每日病例丨不容忽视的胃肠炎与感冒

2017-11-09 MedSci MedSci原创

部分上呼吸道及肠道的感染是由病毒引起的,而对于病毒感染引起的此类疾病,抗生素并无明显效果,很多时候多是考虑对症治疗,然后让自身免疫系统消灭病毒,但是病毒感染也有非常危重的案例,比如下面这个病例。病史:患者平素体健,无心血管、呼吸、消神经系统等疾病病史,3天前无明显诱因出现畏寒发热,无鼻塞、流涕,无咳嗽、胸痛,大便次数增多,平均每日3一4 次,为稀便,无黏液脓血,量不多。自服退热药及诺氟沙星(氟哌酸



部分上呼吸道及肠道的感染是由病毒引起的,而对于病毒感染引起的此类疾病,抗生素并无明显效果,很多时候多是考虑对症治疗,然后让自身免疫系统消灭病毒,但是病毒感染也有非常危重的案例,比如下面这个病例。

病史

患者平素体健,血管、呼吸、消神经系统疾病病史,3前无明显诱因出现畏寒发热,无鼻塞、流涕,无咳嗽、胸痛,大便次数增多,平均每日3一4 次,为稀便,无黏液脓血,量不多。自服退热药及诺氟沙星(氟哌酸)胶囊无效。 

2前突然出现晕厥,无四肢抽搐、无口吐白沫、无牙关紧闭,有短暂意识障碍,持续约5分钟晕厥发作频繁,平均每日10余次。即时心电图检查示三度房室传导阻滞,交界性逸搏心律。以异丙肾上腺素静脉滴注维持,送人病房。

查体

患者神志清楚,发育正常,营养中等。全身皮肤未见出血斑点,浅表淋巴结不大,无皮下结节,无水肿。巩膜无黄染。颈软,气管居中,甲状腺不大,无颈静脉怒张。胸廓对称两肺呼吸音清晰。心浊音界不大,心律规则,心音中等,可闻及大炮音

辅助检查:

心电图三度房室传导阻滞,交界性逸搏心律。

X线胸片未见明显异常

B双肾轻度肿大,弥漫性病变,输尿管、膀胱无异常,腹腔积液。

血常规:白细胞计数14.5×10*9/L中性粒细胞0.896红细胞计数3.34×10*12/L血红蛋白87g/L血小板计数49×10*9/L

尿常规比重1.020隐血+++蛋白+红细胞+

大生化: 丙氨酸氨基转移酶(ALT) 395U/L、天冬氨酸氨基转移酶(AST) 402U/L、碱性磷酸酶(ALP) 121U/L、谷氨酰转移酶(γ-GT) 104U/L、肌酸激酶(CK) 435U/L、肌酸激酶同工酶(CK-MB) 98U/L、乳酸脱氢酶同工酶(LDH) 394U/L、α-羟丁酸脱氢酶(HB-DH) 134U/L、胆红素正常、清蛋白(ALB) 33.9g/L、球蛋白(GLO) 25.6g/L、血糖(GLU) 14.46mmol/L、尿素氮(BUN) 19.17mmol/L、肌酐(CRE) 219μmmol/L尿酸(UA) 1002μmmol/L血脂正常电解质 133.5mmol/L5.61mmol/L99mmol/L1.92mmol/L

动脉血气分析:校正pH 7.175校正二氧化碳分压30.50mmHg校正氧分压43mmHg实际碳酸氢11.10mmol/L剩余碱(BE) 17.50mmol/L

凝血功能凝血酶原时间(PT) 28.7s纤维蛋白原1.81g/L凝血酶时间28.7s活化部分凝血酶时间45.5s

简要解析:

此例患者病情危重,由于病毒感染,最终引发了多脏器功能衰竭,那么详细的诊断有哪些?

更多点评分析,趣味的学习,详情尽在梅斯医生上,您可以在这里体验模拟诊疗


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    2017-11-13 方舒

    学习

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    2017-11-09 1e0f8808m18(暂无匿称)

    典型病例.学习了.

    0

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    2017-11-09 1dd8c52fm63(暂无匿称)

    学习学习.继续关注

    0

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