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患儿,男,9岁。发热,头痛4d,呕吐,腹泻,尿少2d入院。入院前呕吐5次,棕色稀水样便20余次,无里急后重感。查体:T40.3℃,P104次/min,R36次/min,BP12/8kPa。无酒醉貌及“三红征”。皮肤弹性差。颞前,耳后,颈后及腋下有少许散在的针尖大小出血点。颜面,球结膜水肿明显。咽红,软腭无出血点。颈软,心肺无异常。腹软,全腹压痛,无反跳痛。实验室检查;WBC10.9×10~9/L,N0.84,Pt39×10~9/L,尿蛋白(+++),尿素氮18mmol/L,肌酐102mmol/L,出血热抗体IgG,IgM均阳性。EKG示:心肌供血不足。最后诊断肾综合征出血热,给予抗病毒,调节免疫及对症治疗,13d治愈出院。 讨论 肾综合征出血热属病毒性出血热,其发病具有明显高峰季节(黑线姬鼠传播者每年11月至次年1月为高峰),以男性青壮年发病较多。由于病毒直接作用,使
Children, male, 9 years old. Fever, headache 4d, vomiting, diarrhea, oliguria less admission 2d. Vomiting before admission 5 times, brown water samples will be more than 20 times, no relief after heavy feeling. Physical examination: T40.3 ℃, P104 times / min, R36 times / min, BP12 / 8kPa. Drunken appearance and “three red sign.” Poor skin elasticity. Front temporal, ear, neck and armpit have a little scattered in the size of the tip of the bleeding point. Facial, conjunctival edema significantly. Throat red, soft palate no bleeding point. Neck soft, no abnormal heart and lung. Abdominal soft, full abdominal tenderness, no rebound tenderness. Laboratory test; WBC10.9 × 10-9 / L, N0.84, Pt39 × 10-9 / L, urinary protein (+++), urea nitrogen 18mmol / L, creatinine 102mmol / L, hemorrhagic fever antibody IgG, IgM are positive. EKG said: myocardial insufficiency. The final diagnosis of hemorrhagic fever with renal syndrome, given antiviral, immune and symptomatic treatment, 13d cured. Discussion Hemorrhagic fever with renal syndrome is a viral hemorrhagic fever, its incidence has a clear peak season (black line Apodemus communicator from November to January next year as the peak), more incidence of male young adults. Because of the direct effect of the virus