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目前白喉仍是一种严重威胁儿童健康的急性传染病。在不同的流行中,病死率相差悬殊,低者在5%以下,高者竟达30%以上。除与致病菌的毒力、病人的年龄及病变的广泛程度有密切关系外,治疗的早迟和适当与否对预后亦极为重要。死亡的常见原因是窒息、支气管肺炎和心血管系统并发症。虽然合并有喉白喉的患者病死率较高,但自从医界掌握了喉插管术及气管切开术后,若非病情延误过迟,单纯因窒息而亡者已逐渐减少。对并发支气管肺炎者,因近代化学及抗菌药物的进展,在死因中的重要性亦趋下降。而在心血管并发症方面,尽管以往学者们在这方面已有不少成就,但至今临床工作者在对待此种病例的诊疗上仍感辣手。关于心血管障碍的发生率在各家报告中颇不一致,若用心电图检查,有心肌损害表现者达54%—57.8%,可见其发生率之高。若分析白喉死亡病案时,则死因为心血管并发症者占16%—64.4%不等,我院1960年白喉50例死亡病例中,29例为早期或晚期心血管障碍,亦高达58%,更可见此项并发症之严重性。故对此种并发病如何予以早期发现及恰当处理,乃成为提高本病治愈率之重要关键。本文仅就手边的文献结合在临床工作中对此类病人处理方面的点滴体会略作讨论,尚希同道多加批评指正。
At present, diphtheria is still an acute infectious disease that seriously threatens the health of children. Among different epidemics, the case fatality rate varies greatly, the lower is below 5% and the higher rate is above 30%. In addition to the virulence of pathogenic bacteria, the age of the patient and the extent of the lesion is closely related to the early and appropriate treatment is also very important prognosis. Common causes of death are asphyxia, bronchopneumonia and cardiovascular complications. Although patients with laryngeal diphtheria combined with a higher case fatality rate, but since the medical profession mastered laryngeal intubation and tracheotomy, if the delay is not delayed, simply because of asphyxia and death have been gradually reduced. For concurrent bronchial pneumonia, because of modern chemistry and the progress of antimicrobial drugs, the importance of the cause of death also tends to decline. However, in the field of cardiovascular complications, although scholars have made a lot of achievements in this respect, up to now, clinicians are still very hot at the treatment of such cases. About the incidence of cardiovascular disorders in various reports is quite inconsistent, if ECG, myocardial damage performance of 54% -57.8%, showing the high incidence. If the analysis of diphtheria death case, then the cause of death from cardiovascular complications accounted for 16% -64.4%, 50 cases of diphtheria in our hospital in 1960, 29 cases of early or advanced cardiovascular disorders, up to 58% Can even see the seriousness of this complication. Therefore, how to treat such complications early detection and proper treatment has become an important key to improve the cure rate of this disease. This article only on the merits of the literature at hand in clinical work on such patients bit by bit to deal with a little discussion, but Xi Xi more criticism correction.