伤寒33例临床分析

Clinical Analysis of 33 Cases with Typhoid

目的通过分析33例伤寒患者的临床特点,提高对本病的认识。方法回顾分析我院收治的33例伤寒患者的临床表现、实验室检查和治疗效果。结果临床表现发热100%,相对缓脉54.55%,表情淡漠3.03%,消化道症状60.60%,肝脾肿大42.42%,玫瑰疹缺如,白细胞减少36.36%,嗜酸性粒细胞减少或消失81.81%,肥达试验阳性63.63%,血培养阳性率18.18%,并发中毒性肝炎72.72%。经过头孢曲松单用或联合左氧氟沙星抗感染及综合治疗后,平均退热时间4.22±2.77天,所有患者均治愈出院。结论本病好发于青壮年,具有典型临床特点者少见,嗜酸粒细胞计数、肥达试验对诊断有参考意义,血培养可确诊,并发症以中毒性肝炎最多,但临床表现轻。治疗选用三代头孢菌素及氟喹诺酮类效果好。

Objective To analyze the clinical features of typhoid so as to gain better understanding of the disease. Methods A retrospective analysis was made to the clinical manifestation, lab tests and curative effect of 33 hospitalized patients with typhoid. Result All the patients had the clinical manifestation of fever with no roseola, 54.55% of relative slow pulse, 3.03% of apathy, 60.60% of gastrointestinal symptoms and 42.42% of hepatosplenomegaly; 81.81% of the patients showed decrease or disappearance of eosinophils, 63.63% were positive in Widal test and 18.18% in blood culture, 72.72% were complicated with toxic hepatitis; after the treatment of ceftfiaxone or eeftriaxone combined with levofloxacin, all the patients discharged with recovery, the average defervescence time was 4.22 ± 2.17 days. Conclusions Typhoid is often seen in young adults but few have typical clinical manifestation ; eosinophils count and Widal test are of reference significance for diangnosis and blood culture can help final diagnosis ; toxic hepatitis is the most common complication but the clinical manifestation is milder; the third -generation cephalosporins and fluoroquinolones are of good curative effect for typhoid.