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一、临床资料本组32例中男23例,女9例;年龄最小14岁,最大76岁。二、观察方法检查患者颈部有无抵抗、Kernig’s征、Babinski’s征、Oppenhelm’s征、Gordon’s征及踝阵挛。记录其出现的病型、病期及其持续时间,并观察肾功、尿蛋白、血小板等项目与神经系统体征变化的关系。逐日记录,直至病理反射消失为止。①神经系统的阳性体征:病理反射主要为锥体束系统改变,说明病理改变主要在大脑皮层。②病理反射持续存在时间:最短1天,最长29天,平均7.3天。③与病期的关系:出现神经系统阳性体征者以发热期为最高,少尿期次之,休克期更次,多尿期最少。④与病型的关系:各型病人均可出现神经系统症状与阳性病理反射,但以重型与危重型比例最高。⑤与尿蛋白、尿量及血中NPN高低的关系:神经系统的改变与肾功能损害程度有一定关系,尿蛋白增多,少尿严重及NPN高者,病理反射的阳性率亦相应增高。且少尿期血管渗出、出血多最严重,而大脑皮质充血、水肿、出血亦较多见,故神经系统体征阳性率亦高。⑥与血小板多少的关系:随血小板减少,神经系统阳性体征则相应升高。血小板在6万以下者,阳性率占68.75%。这可能与随血小板减少,大脑皮质的充血、出血倾向增加有关。⑦与代谢性酸中毒关系:出现代谢性酸中毒时,神经系体征阳性率较高,但与酸中毒轻重程度则无一定关系。因为约20%患者虽无代谢性酸中毒神经系统亦出现阳性体征。
First, clinical data The group of 32 patients, 23 males and 9 females; the youngest 14 years old, maximum 76 years old. Second, the observation method Check the patient’s neck with or without resistance, Kernig’s sign, Babinski’s sign, Oppenhelm’s sign, Gordon’s sign and ankle clonus. Record the appearance of the disease type, duration and duration, and observed renal function, urinary protein, platelet and other items and the relationship between changes in nervous system signs. Record daily until the pathological reflex disappears. ① positive signs of the nervous system: the main pathological reflex cone system changes, indicating pathological changes mainly in the cerebral cortex. ② pathological reflex persistence time: the shortest 1 day, the longest 29 days, an average of 7.3 days. ③ and the relationship between the duration of disease: positive signs of nervous system to the highest fever, oliguria second, shock more times, the least polyuria. ④ and the relationship between the type: various types of patients may have neurological symptoms and positive pathological reflex, but the highest proportion of heavy and dangerous type. ⑤ with urinary protein, urine volume and blood levels of NPN: changes in the nervous system and renal dysfunction have a certain relationship, increased urinary protein, oliguria serious and NPN were higher, the positive rate of pathological reflex also increased accordingly. And oliguria vascular exudation, the most serious bleeding, and cerebral cortical congestion, edema, bleeding is also more common, so the positive rate of nervous system signs are also high. ⑥ and the relationship between the number of platelets: With thrombocytopenia, the nervous system positive signs are increased accordingly. Platelets less than 60,000, the positive rate accounted for 68.75%. This may be associated with thrombocytopenia, congestion of the cerebral cortex, increased bleeding tendency. ⑦ relationship with metabolic acidosis: metabolic acidosis occurs, the positive rate of neurological signs higher, but the degree of acidosis and no relationship. Because about 20% of patients without metabolic acidosis also have positive signs of the nervous system.