發(fā)布時(shí)間：2018-04-08 21:00

  本文選題：發(fā)熱　切入點(diǎn)：頭痛　出處：《中國當(dāng)代兒科雜志》2017年09期

【摘要】：該研究2例學(xué)齡期患兒于春季急性起病,表現(xiàn)為發(fā)熱、頭痛、嘔吐、意識(shí)障礙,以及皮膚紫癜、腦膜刺激征陽性。外周血白細(xì)胞及中性粒細(xì)胞均增高、血紅蛋白及血小板不同程度降低;CRP明顯增高;腦脊液白細(xì)胞數(shù)增高達(dá)數(shù)百或上千、且以中性粒細(xì)胞為主,腦脊液蛋白增高,糖、氯化物正常。其中1例頭顱CT示右側(cè)小腦、雙側(cè)大腦多發(fā)血腫。骨髓細(xì)胞學(xué)提示感染性骨髓象,血培養(yǎng)、骨髓培養(yǎng)均提示金黃色葡萄球菌(MRSA)。患兒抗感染治療過程中出現(xiàn)心臟雜音,并且血紅蛋白及血小板進(jìn)行性下降,心臟彩超發(fā)現(xiàn)主動(dòng)脈瓣贅生物形成,確診為感染性心內(nèi)膜炎(IE)。根據(jù)藥敏試驗(yàn)改為萬古霉素抗感染治療,1例6周后痊愈,1例放棄治療死亡。兒童IE起病隱匿,臨床表現(xiàn)多樣,建議對(duì)于不明原因發(fā)熱患兒要注意動(dòng)態(tài)觀察心臟雜音,及時(shí)行心臟彩超排除IE;以化腦為表現(xiàn)的患兒伴有難以用血小板減少解釋的皮膚、黏膜出血時(shí),也應(yīng)警惕IE。
[Abstract]:In this study, 2 school-age children developed acute onset in spring with fever, headache, vomiting, disturbance of consciousness, skin purpura and positive meningeal irritation sign.WBC and neutrophilic granulocytes in peripheral blood increased, hemoglobin and platelet decreased in varying degrees, CRP increased significantly, the number of leukocytes in cerebrospinal fluid increased as high as hundreds or thousands, and mainly neutrophil, cerebrospinal fluid protein increased, glucose,The chloride is normal.In one case, the right cerebellum was shown on CT scan and multiple hematomas were found in both sides of the brain.Bone marrow cytology showed that infected bone marrow, blood culture and bone marrow culture all suggested MRSAA.In the course of anti-infection treatment, cardiac murmur appeared, hemoglobin and platelets decreased gradually, aortic valve neoplasm was found by color Doppler echocardiography, which was diagnosed as infective endocarditis.According to drug sensitivity test, vancomycin antiinfective therapy was used in 1 case and 1 case died after 6 weeks.It is suggested that children with fever of unknown causes should pay attention to dynamic observation of cardiac murmur and timely exclusion of IEs by color Doppler echocardiography. Children with encephalic symptoms have skin that is difficult to explain with thrombocytopenia.When the mucous membrane bleeds, should also guard against IE.
【作者單位】： 遵義醫(yī)學(xué)院附屬醫(yī)院小兒內(nèi)科;
【分類號(hào)】：R725.4

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