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我院十年来共收治出血热病人148例,近遇1例出血热合并败血症的病人,特报道如下。患者 女49岁。5天前突然寒颤高热,体温39℃以上持续不退。同时伴头痛腰痛,全身酸胀不适,频繁恶心呕吐,不能进食。尿量减少每日约200ml,色深,无肉眼血尿。腹部阵发性隐痛,无腹泻,按感冒治疗2天后症状加重而转我院。门诊拟诊流行性出血热于1997年5月28日收住院。体检:体温39.4℃,脉搏108次/分,脉搏细速,血压12/9kPa,神志清,精神萎,急性重症面容,全身中毒症状重,烦躁不安,大声呻吟,呼呼稍促,唇无紫绀,球结膜充血水肿,咽及软腭充血明显。前胸及腋下可见数十枚针尖大小出血点,双肺呼吸音粗,未闻及干湿性罗音。心率108次/分,律齐,无杂音。腹平软,满腹轻压痛,无肌卫及包块,双肾区叩击痛(++)。血白细胞21.2×10~9/L,血红蛋白160g/L,血小板65×10~9/L,血象左移。尿蛋白(+++),红细胞(++),白细胞(+),颗粒管型(++)。血清尿素氮19.94mmol/l,肝酐258.3μmol/L。血清EHF·V·IgG检测结果:1:320(+++)。诊断:肾综合征出血热
Our hospital a total of 148 cases of patients with hemorrhagic fever over the past 10 years, nearly 1 case of hemorrhagic fever with sepsis patients, especially reported as follows. The patient is 49 years old. Suddenly shivering and fever 5 days ago, the body temperature above 39 ℃ continued non-refundable. At the same time with headache low back pain, body soreness and discomfort, frequent nausea and vomiting, can not eat. Decreased urine output about 200ml per day, color depth, no gross hematuria. Paroxysmal abdominal pain, no diarrhea, according to cold treatment 2 days later symptoms and transferred to our hospital. Outpatient consultation epidemic hemorrhagic fever on May 28, 1997 admitted to hospital. Physical examination: body temperature 39.4 ℃, pulse 108 beats / min, pulse fine speed, blood pressure 12 / 9kPa, clear mind, spiritual wilt, acute severe face, systemic symptoms of poisoning, irritability, loud moaning, whirring slightly, lip cyanosis , Conjunctival congestion and edema, pharynx and soft palate congestion was obvious. Thoracic and underarm visible dozens of tip size bleeding point, lung breath sounds coarse, unheard-of and wet and dry rales. Heart rate 108 beats / min, law Qi, no noise. Abdomen soft, full light tenderness, no muscle and mass, perineal area percussion pain (++). Blood leukocytes 21.2 × 10 ~ 9 / L, hemoglobin 160g / L, platelets 65 × 10 ~ 9 / L, blood left. Urine protein (+++), erythrocytes (++), white blood cells (+), granular tube (++). Serum urea nitrogen 19.94mmol / l, liver anhydride 258.3μmol / L. Serum EHF · V · IgG test results: 1: 320 (+++). Diagnosis: Hemorrhagic fever with renal syndrome