某区医院发热伴呼吸道症状病人临床分析

CLINICAL ANALYSIS WITH PULMONARY FEBRILE SYMPTOMS OF SHENZHEN LONGGANG PEOPLE'S HOSPITAL.

目的:探讨常见呼吸道发热疾病的临床特点及与传染性非典型肺炎(严重急性呼吸综合症,SARS)的鉴别。方法:发热门诊诊治的以发热体温高于3 8℃伴呼吸道症状患者70 2例,对病因、临床表现、实验室检查、胸部X线、治疗及转归进行比较。结果:常见呼吸道发热患者中,急性上呼吸道感染5 96例占总数的85 % ,5 77病例白细胞计数不高占82 % ,淋巴细胞计数不降低,X线检查正常或仅有支气管炎表现。有基础肺部或全身疾病患者,虽然有发热,但往往以肺部或全身原发疾病相应症状为重要或首发表现,可有气急,体温以中度发热为主,78%病例有白细胞计数及中性比例升高,胸片除肺炎改变外,多有肺部基础疾病的表现,抗生素治疗有效;而单纯性肺炎胸部X线多表现为节段性或局灶性肺炎,这部分病例也以发热为主要或首发症状,一般表现为咳嗽、咳痰,气急少见,易与SARS混淆。结论:临床呼吸道发热疾病以急性上呼吸道感染最多见,容易忽略,要注意筛查。单纯性肺炎与SARS的鉴别,应结合流行病史。

Objective:To explore differential diagnosis between common pulmonary febrile diseases and severe acute respiratory syndrome(SARS).Methods:Analysis of 702 patients with pulmonary febrile symptoms(T>38℃) was conducted and their respiratory symptoms, causes, clinical features, laboratory examinations,X-ray examinations and treatment effects were estimated.Results:85 %(596/702) of the patients with pulmonary febrile symptoms were acute upper respiratory tract infection. And the count of WBC in 82 %(577/596) of the patients was normal, the count of LYM was not low. Chest X-rays showed normal or acute infiltration.Respiratory and systemic symptoms were prominent and they appeared as first sign in the febrile patients who had basic lung disease or systemic disease.Breathlessness was likely to exist and fever was generally mild. The count of WBC and the rate of neutrophil increased among 78% of the patients. Chest X-rays showed appearances of basic lung disease except simple pneumonia. Their symptoms were ameliorated gradually after effective antibiotic treatment. Simple pneumonia characterized by multilobar or single lobar, most of them were manifested as segmental or local lesions. For these patients, fever was very common and appeared as first symptom, and short breath was rare.Conclusion:The patients with pulmonary febrile symptoms were mostly acute upper respiratory tract infection and easily ignored, we should make a careful examination. The differential diagnosis between simple pneumonia and SARS can be improved using the data from epidemics, treatment outcomes and results of laboratory tests.