63例发热伴呼吸道症状患者的临床分析

Clinical Analysis of 63 Cases with Pulmonary Febrile Symptoms

目的 探讨常见呼吸道发热疾病与传染性非典型肺炎 (简称“非典”)的鉴别。方法 对以发热伴呼吸道症状收治入院的 6 3例患者 ,采用回顾性分析的方法 ,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 ,有基础肺部或全身疾病的患者 ,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 ,气急多见 ,体温以中度发热为主 ,6 1.3%病例有白细胞计数及中性比例升高 ,胸片除肺炎或支气管炎改变外 ,多有肺部基础疾病的表现 ,抗生素治疗常有效 ;而单纯性肺炎胸部 X线除部分表现为多叶或单个大叶病变外 ,多表现为节段性或局灶性肺炎 ,病原学检查呈现常见的呼吸道病原体 ,即革兰阳性菌及支原体、军团菌、衣原体和多种病毒 ,这部分病例也以发热为重要或首发症状 ,表现一般咳嗽咳痰 ,气急少见 ,易与传染性非典型肺炎混淆。结论 防治传染性非典型性肺炎 ,不应忽视呼吸道常见发热疾病的存在。单纯性肺炎与传染性非典型肺炎的鉴别 ,应结合流行病史、治疗反应及实验室特殊检查结果进行鉴别。

Objective To explore differential diagnosis between common pulmonary febrile diseases and severe acute respirotory syndrome (SARS).Methods Retrospective analysis of 63 patients with fever was conducted and their respiratory symptoms, causes, clinical features, laboratory examinations, X-ray examinations, and treatment effects were estimated. Results 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 common and fever was generally mild. The count of WBC and the rate of neutrophil increased among 61.3% of the patients. Chest X-rays showed appearances of basic lung disease except acute infiltration. Their symptoms were ameliorated gradually after effective antibiotic treatment. Except for some with simple pneumonia characterized by multilobar or single lobar, most of them were manifested as segmental or local lesions. The pathogen showed typical common pulmonary bacteria and Gram’s positive bacteria. For these patients, fever was very common and appeared as first symptom, and short breath was rare.Conclusion The existence of common pulmonary febrile disease can’t be overlooked in the prevention against SARS and in differential diagnosis between simple and contagious atypical pneumonia. The differential diagnosis can be improved using the data from epidemics, treatment outcomes and results of special laboratory tests.