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聚会散场以后
After the Party’s Over


James N. George ... 其他 • 2017.01.05
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• 奎宁长期暴露与死亡率

在杂志的这一部分,某真实患者的信息按阶段(粗体)呈现给一名临床专家,后者对这些信息做出回应并和读者分享他的推理(普通字体)。作者随后做出评论。


2009年秋季,一名35岁女性参加了一场办公室的晚间聚会,聚会散场后开车回家途中突发寒战、肌痛、恶心和腹部绞痛。她之前的健康状况良好。当晚出现高热(体温38.9℃[102℉])、不带血的剧烈腹泻、频繁呕吐以及腹痛和腰背痛。她第2日上午到医院急诊科就诊时,看起来病得不太严重。当时的体温是37.6℃(99.6℉),血压是153/51 mmHg,心率是每分钟67次。除腹部和背部有轻度压痛之外,体检结果正常。血液检查结果包括血红蛋白水平13.8 g/dL,白细胞计数18,400/mm3(其中中性粒细胞63%、杆状核中性粒细胞27%),此外血小板计数132,000/mm3。尿液样本无法采集。为检测常规病原体,医师培养了粪便样本。推测的诊断结果为病毒性胃肠炎。医师给患者静脉补液并使用昂丹司琼,并且叮嘱患者在3~5日内至其初级保健医师处就诊。

急诊科医师没有引起警觉。患者的症状都是常见的非特异性症状,而且病毒性胃肠炎也是常见病。然而,鉴于患者有腹痛、发热、白细胞增多伴大量杆状核中性粒细胞,以及血小板计数略微偏低,因此如果是我,还会同时考虑患者可能有胆囊炎、胆管炎或胰腺炎等更严重的病况。





作者信息

James N. George, M.D., Jordan M. Morton, M.D., Nathan W. Liles, M.D., M.P.H., and Carla M. Nester, M.D.
From the Hematology–Oncology Section, Department of Medicine, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City (J.N.G., J.M.M., N.W.L.); and the Stead Family Department of Pediatrics and the Department of Internal Medicine, University of Iowa, Iowa City (C.M.N.). Address reprint requests to Dr. George at the Departments of Internal Medicine and Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, P.O. Box 26901, Oklahoma City, OK 73126-0901, or at james-george@ouhsc.edu.

 

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