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为了早期诊断早期治疗,提高治愈率,降低病死率,通过本组散发性病毒性脑炎18例的临床病例分析,参考有关文献,对本病早期拟诊标准问题进行初步的探讨。1 临床资料 本组病例均系根据《内科学》提出的诊断标准而初步确诊。性别与年龄:男8例,女10例,年龄最小16岁,是大63岁,以20～30岁者最多。18例均较急起病。有前驱症状者6例,均于病前1～2周有“上感”表现,如:发热、寒战、头痛、咽痛、周身不适,食欲不振等。有发热者10例,37.3～30.8℃不等。有精神障碍者11例,表现兴奋、躁动、语无化次或呆滞、被动、异常行为,或二便不能自理,还表现自知力、定向力、记忆力、计算力障碍。有意识障碍12例,有程度不等的模糊,嗜睡,昏迷。运动障碍:18例全部都有,但表现不同,如:半身肌力减低,半身肌张力增高或四肢肌张力增高,单支肌张力增高,癫痫表现,小脑性共济失调,肢体多动,单侧或双侧病理反射等。其它:头痛者5例,头痛伴呕吐3例,脑膜刺激征6例,去脑强直4例,去皮层状态1例。辅助检查:末稍血白细胞轻度增高3例,各12.0、14.0、15.0×10~(12)/L。脑脊液:颅内压增高4例;单独潘迪氏反应(+)3例,(±)1例;蛋白与细胞数均略增高5例,正常者5例。
In order to early diagnosis and early treatment to improve the cure rate and reduce mortality, clinical analysis of 18 cases of sporadic viral encephalitis in this group, with reference to the literature, the initial diagnosis of this disease standard preliminary study. 1 clinical data in this group of patients were based on the “medical” proposed diagnostic criteria and initially diagnosed. Sex and age: 8 males and 10 females, the youngest 16 years old, is 63 years old, with the most 20 to 30 years old. 18 cases were more acute onset. Prodromal symptoms in 6 cases, 1 to 2 weeks before the disease have “feeling” on the performance, such as: fever, chills, headache, sore throat, discomfort, loss of appetite and so on. There are 10 cases of fever, 37.3 ~ 30.8 ℃ range. There are 11 cases of mental disorders, the performance of excitement, restlessness, language without subtle or sluggish, passive, abnormal behavior, or two will not be able to take care of themselves, but also demonstrated insight, orientation, memory, calculation of handicap. 12 cases of disturbance of consciousness, varying degrees of fuzzy, lethargy, coma. Dyskinesia: All 18 patients had different manifestations, such as decreased biceps muscle strength, increased biceps tension, increased muscle tone in the extremities, increased tension in the single limbs, epilepsy, cerebellar ataxia, hyperactivity of the limbs, Side or bilateral pathological reflex. Other: 5 cases of headache, headache with vomiting in 3 cases, 6 cases of meningeal irritation, brain deformity in 4 cases, 1 case of cortical state. Auxiliary examination: mild increase in peripheral blood leukocytes in 3 cases, each 12.0,14.0,15.0 × 10 12 / L. Cerebrospinal fluid: increased intracranial pressure in 4 cases; Pandream’s reaction alone (+) in 3 cases, (±) in 1 case; protein and cell number were slightly elevated in 5 cases, normal in 5 cases.