临床误诊误治
臨床誤診誤治
림상오진오치
CLINICAL MISDIAGNOSIS & MISTHERAPY
2015年
4期
9-11
,共3页
丛林斑疹伤寒%焦痂%分布%误诊
叢林斑疹傷寒%焦痂%分佈%誤診
총림반진상한%초가%분포%오진
Scrub typhus%Eschar%Distribution%Misdiagnosis
目的：探究恙虫病患者焦痂全身分布情况，以便寻找有助于恙虫病临床诊断的方法。方法收集广西医科大学第一附属医院及柳州市人民医院2009年1月—2014年7月诊断为恙虫病的249例临床资料，分析焦痂分布情况，以及与患者性别、年龄及居住地的关系。结果本组无焦痂3例(1.2%)，有焦痂246例(98.8%)，共252处焦痂。焦痂分布情况：会阴、外生殖器、腹股沟、臀部76处(30.2%)，胸腹部56处(22.2%)，腋窝和乳房39处(15．5%)，背部31处(12.3%)，头、颈、面部18处(7.1%)，上肢17处(6.7%)，下肢15处(6.0%)。男女性患者的焦痂分布差异有统计学意义(P<0.05)，男性主要分布在会阴和腹股沟区，而女性多分布在乳房和腋窝区。不同年龄段、居住地患者焦痂分布均以会阴、外生殖器、腹股沟、臂部为主，但儿童及老年组背部焦痂出现率高于成人组(P<0．05)，农村人口组上肢焦痂出现率高于城镇居民组(P<0.05)。结论焦痂是诊断恙虫病的重要线索，对发热伴淋巴结增大、肝脾增大、皮疹者应仔细寻找焦痂或溃疡，男性患者注意会阴和腹股沟区，女性患者注意乳房和腋窝区，以减少误漏诊。
目的：探究恙蟲病患者焦痂全身分佈情況，以便尋找有助于恙蟲病臨床診斷的方法。方法收集廣西醫科大學第一附屬醫院及柳州市人民醫院2009年1月—2014年7月診斷為恙蟲病的249例臨床資料，分析焦痂分佈情況，以及與患者性彆、年齡及居住地的關繫。結果本組無焦痂3例(1.2%)，有焦痂246例(98.8%)，共252處焦痂。焦痂分佈情況：會陰、外生殖器、腹股溝、臀部76處(30.2%)，胸腹部56處(22.2%)，腋窩和乳房39處(15．5%)，揹部31處(12.3%)，頭、頸、麵部18處(7.1%)，上肢17處(6.7%)，下肢15處(6.0%)。男女性患者的焦痂分佈差異有統計學意義(P<0.05)，男性主要分佈在會陰和腹股溝區，而女性多分佈在乳房和腋窩區。不同年齡段、居住地患者焦痂分佈均以會陰、外生殖器、腹股溝、臂部為主，但兒童及老年組揹部焦痂齣現率高于成人組(P<0．05)，農村人口組上肢焦痂齣現率高于城鎮居民組(P<0.05)。結論焦痂是診斷恙蟲病的重要線索，對髮熱伴淋巴結增大、肝脾增大、皮疹者應仔細尋找焦痂或潰瘍，男性患者註意會陰和腹股溝區，女性患者註意乳房和腋窩區，以減少誤漏診。
목적：탐구양충병환자초가전신분포정황，이편심조유조우양충병림상진단적방법。방법수집엄서의과대학제일부속의원급류주시인민의원2009년1월—2014년7월진단위양충병적249례림상자료，분석초가분포정황，이급여환자성별、년령급거주지적관계。결과본조무초가3례(1.2%)，유초가246례(98.8%)，공252처초가。초가분포정황：회음、외생식기、복고구、둔부76처(30.2%)，흉복부56처(22.2%)，액와화유방39처(15．5%)，배부31처(12.3%)，두、경、면부18처(7.1%)，상지17처(6.7%)，하지15처(6.0%)。남녀성환자적초가분포차이유통계학의의(P<0.05)，남성주요분포재회음화복고구구，이녀성다분포재유방화액와구。불동년령단、거주지환자초가분포균이회음、외생식기、복고구、비부위주，단인동급노년조배부초가출현솔고우성인조(P<0．05)，농촌인구조상지초가출현솔고우성진거민조(P<0.05)。결론초가시진단양충병적중요선색，대발열반림파결증대、간비증대、피진자응자세심조초가혹궤양，남성환자주의회음화복고구구，녀성환자주의유방화액와구，이감소오루진。
Objective To investigate the preferential sites of eschars over the bodies of patients with tsutsugamushi disease, in order to improve clinical diagnosis of scrub typhus. Methods In a retrospective analysis, we analyzed 249 pa-tients with scrub typhus in the first affiliated hospital of Guangxi Medical University and Liuzhou People's Hospital during Janu-ary 2009 and July 2014, focusing on the distribution of eschars and the relationships between gender, age and residence place. Results In our study, there were 3 patients with no eschar, accounting for 1. 2% and 246 patients (98. 8%) with es-char, 252 in total. The distribution of eschars over the body was: on perineum, genitalia, groin and buttocks, 76 cases (30. 2%);on chest and abdomen, 56 cases (22. 2%);on axillary fossa and breasts, 39 cases (15. 5%);on back, 31 ca-ses (12. 3%);on head, on neck and face there were 18 cases (7. 1%);on upper extremities 17 cases (6. 7%);on lower extremities, 15 cases (6. 0%). There was a difference in the distribution of eschars between males and females(P<0. 05), for males they were mainly distributed in the area of perineum and the groin, while for females, they were distributed in the ar-ea of breasts and axillary fossa. The distribution of eschars in different age and residence groups were mainly on perineum, genitalia, groin and buttocks, but the occurrence rate on back in the young and old group was higher than that of the adult group(P<0. 05), and the occurrence rate of the upper extremities in the rural group was higher than that of the urban group ( P<0. 05).Conclusion The eschar is an important clue in diagnosis of scrub typhus, and thorough examinations should be performed for the patients who run a fever accompanied with lymphadenopathy, enlarged liver and spleen and rash, especially over perineum, genitalia and groin in males, axillary fossa and breasts in females in order to prevent misdiagnosis.
