CAJ | 학술논문

目的：探讨华佛综合征的临床诊治要点，以避免误诊误治。方法对我院尸检法医鉴定的华佛综合征3例的临床及尸检资料进行回顾性分析。结果2例以皮肤淤点或淤斑就诊，误诊为过敏性紫癜及过敏性休克；1例以咳嗽、喘息及呼吸困难为主要表现，误诊为呼吸系统感染。3例均发病急骤，病情危重，很快死亡，尸检并法医病理诊断为流行性脑膜炎并急性肾上腺功能衰竭(华佛综合征)2例，急性肾上腺功能衰竭(华佛综合征)1例。结论本病临床少见，病情进展快，易误诊。临床上一旦明确华佛综合征诊断，治疗应争分夺秒，若发现弥漫性血管内凝血应尽早使用肝素及抗纤维蛋白原溶解药物，积极抗休克治疗是关键。
목적：탐토화불종합정적림상진치요점，이피면오진오치。방법대아원시검법의감정적화불종합정3례적림상급시검자료진행회고성분석。결과2례이피부어점혹어반취진，오진위과민성자전급과민성휴극；1례이해수、천식급호흡곤난위주요표현，오진위호흡계통감염。3례균발병급취，병정위중，흔쾌사망，시검병법의병리진단위류행성뇌막염병급성신상선공능쇠갈(화불종합정)2례，급성신상선공능쇠갈(화불종합정)1례。결론본병림상소견，병정진전쾌，역오진。림상상일단명학화불종합정진단，치료응쟁분탈초，약발현미만성혈관내응혈응진조사용간소급항섬유단백원용해약물，적겁항휴극치료시관건。
Objective To explore the key factors in diagnoses and treatment of Waterhouse-Friederichsen syndrome to avoid misdiagnosis and mistreatment. Methods The clinical and autopsy data of 3 cases of Waterhouse-Friederichsen syn-drome in the Department of Forensic Medicine, Tongji Medical College were reviewed. Results 2 cases presented with pete-chiasis or ecchymosis, and both were misdiagnosed as allergic purpura and anaphylactic shock. However, cough, asthma and dyspnea were complained as main clinical manifestations in 1 case, which was misdiagnosed as respiratory tract infection. All the patients with acute onset died soon. The forensic pathological diagnosis was acute adrenal function failure ( Waterhouse-Friederichsen syndrome) due to epidemic meningitis in 2 cases and acute adrenal function failure ( Waterhouse-Friederichsen syndrome) in 1 case. Conclusion This disease is rare, rapidly progressive and tends to be misdiagnosed. When diagnosis of Waterhouse-Friederichsen syndrome is definite, the patient should be treated as soon as possible. The effective strategy for treatment would be anti-coagulation with Heparin and anti-fibrinolytic drug and anti-shock remedy.