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患儿女,4岁,因咳嗽4天,伴下腹疼,尿频,尿急,尿疼两天,尿少且淋漓不尽而入院。查体:体温38.7℃,发育营养差,意识清,烦躁不安,呈急性病容。皮肤粘膜无黄染,浅表淋巴结不大。双侧扁桃体不大,咽部无充血,胸廓对称,双肺呼吸音粗,有痰鸣音,心率98次/分,律齐,未闻杂音,腹软,下腹部膨隆,叩实音,触有圆形包块(膀胱)平脐,压痛(+),无反跳痛,肝区未见局限性隆起,肝脾未触及。肠鸣音存在。未闻及气过水声,无移动性浊音。两肾区皮肤未见隆起,局部无叩击痛。脊柱无畸形,无压痛及叩痛,活动一般。四肢无畸形。肛门无异常。处女膜闭锁。X线胸透示双肺纹理增粗;实验室检查 WBC 24.2×10~9/L;N 0.68;L 0.32;尿、便常规均正常。入院诊断:1 泌尿系感染;2 尿潴留;3 支气管炎。经导尿;用青霉素160万U加氨苄青霉素1.0静滴,每日两次,三天后效果不佳,体温波动在37～38.8℃。反复查尿常规正常,尿培养无细菌生长,血培养为革兰氏阳性球菌。B超检查:双肾、输尿管、膀胱无异常,子宫增大,宫腔直径5.4cm,内有积
Children, 4 years old, cough for 4 days, with the next abdominal pain, frequent urination, urgency, urinary pain for two days, less urine and dripping and hospitalized. Physical examination: body temperature 38.7 ℃, poor nutrition, consciousness, irritability, was acute disease. No yellow skin and mucous membranes, superficial lymph nodes is not. Bilateral tonsil, pharynx without congestion, thorax symmetry, lung breath sounds rough, phlegm sounds, heart rate 98 beats / min, law Qi, unheard noise, abdominal soft, lower abdomen bulging, knocking real tone, touch A round mass (bladder) flat umbilical, tenderness (+), no rebound tenderness, no localized liver lumps, liver and spleen not touched. Bowel sounds exist. No smell of gas over the water, no mobility dullness. Two kidney area skin no bulge, no percussion pain. Spine without deformity, no tenderness and percussion pain, activities in general. No limb deformities. Anus without exception. Hymen lock. X-ray chest lungs showed thickening; laboratory WBC 24.2 × 10 ~ 9 / L; N 0.68; L 0.32; urine, then routine are normal. Admission diagnosis: 1 urinary tract infection; 2 urinary retention; 3 bronchitis. The catheterization; penicillin 1.6 million U plus ampicillin 1.0 intravenous infusion twice daily, three days after the poor results, temperature fluctuations in the 37 ~ 38.8 ℃. Check urine routinely normal urine culture without bacterial growth, blood culture for Gram-positive cocci. B-ultrasound: kidneys, ureter, bladder no abnormalities, uterine enlargement, uterine diameter 5.4cm, within the plot