一例恙虫病的诊治谈职业史在临床思维中的重要性  

The importance of occupational history in clinical thinking from the diagnosis and treatment of a case of Tsutsugamushi disease

作　　者：何文菊[1] 王东强[1,2] 张平平 付鹏亮[1] 李志军[1] He Wenju;Wang Dongqiang;Zhang Pingping;Fu Pengliang;Li Zhijun(Tianjin First Central Hospital,300192;Tianjin Medical University,300070)

机构地区：[1]天津市第一中心医院,300192 [2]天津医科大学,300070

出　　处：《中华劳动卫生职业病杂志》2019年第8期639-640,F0003,共3页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：天津市中医药重点领域(2017006);天津市中医药管理局一般项目(2017053);天津市卫生计生委科技基金重点项目(2015KR16);天津市卫生计生委中医中西医结合科研课题(2015044);天津市卫生行业重点攻关项目(13KG104);国家中医药管理局“十二五”重点专科建设项目(2012-2);王今达学术思想研究室项目(201208).

摘　　要：天津市某区1例农场工人因发热、间断咳喘3月余就诊,最终诊断为恙虫病并发多脏器功能损害;患者在发病早期因临床医师忽视职业史的询问及对恙虫病防治知识缺乏而延误诊断.职业史作为流行病学史的重要组成部分,对于职业病及工作相关疾病的诊断至关重要.临床思维贯穿临床诊断与疾病处理的全过程,正确的临床思维可有效减少误诊的发生.临床医师应详细询问并记录职业史,以提高诊疗质量.A farm worker in Baodi District of Tianjin was diagnosed with Tsutsugamushi disease due to fever and intermittent cough for more than 3 months.The patient's diagnosis and treatment process was complicated, and the diagnosis was delayed in the early stage of the disease because the clinician neglected the occupational history and lacked knowledge about the prevention and control of tsutsugamushi disease. As an important part of the epidemiological history, occupational history is crucial for the diagnosis of occupational related diseases. Clinical thinking runs through the whole process of clinical diagnosis and disease treatment, and correct clinical thinking can effectively reduce the occurrence of misdiagnosis.Clinicians should ask and record career history in detail to improve the quality of health care.

关 键 词：恙虫病 职业史 职业病 临床思维 

分 类 号：R135[医药卫生—劳动卫生]