| Night SweatsMark Bajorek | 盜汗馬克.巴杰瑞克 |
| Night sweats are drenching sweats that require a change of bedding. | 盜汗為淋透性出汗，需換床單。 |
| I. Approach. The first priority is to exclude night sweats caused by fever. Sweating associated with fever is a separate evaluation. Before the 20th century, night sweats implied infection with tuberculosis. Now, many other ailments are associated with this symptom. Night sweats are often the mark of a known condition such as diabetes （especially with nocturnal hypoglycemia）, cancer, head trauma, and rheumatologic disorders. Night sweats can also be a symptom of a new disorder. The investigation of a patient reporting night sweats requires a review of past illnesses and new symptoms. | I. 診斷。首先要排除發(fā)燒引起的出汗。發(fā)燒性出汗應(yīng)另行診斷。20世紀前，盜汗通常提示有結(jié)核菌感染?，F(xiàn)在，其他很多不適都與此癥狀相關(guān)。盜汗通常是某已知病癥的標志，如糖尿?。ㄌ貏e是伴夜間低血糖者）、癌癥、頭外傷和各種風(fēng)濕病。盜汗也可能是新的疾病的一種癥狀，在給盜汗報告病人進行檢查時，需檢查既往病史及新的癥狀。 |
| II. History. Night sweats can be characterized by determining onset, frequency, exacerbations, and remissions of symptoms. Question patients about the current state of known disorders. Excessive sweating is associated with poor nocturnal glycemic control. Flares of rheumatologic disorders （rheumatoid arthritis, lupus, juvenile rheumatoid arthritis, and temporal arteritis） cause sweating too. Pregnancy temporarily changes the intrinsic thermostat in many women who perspire excessively. Patients who are immuno-compromised are at increased risk for infections, especially with atypical agents. Patients with a history of substance abuse need to be asked about needle use and contaminants. | II. 病史。盜汗可通過確認發(fā)作時間、次數(shù)、加劇及癥狀消退加以確定。詢問病人已知疾病。多汗也與夜間血糖控制不良有關(guān)。風(fēng)濕性疾?。ㄈ珙愶L(fēng)濕關(guān)節(jié)炎、狼瘡、幼兒性類風(fēng)濕性關(guān)節(jié)炎、顳關(guān)節(jié)炎等）也導(dǎo)致出汗，婦娠也會暫時的改變很多婦女的體溫狀況，導(dǎo)致出汗過多。免疫代償病人感染風(fēng)險增加，特別是非典型性病原體感染。有藥物濫用史病人需詢問其針頭使用及其他接觸狀況。 |
| A. Review of systems. Other symptoms that can accompany night sweats include flushing （carcinoid syndrome, pheochromocytoma）, joint pain, sleep apnea, menstrual irregularities, reflux, cough, headache, dysuria, dyspnea, rashes, fatigue, palpitations, and weight and bowel habit changes. | A. 系統(tǒng)檢查。伴隨盜汗的其他癥狀包括潮紅（類癌綜合癥、嗜鉻細胞瘤）、關(guān)節(jié)痛、睡眠性呼吸暫停、月經(jīng)不調(diào)、反流、咳嗽、頭痛、排尿困難、睡眠困難、皮疹、疲乏、心悸及體重與排便習(xí)慣改變。 |
| B. Exposure factors. Inquire about recent immunizations or new medicines such as antidepressants, cholinergics, meperidine, estrogen inhibitors, gonadotropin inhibitors, niacin, steroids, stimulants, over-the-counter preparations, antipyretics, and naturopathic therapies. Question patients about exposure to sexually transmitted diseases （STDs）, human immuno-deficiency virus （HIV）, hepatitis, tuberculosis, or occupational and travel-related exposures. Also ask about increases in general changes in the ambient night temperature. | B. 暴露因素。詢問最近免疫及新藥使用情況，如抗抑郁劑、膽堿能藥、哌替定、雌激素抑制劑、促性腺激素抑制劑、煙酸、類固醇、興奮劑、非處方制劑、解熱劑和自然療法。詢問病人有無接觸性傳染?。⊿TD）、HIV、肝炎、結(jié)核病，有否職業(yè)性及旅游相關(guān)性接觸。也應(yīng)詢問周圍夜間體溫總體變化增多情況。 |
| C. Psychological factors. Anxiety, nightmares, and psychoactive preparations can precipitate night sweats in healthy individuals. | C. 精神因素。焦慮、噩夢及興奮劑可導(dǎo)致健康個體盜汗。 |
| D. Family history. Patients who report a family history of hereditary disorders and possible malignancies should have appropriate screening. | D. 家庭史。有遺傳疾病及可能的惡性腫瘤家庭史病人應(yīng)進行適當?shù)暮Y檢。 |
| III. Physical examination. The physical examination should address the pertinent positives noted in the patient's medical history. Note the patient's weight and temperature. Examination of the head, eyes, ears, nose, and throat （HEENT） should focus on common types of infection: sinusitis, pharyngitis, and otitis. A thorough examination of lymph nodes is helpful to identify infection or lymphatic abnormalities. The cardiopulmonary examination can also signal infection, valvular disease, and stimulant use. Patients should be examined for abscesses, skin ulcers, septic joints, phlebitis, and osteomyelitis. | III. 身體檢查。身體檢查應(yīng)針對病人醫(yī)療史中的相關(guān)陽性記錄。注意病人體重體溫。頭、眼、耳、鼻及喉檢查的重點是普通類型的感染：鼻竇炎、喉炎和耳炎。淋巴結(jié)徹底檢查有助于確認感染及淋巴病變。心肺檢查也可提示感染、辨膜疾病及興奮劑使用情況。應(yīng)檢查病人是否有膿腫、皮膚潰瘍、關(guān)節(jié)膿腫、靜膜炎和骨髓炎。 |
| IV. Testing | IV. 檢驗。 |
| A. Clinical laboratory testing. For patients with a known condition, testing for exacerbations is appropriate: erythrocyte sedimentation rate （infection, osteomyelitis, and temporal arteritis）, C-reactive protein （rheumatologic disorders）, and hemoglobin AiC （diabetes mellitus）. Depending on the patient's symptoms or exposures, other appropriate tests can include purified protein derivative skin test for tuberculosis, free T4 level to rule out thyrotoxicosis, complete blood count with differential （infection）, and follicle-stimulating hormone to investigate the possibility of menopause. Special tests may be required of patients with travel-related or STD exposures. | A. 臨床實驗室檢查。對有已知病癥病人，應(yīng)檢測病癥是否加?。貉粒ǜ腥?、骨髓炎和顳關(guān)節(jié)炎）、C反應(yīng)蛋白（風(fēng)濕性疾?。┖脱t蛋白AIC（糖尿?。?。根據(jù)病人癥狀及暴露情況決定是否進行其他檢查，包括結(jié)合病純蛋白衍生物皮膚測試、排除甲狀腺機能亢進的游離T4水平檢驗、全血計數(shù)及分類（感染）、促卵泡激素檢查停經(jīng)可能性。有旅游相關(guān)及STD接觸病人可能需要進行特種檢驗。 |
| B. Imaging. Chest x-ray studies are useful in the evaluation of night sweats in patients with a smoking history, industrial exposure, or a cough. These patients need to be screened for occult malignancy. Computed tomography scans are generally not appropriate unless other signs or symptoms dictate further evaluation. | B. 影像檢查。胸部X線檢查對評估有下列情況病人的盜汗很有用：吸煙史、工業(yè)性接觸或咳嗽。這些病人需要進行潛在惡性腫瘤篩檢。CT掃描通常并不合適，除非其他癥狀或體征提示要作進一步檢查。 |
| V. Diagnostic assessment. Night sweating as a single entity is not worrisome. | V. 診斷評估。盜汗作為單一征狀并不令人擔(dān)心。 |
| Explore the likelihood of exacerbation of known conditions or the onset of a new disease process. The history is the most helpful part of the patient encounter. A new medication, with perspiration as a side effect, is the culprit. Patients may need cessation of the medication as well as a washout period. Night sweats might be an early symptom of a developing illness so watchful waiting is useful. Patients need to be instructed to watch for weight changes, fevers, and sleep and mood changes. Patients can complete a symptom diary, which is very helpful to the clinician in determining the need for additional evaluation. Consider illnesses that tend to be present in the patient's age group. Screening for common malignancies through mammograms, pap smears, and fecal occult blood testing is appropriate health maintenance as well as often being a part of the evaluation of the presenting complaint of night sweats. | 檢查已知疾病加劇可能性或所得疾病過程的發(fā)作情況。病史在病人疾病中最有幫助。有出汗副作用的新藥常常是盜汗的魁首。病人可能需要停藥及給予一段藥物清除時間。盜汗也可能是某種疾病發(fā)展的早期癥狀，因此觀察等待是有用的。應(yīng)指導(dǎo)病人留意體重變化、發(fā)燒及睡眠和情緒變化。病人可填寫一份癥狀日誌，它對臨床醫(yī)師確定是否作進一步檢查很有幫助?？紤]該病人年齡組常見的疾病。通過乳房X線、巴氏涂片及糞便潛血試驗篩檢常見惡性腫瘤，既適于健康維持，也是當前盜汗主訴檢查的內(nèi)容之一。 |
掃一掃立即下載
