1例三期重叠肾综合征出血热救治体会  

Rescue experience in treatment of one patient with hemorrhagic fever and renal syndrome presenting 3-phase overlapping clinical manifestations

作　　者：袁伟伟[1] 惠智艳[1] 贺芬[1] 郑艳妮[1] 陈延平[2] 沙海旺[1] Yuan Weiwei;Hui Zhiyan;He Fen;Zheng Yanni;Chen Yanping;Sha Haiwang(Department of Intensive Care Medicine,Affiliated Hospital of Yan'an University,Yan'an 716000,Shaanxi,China;Department of Infection,Affiliated Hospital of Yan'an University,Yan'an 716000,Shaanxi,China)

机构地区：[1]延安大学附属医院重症医学科,陕西延安716000 [2]延安大学附属医院感染病科,陕西延安716000

出　　处：《中国中西医结合急救杂志》2021年第4期485-487,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：肾综合征出血热(HFRS)是由汉坦病毒属中各型病毒引起的一种自然疫源性疾病,宿主动物和传染源主要是小型啮齿动物(包括野鼠及家鼠等)。典型HFRS患者通常经历发热期、低血压休克期、少尿期、多尿期和恢复期5期过程,机体肾脏容易发生损害。延安大学附属医院2019年5月18日收治1例HFRS三期重叠患者,以“发热、头痛3d,乏力、嗜睡1”之代诉入院。该患者潜伏期约2周,早期表现类似上呼吸道感染症状,出现发热、低血压休克、无尿三期重叠、并发意识障碍、弥散性血管内凝血(DIC)等多器官功能衰竭。按照脓毒性休克的液体复苏策略予以治疗。突破HFRS少尿期“量出为入”的观念。同时注重早期液体复苏治疗。经过积极救治,患者休克期持续约48h,昏迷和无尿持续2周后,意识逐渐清醒,尿量逐渐恢复,病情危重程度下降,器官功能衰竭得以纠正。Hemorrhagic fever with renal syndrome(HFRS)is a natural forus disease caused by various lyprs of hanlavins.The host animals and infeetious soures are mainly small modents(ineluding wild mice and house mice).The lypical HFRS patients usually go through 5 phases.such as fever.hypotension shock.oliguria.polyuria and rerovery.and their kidnrys ar prone to damagr.0n May 18.2019.a patient with above trrephase overlap of HFRS symptoms and signs was admited to the Afiliaterd Hospital of Yan'an Lniversily and complained by other person of"fever.headache for 3 days.fatigue and sleepiness for 1 day".The incubation period of the patient was aboul 2 weeks.The early manifrslations were similar to upper respiratory tract infertion,w ith overlapping three phases of fever,hyptension shork and anuria.complicated with mulhiple organ failure such a disturhance of consciousness and disseminated intravasrular coagulation(DIC).According to the fluid resuseitation strategy of septie shock.the concept of"measuring oul for entering"in the oligurie slage of HFRS was broken through.and the early fluid resuscitation Ireatment was paid attention to.After aetive resrue and treatment,the shock period lasted for aboul 48 hours.Afer coma and anuria lasted for 2 werks.the patien's consciousness gradually woke up.the urine volume was gradually recovered,the eritical degree of the disraser deraserd.and the organ failur was corrcted.

关 键 词：肾综合征出血热 危重型 三期重叠 救治体会 

分 类 号：R51[医药卫生—内科学]