急诊观察区338例不明原因发热的临床诊断探讨

A Clinical Review of 338 Cases of Fever with Unknown Origin in Emergence Observation Unit

目的探讨急诊观察区不明原因发热的病因。方法采用前瞻性研究方法,入选2001年4月～2005年5月338例不明原因发热病例,由急诊内科医生详细记录患者入院后热型,伴发症状及用药情况,并按单一器官损害或与多器官损害(涉及两个以上的器官或系统病变)分组。结果338例患者中317例(93.7%)最终明确诊断,21例(6.2%)诊断未明。诊断明确的病因包括:感染性疾病207例(61.2%);结缔组织病、肿瘤及血液系统疾病分别为47例(13.9%)、61例(18.0%);21例(6.2%)未明原因。发热伴多器官损害患者178例(52.6%),恙虫病、钩端螺旋体病、流行性出血热、脓毒症休克伴有100%的多器官损害,而红斑狼疮、淋巴瘤分别有16/18、18/21例伴有多器官损害。结论重视不同地区不明原因发热情况,仔细的病史采集、详细的体格检查,有效的实验室辅助检查,并结合患者的地区来源,对早期做出诊断及减少多个器官损害至关重要。

Objective To investigate the causes of fever of unknown origin （FUO） in emergence observation areas. Methods Retrospectively analysis of 338 patients with FUO between Apr 2001 and May 2005 was carried out. Results Out of the 338 FUO cases, definite diagnosis was eventually achieved in 317 patients （93.7%）. The most common causes of FUO were infectious diseases （61.2%）, with tuberculosis accounting for 25% and tsutsugamushi disease accounting for 15%. Collagen vascular diseases, malignancy and blood systemic diseases accounted for 14% and 18%, respectively. The cause of FUO for the remaining 21 （6.2%） cases was unknown. Tsutsugamushi disease, leptospinosis, epidemic hemorrhagic fever and septicemia have all complication of multiple organ damage. 88% SLE （Systemic lupus erythematosus） and 85% lymphoma patients had complication of multiple organ damage. Conclusion Attention must be paid to the patients with fever of unknown origin. The cause of FUO can be identified by clinical symptoms, signs and laboratory examinations.