发热的诊断要点

发热是指体温病理性升高.成年人腋下、口腔或直肠内温度分别超过37℃、37.3℃或37.6℃,昼夜波动超过1℃时,在除外各种生理性因素,如年龄、性别、活动量、情绪、月经周期、餐前餐后、代谢状态、季节变化等的情况下,可以认为有发热.     

正常成人、发热病人口、腋温测值差异的比较研究

目的　准确、客观地了解正常成人和发热病人口温与腋温差值 ,提高对发热性疾病的诊断水平。方法　将正常成人和发热病人分为 2组 ,各组分为 5个年龄段 ,分别测量 10 :0 0、16 :0 0、2 0 :0 0 3个时间段口温和腋温值 ,并进行比较分析。结果　 2组人群口温和腋温平均温差经统计学分析差异无显著性 (P >0 .0 5 )。结论　“口温高于腋温 0 .3～ 0 .5℃”之定义不准确 ,应重新界定。本研究提示 ,在临床实践中 ,将所测腋温值加 0 .2℃即等于口温较准确 ,发热病人原则上不加 0 .2℃。     

发热患儿肛温与腋温测量值差异的研究

目的探讨发热患儿肛温测量值与腋温测量值加0．6℃之间的差异。方法将101例发热患儿采用自身对照的方法同时测量肛温与腋温,对肛温测量值与腋温测量值加06℃之间的差异进行比较分析。结果发热患儿肛温测量值与腋温测量值加0．6℃之间的差值在0～1．7℃之间,发热患儿肛温测量值与腋温测量值加0．6℃之间的差异具有统计学意义（P〈0．05）。结论发热患儿测量肛温更准确。     

儿童发热的诊治

儿童正常体温可波动于一定范围。短暂的体温波动,全身情况良好,又无自觉症状者,可不考虑为病态。正常小儿腋下体温一般为36℃～37℃;喂奶或饭后、运动、哭闹、衣被过厚、室温过高均可使小儿体温暂时升高达37．5℃,甚至380C（以下均指腋温）,新生儿或小婴儿更易受以上条件影响;相反,若饥饿、低热量,尤其体弱患儿处于少动状态或保温条件不佳,体温可低至35℃以下,称为体温过低或体温不升,应采取保暖措施。测体温的时间和条件以及测定的持续时间对数值均有影响;一般测腋温应以5min为准,不宜过短或过长,过短则偏低,过长则偏高。小儿年龄越小,体温调节越差,体温波动越大。但对于发热的耐受力却较好或反应不大,如小婴儿感冒时体温可突然升高达40℃左右,而病儿一般情况却较好,热退后恢复也较快。年长儿体温已较稳定,若体温突然升高,全身情况较差,往往反映有较严重疾病发生。对于长期（2周以上）发热或反复体温升高,则应认真查明原发病,并分析有无并发症存在。时期体温改变不似成人的典型,而且近年来经过早期诊断、早期处理,尤其应用抗生素药物或肾上腺皮质激素治疗益增多,已使不少发热性疾病的体温曲线与传统概念有明显差异,失去了热型原有的鉴别诊断意义。     

胸痛的诊治要点

胸痛(chest pain)是社区常见的症状，一般是由胸部疾病引起，胸痛的严重程度与引起胸痛的原因不一定有确切的关系，如胸部带状疱疹可产生剧烈胸痛，而急性心肌梗死的胸痛有时并不很严重。因此，对胸痛的患者应认真检查，尽可能找到引起胸痛的原因及时诊断与治疗。     

SARS流行期发热患者的诊治及影响因素分析

目的：对严重急性呼吸综合征(SARS)流行期发热患者的病因构成、诊治状况及影响因素进行分析，探讨SARS及发热相关疾病的早期诊断及鉴别诊断方法。方法：将2003年3月15日—5月10日北京大学附属第三医院急诊科接诊的4060例发热患者流行病学及临床资料进行总结分析，并评价其影响因素的作用。结果：4060例发热患者中，被收入隔离病房者275例，145例确诊为SARS(占3．57％)，29例为疑似病例，排除诊断101例。诊断非SARS性肺感染93例，并诊断流行性脑膜炎2例，化脓性脑膜炎8例，流行性出血热3例。结论：SARS高发期发热患者中约90％的病因为流行性感冒或其他病毒感染，非SARS性肺感染及发热相关传染病占有一定比例。应提高发热的鉴别诊断意识和水平，白细胞升高不是排除SARS的诊断依据，X线胸片异常可不与发热同时出现，必须进行胸片复查。     

布洛芬口服混悬液治疗小儿发热的护理要点

小儿发热是儿科常见的临床症状之一，多伴有食欲不振、哭闹、高热惊厥等。对儿科发热性疾病常需应用解热药物，护理非常关键。我院2003年10月-2004年10月对65例发热患儿服用布洛芬口服混悬液治疗，取得了较好的效果，现将护理经验报告如下。     

非感染非肿瘤性炎症和(或)发热的临床诊治思维

1引言 在不少人的观念中,风湿性疾病(风湿病)就是那些因天气变化出现腰酸腿痛的疾病,只将关节炎视为风湿病.其实,风湿病的范围远远不止这些,风湿病包括全部的结缔组织病(包括系统损害为主的和关节损害为主的)、骨关节退行性病变(如骨关节炎),以及代谢因素导致的关节病变(如痛风)等等.在临床实践中,许多被临床各科视为疑难病例的患者,实际上多是风湿病病人.例如,一个以炎症性病变为特征的疑难病例,临床、病原学和病理学检查均找不到感染和肿瘤的证据,临床诊治应如何下手?本文着重谈谈有关的诊治思维体会.     

Diagnosis and treatment of pediatric fever by caretakers

Assessment of pediatric temperature is a multistep task involving both manipulative and cognitive skills. Emergency Physicians typically assume that parents possess these skills, but this assumption has never been fully tested. A prospective survey was conducted of caretakers of children < or = 36 months of age presenting to an inner city emergency department or pediatric clinic. Participants were asked to read a Fahrenheit scale mercury thermometer and to demonstrate use of that thermometer to "take" the temperature of an infant doll. They were then asked what temperature constituted a "fever" and what temperature would require antipyretic therapy. Caretakers were also asked how they would treat a fever in the child they had brought for treatment. Proportions of correct responses were tabulated and also compared by age and level of education of caretaker. Eighty-two of 92 caretakers (89.1%) possessed working thermometers in their homes. Thirty-six subjects (39.1%) were able to measure temperature appropriately using the mercury thermometer, 52 (56.5%) were able to read the mercury thermometer correctly, and 28 (30.4%) could both measure and read correctly. Sixty-seven subjects (72.8%) described correct treatment of fever. Overall, 27 subjects (29.3%) could measure, read, and treat fever appropriately. There was no statistically significant difference in age or percentage of high school graduates between caretakers who could successfully measure, read and treat and those who could not. In this inner city patient population, caretakers of any pediatric patient whose discharge instructions contain a reference to patient temperature should receive a brief refresher along with written instructions on temperature measurement and treatment.     

Diagnosis of hemorrhagic fever with renal syndrome

The authors observed 22 patients with hemorrhagic fever with the renal syndrome (HFRS). The diagnosis turned out to be difficult in outpatient clinics as all the patients were referred to hospital with erroneous diagnoses. Epidemiological causes of infection of HFRS were indicated. The authors singled out 3 periods in a course of this disease with characteristic symptoms. The diagnosis was confirmed serologically in the reaction of indirect immunofluorescence, a 4-fold increase and over in antibody titer was observed. A case history was presented.     

Diagnosis and management of pseudoaneurysms

Pseudoaneurysms develop at the site of arterial access when there is failure to establish adequate hemostasis. The number of percutaneous diagnostic and therapeutic coronary and peripheral vascular interventions has increased and with it a commensurate rise in the incidence of pseudoaneurysms is observed. Clinical examination and color-flow duplex ultrasound identify the majority of pseudoaneurysms. Ultrasound-guided thrombin injection has been shown to be the ideal method to treat the vast majority of false aneurysms. In a small number of cases, alternative endovascular techniques or open surgical repair is required.