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[结核病的诊断与病程,尤其从临床不明死因的角度来看]

[Diagnosis and course of tuberculosis especially from the viewpoint of clinically unknown deaths].

作者信息

Werner E

出版信息

Z Gesamte Inn Med. 1985 Oct 1;40(19):576-82.

PMID:4072312
Abstract

Every time the tuberculosis is present and it is to be included in the differentialdiagnosis if the occasion arrises. In the anamnesis it is necessary to pay attention to specific diseases and the risk groups like patients with "21-day-cough", silicotics, "Contrast-articularis bronchitics", diabetics, so-called "persons with fibrotic lesions" and patients with frequent influenzal infections. The symptoms unclear gastric distress, want of appetite, indifferent loss in weight, uneasiness, slight vertigo and fast tiredness already give further references. Breath-pain, haemoptysis and subfebrile temperatures are already severe symptoms. A thorax X ray-photograph, tuberculin test, heamogram, sedimentation test and intensive search for mycobacteria, belong to the diagnosis. In extrapulmonary foci the search for mycobacteria is to try by swab, puncture, control of urine and menstrual blood. It is possible, that a histologic corroboration will be necessary. Unclear fever, headache and vomiting with or without dyspnoea, cyanosis and diaphragmatic lowness indicate a ocular reflection, liver biopsy and, in special case, a lumbar puncture without delay. Sooner or later the course of an unrecognized phthisis can result in death. It is necessary to fill up the gap between welltime diagnosis and death by unknown tuberculosis. That means: Thorough knowledge of matter, insight into the disease-course and inducement of all necessary diagnostic possibilities.

摘要

每当存在结核病时,如果情况出现,它都应被纳入鉴别诊断。在病史中,有必要关注特定疾病和风险群体,如患有“21天咳嗽”的患者、矽肺患者、“对比性关节炎支气管炎患者”、糖尿病患者、所谓的“纤维化病变者”以及频繁发生流感感染的患者。胃部不适、食欲不振、不明原因的体重减轻、不安、轻微眩晕和快速疲劳等症状已经提供了进一步的线索。呼吸疼痛、咯血和低热已经是严重症状。胸部X光照片、结核菌素试验、血常规、血沉试验以及对分枝杆菌的深入查找,都属于诊断手段。在肺外病灶中,通过拭子、穿刺、尿液和经血检查来查找分枝杆菌。可能需要进行组织学证实。不明原因的发热、头痛和呕吐,伴有或不伴有呼吸困难、发绀和膈肌降低,提示应立即进行眼部检查、肝脏活检,特殊情况下还应进行腰椎穿刺。未被识别的肺结核病程迟早可能导致死亡。有必要填补及时诊断与因不明结核病导致死亡之间的差距。这意味着:对病情有透彻了解,洞察疾病进程,并采用所有必要的诊断方法。

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