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老年伤寒多不典型,在日常医疗工作中往往出现误诊、误治。笔者根据个人在以往临床实践中所遇到的一些误诊病例,初步分析探讨误诊原因,以便吸取教训,为提高诊断质量提供一点参考。一、老年伤寒患者常伴有其它慢性疾病,其症状互相混杂,给诊断带来困难,以致造成误诊。例1:男,65岁。因发热伴咳嗽5天入院,原有慢性支气管炎史10余年。当地卫生院给予青霉素肌注治疗3天,无效。T39℃、P88次/分,精神萎,无欲状。两肺叩诊过清,呼吸音粗,右肺可闻及干罗音。心率齐,无杂音,剑突下左侧心音较心尖区增强。肝脾(一)、两下肢不肿。胸透示:两肺纹理增粗,肺气肿。
More elderly atypical typhoid fever, often misdiagnosis, mistreatment in the daily medical work. According to some cases of misdiagnosis encountered by individuals in previous clinical practice, the author initially analyzes and discusses the causes of misdiagnosis in order to learn the lessons and provide some reference for improving the quality of diagnosis. First, the elderly typhoid patients are often accompanied by other chronic diseases, the symptoms mixed with each other, to the diagnosis of difficulties, resulting in misdiagnosis. Example 1: Male, 65 years old. Due to fever with cough 5 days admitted, the original history of chronic bronchitis more than 10 years. The local hospital for penicillin intramuscular treatment for 3 days, invalid. T39 ℃, P88 times / min, spiritual wilting, no desire-like. Percussion lung clearance, breath sounds thick, right lung can smell and dry rales. Qi heart rate, no noise, the left xiphoid than the apex enhanced. Liver and spleen (a), two lower extremities is not swollen. Chest show: thickening of the two lungs, emphysema.