重型及危重型肾综合征出血热临床特点及救治体会

目的探讨重型、危重型肾综合征出血热（HFRS）临床特点及救治体会。方法回顾性分析53例重型、危重型HFRS临床资料，早期诊断及误诊情况，实验室检测，并发症，死亡原因。结果①化验检查：白细胞（WBC）、红血球压积（HCT）、总胆红素（TBil）、血清丙氨酸氨基转移酶（ALT）、血清天冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）、尿素氮（BUN）、肌酐（Cr）有不同程度的升高，血小板（PLT）有不同程度降低，30．2％找到异常淋巴细胞，尿蛋白〉＋＋＋＋。②超声声像图检查：25例作超声检查，100％显示双肾肿大、肾内结构模糊、肾包膜水肿周围渗出，76％示胆囊肿大、胆囊壁毛糙、双层水肿，44％示肝脾肿大，16％示胰腺肿大、回声增强，40％示胸腹腔积液。③心电图检查：15．1％示房室传导阻滞、ST-T段改变、房室交界性早搏。④并发症：肝功能损害50例，继发感染11例，心律失常和心肌损害8例，消化道出血6例，颅内疾患4例。⑤本组共死亡8例，病死率15．1％。结论对重型、危重型HFRS需提高认识，谨防误诊，严密观察病情变化；合理治疗，抢救休克、急性肾功能衰竭；防治并发症，可提高抢救有效率。

The clinical characteristic and remedy perception of 53 severe and critical type HFRS

Objective To explorer the clinical characteristics of severe and critical type Hemorrhagic Fever with Renal Syndrome （HFRS）. Methods Clinical data of 53 severe and critical type HFRS cases were analyzed,including early diagnosis, diagnostic errors, laboratory findings, complications and cause of death. Results （1）Laboratory findings： white blood cell, hematocrit, total bilirubin, alanine aminotransferase, aspartic transaminase, alkaline phosphatase, urea nitrogen, serum creatinine, increase to some extent The platelet count decreased. 30.2% cases were detected abnormal lymphocytes. Urine protein was enumerated 〉＋＋＋＋. （2）Ultrasonography： 25 cases were inspected with ultrasound. All patients showed both kidneys swelling, kidney structure obfuscation, kidney envelope edema and exudation. 76% cases showed gallbladder enlargement, gallbladder wall not smooth, double-deck and edema. 44% cases showed hepatosplenomegaly, 16% cases showed pancreasenopathy and echo enhancement. 40% patient splanchnocoel were hydrops. （4） Complications： 50 cases had liver functional lesion. 11 cases had involved in secondary infection. 8 cases had arrhythmia and cardiac damage. 6 cases had alimentary tract hemorrhage. 4 cases had intracalvarium diseases. （5）8 cases died（fatality rate： 15.1%）. Conclusions The full realization of severe and critical type HFRS make sure not to diagnose incorrectly with HFRS, observing closely have been done. Reasonable therapeutics, rescuing shock and acute renal failure, preventing and curing complication will raise achievement ratio.