| Objective: To analyze the clinical characteristics, theabnormal appearance of laboratory examination, the therapy ofmedicine and dialysis, the results of therapy of hospitalizedpatients with epidemic hemorrhagic fever (EHF) in the recent tenyears in one of the general hospitals of Tianjin. A conclusion couldbe made about clinical characteristics, diagnosis and treatment ofhospitalized cases with EHF. More information of the early diagnosisand reasonable treatment strategy would be provided.Method: We collected 120 hospitalized cases with EHF in therecent ten years (from January lst, 1996 to December 31st, 2005) inone of the general hospitals of Tianjin. Recorded the basicinformation, clinical manifestation, laboratory examination,treatment, therapeutic effect and turnover of the patients. Then,we analyzed these datas in a retrospective investigation.Result: (1) In the 120 cases of EHF, male 98, female 22, the ratiowas 4.45:1. The youngest onset was 18 years old and the oldest onsetwas 74 years old. The incidence of people between 20 to 49 years oldwas the highest and the ratio was 74.2％. In these cases, 22 caseswere people without regular job and the ratio was 18.3％. The nextwere 19 workers and 19 officers and the ratio was 15.8％.Then therewere 12 farmers and the ratio was 10.0％.Half of the patients inhabitedin the place where there weremurine. (2) There are invasions in everymonth all the year. Among these months the incidence of March andApril were the highest and the ratios were 18.3％and 20.8％. Accordingto annual statistics of the cases with EHF, the peak invasion yearwas 2000 to 2003 and the ratio was 74.2％.(3) In the 120 cases, therewere 57 cases by preliminary diagnosis in the out-patient deparment(OPD),and the ratio was 47.50％. The ratio of EHF preliminary diagnosised in the infection department was higher than the otherdepartments(x2=14.4634, P＜0.0001). The clinical manifestation ofthese patients were not very typical and they didn't have typicalfive-stage process. In the 120 cases, there were only 11 cases(9.17％)which had typical five-stage. The ratio of cases that didn't havelow blood pressure shock stage and oliguria stage was 57.50％. Themain clinical manifestation were fever, dermahemia, lumbago,headache and alimentary tract symptom, and their incidence were99.17％,51.67％,41.67％,36.67％and 38.33％. (4) The main abnormalappearance of laboratory examination were proteinuria, the step upof blood ALT and plate-reduction, and their incidence were 84.17％,81.67％,70.00％. The incidence of abnormal BUN, Cr were 50.00％,48.33％.In the midrage and serious cases, the incidence of proteinuria was100％. While among the mild cases, the incidence of proteinuria wasmuch lower than themidrageandseriouscases (X2=22.949, P=0.001).There were no significant differences at the step up of blood ALTand the reduction of PLT in all the cases(H=1.330, P=0.514 vs H=1.095,P=0.587) The shortest time of EHF antibody masculine detection wasthree days after invasion and the longest time was 25 days afterinvasion. The average time was 8.94±3.44 days. During all the typesof the cases, there were no significant differences at the time ofEHF antibody masculine detection (F=0.577, P=0.631). (5) Accordingto the direct signs of B-USE, the ratio of renomegaly was 28. 3％;the diffuse affection of renal parenchymawas 53.1％.In the undirectsigns, the ratio of enlarged spleen was 24.8％; seroperitoneum was13.3％; pleural effusion was 9.7％; dropsy of the capsule wall ofcholecyst was 6.2％; thickening of the capsule wall of cholecyst was4.4％; hepatauxe was 4.4％; cavitas pelvis fluidify was 2.7％. In themild cases, the incidence of direct sign was lower than the midrageand serious cases (P=0.000), and no significant difference between midrange and serius cases (P＞0.05). During our data, the incidenceof abnormal ECG was 32.2％and the highest incidence of sinusbradycardia was 13.9％.(6) All the patients in our group greatlyimproved their conditions through our positive and rational therapy.There were 24 cases (containing 5 midrange cases, 13 serious casesand 6 very serious cases) who suffered dialysis therapy. Among thecases whose renal function were damaged seriously, 7 cases (2midrange cases and5 serious cases) didn't suffer dialysis therapybecause renal failure, however, their conditions were also improved.Conclusion: In the recent ten years, the tendency of the annualincidence was low-high-low in general cases withEHF. The incidenceof young and prime man among all the EHF patients were the highestand the incidence was due to occupation, inhibit environment, etc.The invasion could happen each month of the year but Spring was thehighest. The patients usually didn't have typical clinicalmanifestation and didn't have typical five-stage process and therewere not typical three-pain symptoms and three-red signs. Fever,proteinuria, plate-reduction are the main clues in the earlydiagnosis of EHF. The ratio of EHF preliminary diagnosised in theinfection department of OPD is obviously higher than other.departments. There were no significant differences at the step upof blood ALT and the induction of PLT in the cases. The patients whohad renal functional lesion could be therapied through dialysis ornot and the turnovers had no significant difference. However, becausethe cases were not so many, we have to try further investigation inthe future to get a truly evaluation. |
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