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患儿,女,15个月,因间断发热,咳嗽4个月、气促加重1个月,于1991年4月5日收住。入院前4个月患儿出现咳嗽、发热,体温在39℃左右,在当地按肺炎治疗。1月后出现腹胀、气促,仍轻咳,继续在当地医院给青霉素、氨苄青霉素治疗,好转出院。近1月来患儿又再度发热、咳嗽、气喘加重,在当地治疗无效以“长期发热待查”收住。入院查体T36℃,P140次/min,R42次/min,体重10kg,神志清,呼吸急促,口周稍发绀,全身皮肤未见皮疹,出血点,鼻翼扇动,浅表淋巴结不大,轻度方颅,前囟1×1cm平软,咽红、颈软、气管居中,双侧胸廓饱满、对称,呼吸动度相等。双肺肩胛下区叩呈浊音,听诊呼吸明显减低,叩诊心界不大,心率142次/min,心音低钝,各瓣膜区未闻及杂音。腹部稍膨隆,紧张,移动性浊音(士),肠鸣音正常,肝脏右肋下6cm,剑突下5cm,质地中等,边缘钝,脾左肋下2.0cm,双下肢足背轻度凹陷性水肿,NS(一)。住院后检查及治疗:血红蛋白83g/L红细胞2.7～2.8×10~(12)/L,白细胞8.4～10.4X10~9/L、中性细胞0.62～0.68,淋巴细胞0.32～0.38,嗜酸细胞
Children, women, 15 months, due to intermittent fever, cough for 4 months, 1 month increase in shortness of breath, April 5, 1991 admitted. 4 months before admission, children with cough, fever, body temperature around 39 ℃, according to the local treatment of pneumonia. 1 month after bloating, shortness of breath, still light cough, continue to penicillin in the local hospital, ampicillin treatment, improved discharge. Nearly a month to children with fever, cough, asthma exacerbated, ineffective in the local treatment to “long-term fever to be checked” to stay. Admission examination T36 ℃, P140 times / min, R42 times / min, weight 10kg, clear consciousness, shortness of breath, slightly cyanotic perioral, skin rash, bleeding point, nose flap, superficial lymph nodes, mild Square skull, anterior fontanelle 1 × 1cm flat soft, throat red, soft neck, tracheal center, bilateral thorax full, symmetrical, equal breathing. Pulmonary subscapular area knocking was voiced, auscultation significantly reduced breathing, percussion little heart, heart rate 142 beats / min, low heart sound blunt, the valve area did not smell and noise. Abdomen slightly bulging, nervous, mobility dull (disabilities), bowel sounds normal, the right rib 6cm under the liver, the xiphoid 5cm, medium texture, blunt edge, spleen left rib 2.0cm, lower extremity dorsal mild depression Edema, NS (a). After inpatient examination and treatment: Hemoglobin 83g / L 2.7 ~ 2.8 × 10 12 / L,