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目的研究发热伴血小板减少综合征(简写SFTS)死亡病例的早期临床表现和流行特征,探讨死亡可能影响因素。方法对2010—2014年蓬莱市发热伴血小板减少综合征死亡病例采用描述性流行病学方法分析。结果 SFTS死亡病例多为老年农民,平均死亡年龄为65.76岁,死亡高峰为6—9月,发病前均有到野外干农活或接触牛羊。大部分患者发病早期以高烧、全身不适、乏力、肌肉酸痛为主,主要体征为浅表淋巴结肿大(57.89%)、舌体或肢体震颤(42.11%)和肾区或肝区叩痛(31.58%),白细胞(94.74%)、血小板(94.44%)计数减少,ALT(76.47%)、AST(100%)、CK(58.33%)、血糖(88.24%)升高,部分伴有血尿、粪潜血阳性。发病至初次就诊二级以上医院时间间隔平均4.95d,52.63%病例转诊一次,从县级以下医院转诊至县级以上医院平均5.11d,首诊在村卫生室或私人诊所输液(57.89%)、伴有慢性基础性疾病(52.63%)较多。结论发热伴血小板减少综合征死亡病例发病初期临床表现无特异性,初诊多伴有肝肾和神经系统损害,就诊不及时,滞留在村级卫生医疗机构较长,伴有慢性基础性疾病可能是导致死亡病例发生的重要因素。
Objective To study the early clinical manifestations and epidemiological features of death from fever with thrombocytopenia syndrome (SFTS) and explore the possible influencing factors of death. Methods 2010-2014 Penglai fever with thrombocytopenia deaths were analyzed by descriptive epidemiological method. Results Most cases of SFTS death were elderly peasants. The average age of death was 65.76 years and the peak of death was from June to September. Before the onset of illness, both were working in the wild or exposed to cattle and sheep. Most of the patients had early onset with high fever, general malaise, weakness and muscle ache. The main symptoms were superficial lymph node enlargement (57.89%), tremorment of tongue or limb (42.11%) and percutaneous pain in kidney or liver area (31.58 (94.74%), platelet count (94.44%), ALT (76.47%), AST (100%), CK (58.33%) and blood glucose (88.24%) were increased, some of them were associated with hematuria, Positive. The average time between the onset and the first visit of more than Grade 2 hospitals was 4.95d and 52.63% respectively. The number of referrals from hospitals below the county level to hospitals above the county level was 5.11d on average, and the first visit was in the village clinics or private clinics (57.89% ), Accompanied by chronic basic diseases (52.63%) more. Conclusions The incidence of death in patients with fever and thrombocytopenia is nonspecific in the early stage of disease. The first visit is often accompanied by liver, kidney and nervous system damage. When the doctor fails to attend the clinic, there is a long stay in the village health care institution. Chronic basic diseases may be Lead to the death of the important factors.