论文部分内容阅读
患者女性,37岁(住院号14069),因多食、怕热、多汗、心悸5个月.于93年9月到我院门诊检查,诊断为“甲状腺机能亢进”.给予甲巯咪唑5mg、普索洛尔10mg,tid治疗后,症状减轻.10月份因发热、咽喉痛1周入我院,诊断为“上呼吸道感染及甲亢”.血常规检查:WBC4.8×1O_9/L、L46%、N54%,从青霉素治疗痊愈出院,继续服用甲巯咪唑.1994年1月3日因高热、咽喉痛、全身无力、心悸3d再来我院门诊.体检:T39℃,R24次/min,HR100次/min,BP15/10KPa;急性重病容,左颌下可扪及一个1cm×1cm大淋巴结,质中、可移动、明显触痛;咽充血,双侧扁桃体Ⅰ°肿大,未见脓点;甲状腺Ⅰ°肿大,质软,无结节;双肺呼吸音粗,未闻干湿啰音;余未发现异常.血常规检查:WBC1.7×1O~9/L、N1O %、L90%、诊断为“粒细胞缺乏症.上呼吸道感染、甲亢.”收入院治疗.①用青霉素640万加5%葡萄糖500mL Bid静脉滴注;②停用抗甲状腺药物;③口服利血生200mg、鲨肝醇50mg,tid;④物理降温;⑤隔离,防止交叉感染.治疗3d后,高热仍达40℃;血培养无菌生长;骨髓血细胞检查:①增生低下;②粒系细胞增生显著减低,仅见早幼粒细胞0.5%,晚幼粒以下价段细胞缺如;③淋巴细胞显著增多占83%,形态正常;①红系细胞增生、各价段比例、形态正常;⑤数50个幼细胞中未见有核红细胞及中性粒细?
Female patient, 37 years old (hospital number 14069), due to eating more, afraid of fever, hyperhidrosis, palpitations 5 months in September 93 to our hospital clinic diagnosed as “hyperthyroidism.” Given methimazole 5mg , Pusolol 10mg, tid treatment, the symptoms reduced .10 months due to fever, sore throat 1 week into our hospital, diagnosed as “upper respiratory tract infection and hyperthyroidism.” Blood tests: WBC4.8 × 1O_9 / L, L46 %, N54%, recovered from penicillin treatment, continue to take methimazole January 3, 1994 due to fever, sore throat, general weakness, palpitations 3d come back to our hospital. Physical examination: T39 ℃, R24 times / min, HR100 Times / min, BP15 / 10KPa; acute severe disease, left submandibular palpable and a 1cm × 1cm large lymph nodes, quality, mobile, obvious tenderness; pharyngeal congestion, bilateral tonsil I ° enlargement, no pus point ; Thyroid Ⅰ ° swollen, soft, non-nodular; lung breath sounds coarse, no wet and dry rales heard; I found no abnormal blood tests: WBC1.7 × 10 ~ 9 / L, N1O%, L90 %, Diagnosed as “agranulocytosis. Upper respiratory tract infection, hyperthyroidism.” Income hospital treatment. ① with penicillin 6.4 million plus 5% glucose 500mL Bid intravenous infusion; ② anti-thyroid drugs disabled; ③ oral reserpine Health 200mg, batyl alcohol 50mg, tid; ④ physical cooling; ⑤ isolation to prevent cross-infection. After 3 days of treatment, the high fever is still up to 40 ℃; blood culture sterile growth; bone marrow blood cell examination: ① hyperplasia; ② granulocytic hyperplasia Significantly reduced, only see the promyelocytic 0.5%, late promyelocytic following paragraph lack of cells; ③ significantly increased lymphocyte accounted for 83%, normal morphology; erythroid hyperplasia, the price of the proportion of segments, the morphology is normal; No young cells in the nucleated red blood cells and neutrophils?