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伤寒的呼吸系统改变１８例临床分析浙江省宁海县人民医院（３１５６００）林亚静广泛应用抗生素及免疫治疗，非典型伤寒病例不断增加，在临床上易于漏诊、误诊。本文收集我院１９８９年６月至１９９１年６月，以呼吸系统改变为首发症状的１８例作一分析，现报告如下。临床资料１８例中男性１３例，女性５例；年龄均在２８～４５岁之间；其中１０例诊为右肺炎，支气管炎和间质性肺炎各４例。均为急性起病，首发症状为持续发热，咳嗽，咳痰１８例，胸痛４例，胸闷气促３例；体征：肝脾肿大１８例，淋巴结肿大１６例，呼吸改变１５例，有干湿罗音３例；ｘ线；右上肺炎１０例，肺纹理增粗和毛玻璃样变各４例。实验室检查：周围血象：白细胞计数７．８×１０９～１０×１０９／Ｌ１０例，１０×１０９～１２×１０９／Ｌ８例，中性粒细胞＞８０％６例，嗜酸性细胞绝对值减少１８例。肝功能：ＧＰＴ升高６例，１８例均无黄疸。细菌学检查；血培养伤寒杆菌１４例，付伤寒甲２例，付伤寒乙２例。骨髓培养共８例，检查均呈阳性。血清学检查：第２周未肥达氏反应阳性１８例，且复查后滴度均大于原滴度４倍。治疗及转归：入院时诊为肺炎，间质性肺炎，支气管炎以青霉素或林可霉素加氟哌酸或庆大霉素治疗后，１８例
Clinical analysis of 18 cases of respiratory changes in typhoid fever Ninghai County People’s Hospital of Zhejiang Province (315600) Lin Yajing widespread use of antibiotics and immunotherapy, cases of atypical typhoid fever continued to increase, clinically easy to misdiagnosis. This collection of our hospital from June 1989 to June 1991, with respiratory changes as the first symptom of 18 cases for an analysis, are as follows. Clinical data of 18 cases, 13 males and 5 females; aged 28 to 45 years old; 10 cases were diagnosed as right pneumonia, bronchitis and interstitial pneumonia in 4 cases. Were acute onset, the first symptom was sustained fever, cough, sputum in 18 cases, chest pain in 4 cases, chest tightness and shortness of breath in 3 cases; signs: liver and spleen enlargement in 18 cases, 16 cases of lymphadenopathy, respiratory changes in 15 cases, 3 cases of dry and wet rales; x-ray; 10 cases of right upper respiratory tract, pulmonary thickening and frosted glass-like change in 4 cases. Laboratory tests: Peripheral blood: white blood cell count of 7.8 × 109 ~ 10 × 109 / L 10 cases, 10 × 109 ~ 12 × 109 / L8 cases, neutrophils> 80% in 6 cases, eosinophils reduced by 18 example. Liver function: GPT increased in 6 cases, 18 cases without jaundice. Bacteriological examination; 14 cases of blood cultures of Salmonella typhi, typhoid fever in 2 cases, 2 cases of typhoid fever. A total of 8 cases of bone marrow culture, examination was positive. Serological tests: Week 2 did not Wade reaction positive in 18 cases, and the titers were greater than the original review 4 times. Treatment and outcome: admitted to hospital diagnosed with pneumonia, interstitial pneumonia, bronchitis to penicillin or lincomycin and norfloxacin or gentamicin treatment, 18 cases