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目前饲养家犬较为普遍,狂犬病发病率增加。狂犬病主要的临床表现是恐水、发热、烦燥不安、流涎等,但也有哭笑无常、打人毁物等癔病样发作的,还有症状不典型的,若不仔细询问病史和体检容易造成误诊,现报告3例。例1:男,22岁。四天前因做生意亏本被兄打骂及未婚妻出走而卧床不起、拒食拒水、哭笑无常、四肢乱动、见有人进他住室立即用手帕捂着嘴说有风,别人卡了他的喉龙。当晚求治于某医院,诊为“癔病”,治疗无效。于1988年3月1日上午来本院门诊,见病人神清,流涎,呈脱水貌,阵发性四肢抽动伴吡牙咧嘴,不时喊叫有人卡住喉龙、快松开呀等。体格检查:体温正常,脉搏120次/分,呼吸20次/分,血压70/50mmHg。颈软无抵抗,气管居中,心肺及腹部未见异常。未引出病理反射。RBC6.17×10~(12)/L,Hb17.0g/L,WBC18.8×10~9/L,/N75％,L25％,拟诊:癔病,脱水(三度),低血溶量性休克。入院后给于快速扩容,冬眠镇静和暗示治疗。下午4时
At present, breed dogs are more common, the incidence of rabies increased. The main clinical manifestations of rabies are water, fever, irritability, drooling, etc., but there are dumbfounding, hitting people and other diseases 癔 disease-like episodes, as well as atypical symptoms, if not carefully asked history and physical examination easily lead to Misdiagnosis, now report 3 cases. Example 1: Male, 22 years old. Four days ago because of business losses were beaten scold by his brother and his fiancee running away and bedridden, refused to eat water, dumbfounded, limbs were disturbed, see someone into his room immediately covered his mouth with a handkerchief windy, others card His throated dragon. Seeking treatment in a hospital that night, diagnosed as “hysteria”, the treatment is invalid. In the morning of March 1, 1988 to our hospital, see the patient Shenqing, salivation, dehydration appearance, paroxysmal limbs twitch with teeth grinning, from time to time someone yelling stuck throat, quick release Yeah. Physical examination: normal body temperature, pulse 120 beats / min, breathing 20 beats / min, blood pressure 70 / 50mmHg. Neck soft non-resistance, tracheal center, heart and lungs and abdomen without exception. Did not lead to pathological reflex. RBC6.17 × 10-12 / L, Hb17.0g / L, WBC18.8 × 10-9 / L, /N75%, L25%, proposed diagnosis: hysteria, dehydration (third degree), low blood volume Sexual shock. After admission to the rapid expansion, hibernation and implied treatment of calm. 4 o’clock in the afternoon