对一家三级医院收治的发热和意识改变患者的临床病理评估

Mymensingh medical journal : MMJ Pub Date : 2024-10-01
M F H Hera, S Momtaj, M Rashid, M Asaduzzaman, M M Rana, M Fakruzzaman, M S Al Mozahid
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引用次数: 0

摘要

需要注意的是,精神状态改变本身并不是一种疾病,而是一种症状,其潜在诊断范围很广。但是,对有这种症状的病人进行有条理的评估往往能获得有用的信息,并能排除最坏的情况。在发烧后出现意识改变的情况下,快速评估患者的意识水平和潜在病因具有决定性意义。重点突出的病史和体格评估有助于区分结构性原因还是医学原因。不对称的神经系统检查结果,如瞳孔散大和固定、眼外肌运动障碍和不对称的运动检查结果,提示结构性病变导致的脑干功能障碍,而对称的神经系统检查结果通常提示内科疾病。最近的一项研究旨在确定急性和长期发热性疾病患者的不同病因特征、人口统计学模式和常见病因。这项横断面观察性研究于 2014 年 4 月至 2015 年 10 月在孟加拉国迈门辛医学院医院医学系进行。在研究期间,从住院病人中有目的(非概率)地挑选了符合研究纳入和排除标准的住院病人。共对 100 例符合排除和纳入标准的发热和意识改变病例进行了检查和调查,以找出实际病因。在 100 名患者中,观察到 26(26.0%)名患者患有肺炎,22(22.0%)名患者患有尿路感染,18(18.0%)名患者患有脑膜炎,14(14.0%)名患者患有伤寒,8(8.0%)名患者患有脑膜脑炎,6(6.0%)名患者患有脑疟疾,4(4.0%)名患者患有肺结核,2(2.0%)名患者患有肺结核瘤。结果显示,大量发热和意识改变的患者患有肺炎和尿路感染。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinicopathological Evaluation of the Patients with Febrile Illness and Altered Consciousness Admitted in a Tertiary Level Hospital.

This is important to note that altered mental status is not a disease in itself, but rather a symptom with a wide range of potential diagnoses. But a structured approach to assessing the patients with this symptom frequently leads to helpful information and can rule out worst-case scenarios. In cases where fever is followed by changes in consciousness, quick assessment of the patient's level of consciousness and potential causes is decisive. A focused history and physical assessment can help differentiate between structural or medical causes. Asymmetrical neurological findings, such as a dilated and fixed pupil, dysconjugated extraocular movements and asymmetrical motor findings, suggest brainstem dysfunction due to a structural lesion, while symmetrical neurological findings usually indicate a medical disorder. A recent study aimed to identify features of different etiologies, demographic patterns, and common causes of both acute and prolonged febrile illness in patients. This cross-sectional type of observational study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Bangladesh from April 2014 to October 2015. Over the study period patients admitted with satisfying the inclusion and exclusion criteria of study and purposively selected (non-probability) from the hospitalized patients. Total 100 cases with febrile illness and altered consciousness meeting the exclusion and inclusion criteria were examined and investigated to find out the actual etiology. Out of 100 patients, it was observed that 26(26.0%) of patients were suffering from pneumonia, 22(22.0%) urinary tract infection, 18(18.0%) meningitis, 14(14.0%) typhoid fever, 8(8.0%) meningo-encephalitis, 6(6.0%) cerebral malaria, 4(4.0%) tuberculosis and 2(2.0%) from tuberculoma. The result revealed that large number of patients with febrile illness and altered consciousness were suffering from pneumonia and urinary tract infection.

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