课件：发热的急诊诊治思路吴伟.ppt

女，60岁。2002年12月因“慢性乙型肝炎、肝硬化脾功能亢进” 行脾切除术，同时结扎三条胃底静脉。术后出现腹水、胸水， 伴发热畏寒、寒颤，体 温最高达39.8℃。 血常规: 白细胞9.07× 109 /L ， N 72.6%，Hb 96g/L 腹水常规: 细胞数2700×106/L。单核细胞55％，多核细胞45％ 予菌必治、先锋必、复达欣等治疗，疗效欠佳 体检：神志清楚，T 39.6℃ ，贫血貌，巩膜无黄染，可见肝掌 右下肺湿啰音，肝区叩痛（＋），移动性浊音（＋），双下肢 轻度浮肿 入院后，查胸片，两肺纹理增多，B超示慢肝，肝囊肿，盆腔 中度积液，腹部CT示肝脏多发囊肿，左膈下轻度不规则强化， 左膈下间隙脓肿形成。 腹水常规：细胞数1500×106/L，腹水培养无细菌生长 血常规:白细胞12.46× 109 /L ， N 83% 诊断：脾切除术后膈下脓肿 处理：去甲万古霉素0.8BID ＋舒氨新3.75BID＋ 灭滴灵0.5 BID ，静脉滴注 效果：一周后，体温下降至正常，腹水消退，继续 抗感染治疗 一周，复查腹部CT，膈下脓肿消退， 好转出院 THANK YOU SUCCESS * * 可编辑 * short-term pyrexia :Main viral infection ,second bacterial infection ,third parasitic infection , infusion reaction and recent surgeries , Allergies long-term pyrexia :TB, local infection，chronic hepatitis, connective tissue disease( CTD),hyperthyroidism * *Cancer can cause fever in a variety of ways: 1.The tumor makes pyrogens, which cause a fever on their own. 2.Some tumors may become infected. 3.Tumors in the brain may prevent the hypothalamus from regulating the temperature. 4.Many of the medications that a cancer patient takes can cause a fever. 5.Finally, immune systems in cancer patients may be weakened, which makes them prone to various infections. * Two conditions : at one time shiver/chill :high fever after shiver/chill, and a shiver/chill occurs no more/no longer after fever. lobar pneumonia大叶性肺炎, Legionella pneumonia军团菌肺炎, infusion reaction repeat chills: fever after chill again and again. Such as sepsis, infective endocarditis , malaria, acute cholecystitis急性胆囊炎, acute pyelonephritis 急性肾盂肾炎, Lymphoma , Acute hemolysis 急性溶血 * 淋巴结、肝、脾进行性肿大 ——恶性组织细胞病与淋巴瘤 * Drug fever A fever that occurs after starting a new medication, without another source, may be a drug fever. Such as antibiotics, heart and seizure medications , excess aspirin and thyroid hormone , antihistamines, certain antidepressant medications, 1.An immediate fever may be caused by an allergic response to the medication or a preservative in the medica