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目的分析宿迁地区恙虫病临床特征,为临床诊断与治疗提供参考。方法对宿迁市人民医院急诊中心近2年来诊治的32例恙虫病患者的病例资料进行回顾性分析。结果恙虫病在每年8-11月高发,32例患者均有野外草地等接触史,均有高热及恙螨叮咬处焦痂、溃疡、淋巴结肿大等症状,其中30例出现不同程度肝损害(93.75%),14例有肺部损害(43.75%),9例有心脏损害(28.13%),6例有肾损害(18.75%),1例发生弥散性血管内凝血和多脏器功能障碍综合症(MODS)(3.1%);变形杆菌OX2和OX19均阴性,OXK凝集反应仅6例阳性(18.75%)。32例病例首诊误诊24例,误诊率高达75%。阿奇霉素治疗效果较好,治愈率为96.88%,仅1例死亡,病死率为3.13%。结论恙虫病临床表现比较复杂,且合并肝损害最常见,但是外斐氏试验结果对本地区恙虫病的早期诊断意义不大。临床医生尤其是急诊医生要对该病充分认识,对不明原因发热伴肝损害的患者,应考虑恙虫病的可能,减少误诊。
Objective To analyze the clinical characteristics of scrub typhus in Suqian and provide reference for clinical diagnosis and treatment. Methods The data of 32 cases of tsutsugamushi disease diagnosed and treated in emergency center of Suqian People’s Hospital in recent 2 years were retrospectively analyzed. Results tsutsugamushi disease in each of 8-11 months of high incidence, 32 patients have history of exposure to grassland and other places, have high fever and chigger bites eschar, ulcers, lymph nodes and other symptoms, of which 30 cases of varying degrees of liver damage ( 93.75%), 14 cases had lung damage (43.75%), 9 cases had heart damage (28.13%), 6 cases had renal damage (18.75%), 1 case had disseminated intravascular coagulation and multiple organ dysfunction syndrome (MODS) (3.1%). Proteus OX2 and OX19 were both negative. OXK agglutination was positive in only 6 cases (18.75%). Twenty-four cases were misdiagnosed in 24 cases, with a misdiagnosis rate as high as 75%. Azithromycin treatment is better, the cure rate was 96.88%, only 1 case died, the case fatality rate was 3.13%. Conclusion The clinical manifestations of scrub typhus are complicated, and hepatic damage is the most common. However, the results of the external Phoebe spp. Have little significance in the early diagnosis of scrub typhus in this area. Clinicians, especially emergency doctors to fully understand the disease, fever of unknown cause with liver damage in patients should consider the possibility of scrub typhus, reduce misdiagnosis.