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陈某,男,2岁,于1990年5月22日凌晨4h出现畏寒、发热,体温39℃,13h发现下肢皮肤瘀点。15h患儿突然抽搐,约4min。立即去当地诊所就医,给予吸氧,肌注异丙嗪25mg来我院,门诊以暴发型流脑收住传染科。平素健康,否认过敏史。查体:体温39.5℃,脉搏细弱,呼吸急促。发育正常,营养中等,昏睡。面部、躯干、下肢见较密集的大小不等的暗紫色瘀点、瘀斑,压之不褪色。四肢末梢厥冷,指、趾发绀。眼神呆滞,两侧瞳孔等大等圆,对光反射迟钝。口唇发绀,颈强(±),心律180/min,律整,肺呼吸音正常。腹软,肝脾未触及。膝腱反射减弱,克氏征(-),布氏征(-),巴彬斯基征(-)。化验检查:血红细胞3.4×10~(12)/L,血红蛋白110g/L,白细胞总数4.3×10~9/L,其中分叶细胞0.43,杆状细胞0.03,淋巴细胞0.26,嗜酸粒细胞0.06,幼稚粒细胞0.22,血小板计数42×10~9/L,瘀
Chen, male, 2 years old, on April 22, 1990 morning 4h chills, fever, body temperature 39 ℃, 13h found lower extremity skin petechia. 15h children suddenly convulsions, about 4min. Immediately to the local clinic for medical treatment, given oxygen, intramuscular injection of promethazine 25mg to our hospital, outpatient department to catch the epidemic of infectious meningitis. Usually healthy, denied the history of allergies. Physical examination: body temperature 39.5 ℃, weak pulse, shortness of breath. Normal development, moderate nutrition, lethargy. Face, torso, lower extremities see more dense dark purple petechia, ecchymosis, the pressure of the fade. Extremities Jueleng, fingers, toes cyanosis. Glazed eyes, pupils on both sides of the other round, slow reflection of light. Lips cyanosis, neck strong (±), heart rate 180 / min, law, pulmonary breath sounds normal. Abdomen soft, liver and spleen not touched. Knee tendon reflex, Kirschner Sign (-), Brinell’s sign (-), Babinski sign (-). Laboratory tests: 3.4 × 10 12 / L hemoglobin, 110 g / L hemoglobin, 4.3 × 10 9 / L total leukocytes, 0.43 for leaf cells, 0.03 for rod cells, 0.26 for lymphocytes, and 0.06 for eosinophils , Immature granulocytes 0.22, platelet count 42 × 10 ~ 9 / L, stasis