尔、更昔洛韦针等)、祛痰(氨溴索)、清热解毒(喜炎平注射液)、床边移动透析机床边透析及其全身营养、对症支持治疗。经过 2 周治疗,患者恢复良好,精神状态可,无发热、咳嗽、喘气等不适,食欲可,伤口干燥,无明显渗出,右下肢及右足感觉、运动功能逐渐恢复(肌力 4 级)。

2 讨论
骨筋膜室综合征是指骨筋膜室内的肌肉和神经因急性缺血、缺氧而产生的一系列早期症候群,是临床常见的急症,多见于前臂和小腿。骨筋膜室综合征的致病原因分为创伤性和非创伤性,前者多见,后者临床上少见。其治疗关键在于早发现、早诊断、早治疗,早期彻底切开筋膜减压是治疗骨筋膜室综合征的有效方法;一旦 5P 征同时出现,提示神经肌肉已发生不可逆性损伤,发展为缺血性肌挛缩和坏疽[1-3]。切开减压要彻底敞开受累骨筋膜室,解除室内高压,阻断缺血-水肿-缺血恶性循环。切开减压后,血循环得到改善,大量坏死组织、分泌物、代谢产物和毒素等进入血液循环,可导致休克、心率不齐和急性肾功能衰竭等并发症。血液透析可清除进入血液循环中的毒素,清除体内的代谢废物,纠正体内代谢紊乱,改善肾功能。此外,术后配合适度的功能锻炼,可以促进肢体功能早日恢复。
一氧化碳中毒的主要临床表现为头痛头昏、四肢无力、恶心呕吐等症状,严重者可出现意识障碍,甚至危及生命。对一氧化碳中毒的患者,首诊医生在做好急救的同时,要重点关注患者四肢感觉、运动功能及末梢血液循环、肢体疼痛、肿胀等情况,及时排查处理骨筋膜室综合征。本例患者发生骨筋膜室综合征的可能机制:① 一氧化碳中毒,导致横纹肌溶解,筋膜间室内压力增加,循环受阻,造成室内肌肉及神经缺血、缺氧;② 一氧化碳与血液中红细胞的血红蛋白结合形成稳定的 COHb,既不能携带氧,又使血氧不易释放,加重了组织缺氧;③ 压迫性肌肉坏死,右下肢长时间受压会使肌肉缺血、肿胀,使筋膜室内压力升高,形成缺血-水肿恶性循环,导致骨筋膜室综合征的发生与进展;④ 该患者有肾功能衰竭病史,体内代谢产物和毒素的潴留,水、电解质酸碱紊乱,致使红细胞被破坏或寿命缩短,加重组织细胞缺血、缺氧[4-5]。
新冠肺炎临床上以发热、乏力、干咳为主要表现,少数患者伴腹泻症状。肺部 CT 和呼吸道标本实时荧光定量 PCR 检测新型冠状病毒核酸,是目前此病的主要辅助检查方法。新冠肺炎尚无针对性有效治疗方法,其基础治疗包括对症支持治疗,维持氧、水、电解质等内环境的稳定;抗生素只对细菌有效,对病毒无效,建议慎用,只有考虑合并细菌感染时才使用抗生素;抗病毒治疗主要包括 α-干扰素、洛匹那韦/利托那韦等抗病毒药物,目前没有特效抗病毒药物。此外,氧疗也是一个很重要的手段,包括鼻导管、面罩给氧和经鼻高流量氧疗等措施。从目前临床报道来看,老年人和有慢性基础疾病者预后较差。Huang 等[6]通过对 59 例可疑患者进行临床、影像及病原学检查,其中 41 例确诊为新冠肺炎;通过进一步分析发现,32% 患者伴有慢性基础性疾病,且伴发合并症的中老年患者更易感染 2019-nCoV。
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