hfrs合并腎病綜合征的出血熱(編輯修改稿)
2025-02-13 20:21 本頁(yè)面
【文章內(nèi)容簡(jiǎn)介】 。ofdiseasescourse,lasts1to3days.2.Mainsigns:Hypotensionorshock3.nausea,vomiting,abdominalpain.Platelet,hematocritvalueproteinuria,leukocytosis,atypicallymphocytes10%■ Clinical Manifestations403.OliguricphaseOliguriaoranuria UremiaMetabolicacidosisandimbalanceoffluidsandelectrolyte■ Clinical Manifestations41 3.OliguricphaseOccurduringorsoonafterhypotensivephase,in5to8daysofdiseasescourse,lasts25days.1.OliguriaoranuriaOliguria:urinevolume500ml/24hAnuria:urinevolume50ml/24h42 2.Uremiaa.gastrointestinalsymptomshiccup,vomiting,abdominalpain,diarrheab.Aggravatinghemorrhagehemoptysis(咳血 ),hematemesis(咯血 ),hematuria(血尿 )ormelenac.Nervoussystemsymptoms 433.Metabolicacidosisandimbalanceoffluidsandelectrolyte ▲Metabolicacidosis▲fatalhyperkalemia▲hypervolemicsyndromeedemaandrestlessnesshighbloodpressureengedneckveins.444Diureticphase▲Urine3000ml/24hOccurin9to14daysofdiseasescourse,lastfor1dayorseveralmonths▲Threephaseaccordingtourinevolumeandazotemiasigns?Transitionphase?Earlystageofdiureticphase?Latestageofdiureticphase■ Clinical Manifestations45 1.Transitionphasefrom500mlto2022ml/24hb.BUNandCrpersistentlyc.Stateofpatientmaychangetomoreserious.moreseriousalthoughurineincreasehighmortality462.Earlystageofdiureticphaseurinevolume2022ml/24hnomarkeddecreaseinazotemia3.Latestageofdiureticphasea.urinevolume3000ml/24hinmostofcases:4000to8000/24h,15000ml/24hb.azotemiaimproving,BUNfallingdownc.Secondaryshock,dehydrationhypokalemia,hyponatremia47 5.Convalescentphaseurinereturnto10002022ml/24hnormalappetitetaking13monthsforrecoveringFivephasebenotseenineverycase.hypotensionand/oroliguriaphasemaybeabsentinatypicalcases■ Clinical Manifestations48B:Fiveclinictypes1.Mildtype2.Moderate 3.Severe4.Veryserious5.Atypicaltype491.Mildtype:T39oC,mildintoxicationsymptomswithoutoliguriaandshock50 :T39oC,severeintoxicatingsymptoms,drunkenness,conjunctivaedema,hemorrhage,hypotension,oliguriaandmarkedproteinuria.51 :T40176。C,moresevereintoxicatingsymptoms,shock,bleeding,oliguriaforlessthan5daysoranuriaforlessthan2days.52serious:Thesymptomsandsignsinseveretypewithoneoffollowingsixsigns:1.hardcorrectiveshock2.bleedinginmainan3.acuterenalfailure4.Cardiacfailurepulmonaryedema5.ComplicationinCentralnervoussystem6.Serioussecondaryinfection535.AtypicalT38176。C,atypicalsymptoms54■LaboratoryFinding1.Bloodroutineleukocytosis,1550x109/L,neutrophilsdominatedinearlystage,lymphocytesinlatestage.Atypicallymphocytes10%~15%hematocritvalueandhemoglobinrise,thrombocytopenia55routineProteinuria,sometimeswithcasts,bloodcellsandmembraneshapedsubstance,consistingofprotein,bloodcellsandmucosalepithelia.maybefoundinseconddayofdiseasescourse56 3.BloodbiochemicalexaminationBUNandCrincreased.CO2CPdecreased.hyperkalemiainoliguricphase.hypokalemiaindiureticphase.574.Bloodcoagulatingfunctionexamination thrombocytopenia,plateletprolongatedPTFibrinogendecreasedsecondaryfibrinlysis585.SerologicaltestsHantanvirusantigenandspecificantibodytestbyIFAT,ELISA,RIAorWB.Antibodyagainstnuclearproteinisusefulfordiagnosis.1IgMantibody:1:20positive:diagnosismarker2IgGantibody:4times/weekuseful
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