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患者,男,5岁.因右足疼痛伴发热10余天,心慌、面色苍白3天入院.患者于入院前10余天无明显诱因出现右足跟剧痛及局部皮肤变黑、肿胀,伴持续性发热,曾在当地医院行右足跟骨脓肿切排术,经积极抗炎治疗病情无好转.拟诊“右跟骨骨髓炎”、“脓毒败血症”.患者既往体健,家族史无特殊.入院体检:T37.8℃,P146次/分,R40次/分,急性病容,皮肤粘膜未见出血点、皮疹及黄疸,浅表淋巴结无肿大.咽充血,双扁桃体肿大.颈软,颈静脉充盈,肝颈回流征(+).双肺呼吸音清晰,未闻及干湿罗音.心搏减弱,心界扩大,HR146次/分,律齐.心音遥远,心尖部可闻Ⅱ/6级收缩期杂音.腹平软,肝肋下4cm,质地较硬,脾不大,肠鸣正常.奇脉,右小腿肿胀,右外踝见5cm×4cm大小创面,深入关节腔,局部红肿,渗液较多.入院时辅助检查;外周血白细胞总数达26.0×10~9/L,分类正常,血沉78mm/h,2次血培养均为金黄色葡萄球菌生长;超声心动图可见心包腔内液性暗区,混杂
The patient, male, aged 5. Because of right foot pain with fever for more than 10 days, palpitation, pale 3 days admitted to the hospital.Patients in the hospital more than 10 days no obvious incentive to appear right heel pain and local skin darkening, swelling, with persistent fever, Had a right foot in the local hospital abscess incision of the right heel, after active anti-inflammatory treatment of the disease did not improve.Reasonable diagnosis of “right calcaneus osteomyelitis”, “septic sepsis.” Patients with previous health, family history no special. : T37.8 ℃, P146 times / min, R40 beats / min, acute disease, skin and mucous membrane no bleeding, rash and jaundice, superficial lymph nodes without swelling. Pharyngeal congestion, double tonsil enlargement. Neck soft, jugular vein Filling, hepatic neck reflux syndrome (+) .Life lung breath sounds clear, unheard of and wet and dry rales .Behavioral weakness, heart expansion, HR146 times / min, law Qi. Heart sounds far, the apex can be heard II / 6 Systolic murmur abdominal weak, liver ribs 4cm, texture hard, spleen not, bowel normal. Qi pulse, right lower leg swelling, see the right lateral malleolus 5cm × 4cm size wounds, deep into the joint cavity, local swelling, seepage Fluid more auxiliary examination at admission; the total number of peripheral blood leukocytes 26.0 × 10 ~ 9 / L, normal classification, ESR 78mm / h, two blood cultures were Staphylococcus aureus Length; echocardiography shows pericardial fluid areas, mixed