• / 51
  • 下载费用:25 金币  

变应性鼻炎诊治指南(2007)及现状课件

关 键 词:
变应性鼻炎诊治指南及现状ppt 及现状ppt 变应性鼻炎诊治指南2007及现状 变应性鼻炎诊治指南2007及现状课件 变应性鼻炎诊治指南 变应性鼻炎治疗 变应性鼻炎诊疗现状
资源描述:
单击此处编辑母版标题样式 单击此处编辑母版副标题样式 * * 1 1 变应性鼻炎诊治指南(2007)及现状 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 变应性鼻炎流行率 n 近20年呼吸道变态反应性疾病 流行率急剧增加 n变应性鼻炎(AR)平均10-25% —— ARIA form WHO ,2001 n美国儿童患者 40% —— Karri J Clin Pediatr. 2006 n我国11个中心城市 12% —— 中华耳鼻咽喉头颈外科杂志 2007 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. n概念:Allergic rhinitis and its impact on asthma n1999年,WHO召开变应性鼻炎处理和预 防工作会议 nARIA 根据大量研究资料论述了变应性鼻 炎发病机理、诊断、治疗及其与哮喘关系 的进展 n出版ARIA手册,供医护人员使用 ARIA的制定 单击此处编辑母版标题样式 单击此处编辑母版副标题样式 * * 4 4 ARIA—变应性鼻炎治疗及对哮喘 的影响 WHO 2001 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ARIA指南的目的 n为医师和保健人员提供最新的临床研究总结 n更新对变应性鼻炎发病机制诊断治疗的认识 n重视上下呼吸道-变应性鼻炎对哮喘的影响 n提供关于变应性鼻炎诊疗方案的循证的文件 n提供关于变应性鼻炎阶梯式的治疗方案策略 n评估该疾病在发展中国家的严重性提供指南 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 2007年ARIA再次进行更新 n在2001年ARIA的基础上 ,在新的循证医学证据 基础上进行了更新 n力求在变应性鼻炎诊断 、治疗上给予临床医护 人员更多循证医学指导 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 流行病学 (ARIA 2007) n全球患病人口 5亿 n欧美 1亿以上 n亚太 1.5亿以上 n印巴及周边 1亿以上 n中南美洲 7.5千万以上 n非洲 3千万以上 n其他 5千万以上 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 变应性鼻炎是一种主要的慢性呼吸道疾病 n高发病率 n影响患者的生活质量 n影响患者的工作/学习效率 n经济负担 n与哮喘有关 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 变应性鼻炎病理机制 Th0 Th2 Th1 树突状细胞 变应原 B细胞 IgE 肥大细胞 嗜酸性粒细胞 骨髓 IL-5 IL-4 IL-4 IL-13 ICVAM-1 Eotaxin Rantes IL-5 YY Y Y Y Y YY INFγ 早发相反应 急性炎症 粘膜水肿 喷嚏 流涕 鼻塞 痒 组胺 白细胞三烯 激肽类 MBP ECP 晚发相反应 慢性炎症 粘膜暗红 鼻塞 粘性鼻涕 Y 骨髓反应 Th2炎症反应 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. Th2 B IL-4IL-4 变应原变应原 Naive Th IgEIgE IL-4IL-4 IL-5IL-5 释放释放 炎症介质炎症介质 毒性蛋白毒性蛋白 细胞因子细胞因子 释放炎症介质释放炎症介质 和细胞因子和细胞因子 Eo 变应性鼻炎免疫学机制 -以Th2反应为主的免疫性疾病 嗜酸性粒细胞嗜酸性粒细胞 肥大细胞和肥大细胞和 嗜碱性粒细胞嗜碱性粒细胞 速发反应速发反应 ((Early PhaseEarly Phase ReactionReaction)) 迟发反应迟发反应 ((Late PhaseLate Phase ReactionReaction)) 抗原提呈细胞抗原提呈细胞 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. n最低持续性炎症反 应(MPI) Canonica GW. Allergy Clin Immunol Int – J World Allergy Org, 18/4 (2006) n组织重塑 n重视无症状患者的 药物治疗 symptoms Inflammation Specific/nonspecific hyperreactivity Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 组织重塑的后果 n分泌物增多,增加感染机会 n成纤维细胞激活释放较多促炎细胞因子 n促进炎性细胞浸润 n粘膜纤维化,不可逆性病变 n上皮破坏,高反应性 n炎症慢性化,增加治疗难度 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 中重度 包括以下一条或多条 睡眠不正常 影响白天活动,运动,娱 乐 影响工作和上学 令人烦恼的症状 持续性 每周≥ 4天 和≥ 4 周 轻度 包括以下各项 睡眠正常 白天活动,运动,娱乐 不受影响 正常工作和上学 无令人烦恼的症状 间歇性 每周 4天 或 4周 ARIA 分类 针对未接受治疗的患者 Bousquet J, Van Cauwenberge P, Khaltaev N, et al, and World Health Organization. Allergic rhinitis and its impact on asthma.J Allergy Clin Immunol.2001;108:S147-334. Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 诊断(1)症状诊断 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 诊断(1)症状诊断 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 诊断(2) VAS-病情评 估 1 2 3 4 5 6 7 喷嚏 流涕 鼻塞 鼻痒 鼻后流涕 总体感觉 1. 无或仅有偶尔发作 3. 较轻,稳定,可耐受 5. 较重,难以耐受, 甚至影响场活动 7. 难以忍受,整天 都不能正常活动 1-3 轻度 5-7 中重度 AAAAI 2003 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 1 2 3 4 5 6 7 眼 痒 咽不适 耳部症状 慢性咳嗽 头 痛 心 情 1. 无或仅有偶尔发作 2. 3. 较轻,可耐受 4. 5. 较重,难以耐受, 甚至影响场活动 6. 7. 难以忍受,整天 都不能正常活动 1-3 轻度 5-7 中重度 AAAAI 2003 诊断(2) VAS-病情评估 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. n常规鼻镜——鼻甲 中隔 n鼻内镜——中鼻道 息肉 粘膜状态 n影像检查—— 鼻窦状态 必要时 n胸部——哮喘 呼吸科协诊 诊断(3)体格检查 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 诊断(4)——实验诊断 n变态反应试验诊断—— 特异性IgE YY Y Y Y Y 细胞结合型IgE血循环游离型IgE Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 综合诊断 n单一的阳性结果不能作为诊断依据 n总IgE水平无诊断价值 n特异性IgE结果需与病史、皮试结果相 结合 n变应原皮试仍是重要手段 n变应原试剂应使用标准化疫苗 n注意对下呼吸道的评估 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 噢唔 避免接触变应原 尽可能尽可能 药物治疗 安全 有效 容易采用 免疫治疗 有效 专家开处方 可能会改变疾病的自然过程 患者教育 经常推荐 费用费用 治疗策略 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 教育是治疗变应性鼻炎的重要措 施 n对变应性鼻炎做出诊断容易,但仍然有许多患者未被 诊断,通常是因为他们不认为变应性鼻炎是一种疾病 n对变应性鼻炎治疗应包括: –避免接触过敏原(如有可能) –药物治疗 –免疫治疗 –教育 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 循证基础上的治疗方案 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 变应性鼻炎诊治流程 轻度间歇性鼻炎 选择 (无先后顺序) - 口服或鼻用H1受 体拮抗剂 - 鼻用减充血剂(少 于10天并且1月内不 超过2次) - 口服减充血剂 (通 常不推荐用于儿童) 中重度间歇性鼻炎 轻度持续性鼻炎 选择 (无先后顺序) - 口服或鼻用H1受体拮抗剂 - 口服或鼻用H1受体拮抗剂+ 减充血剂 - 糖皮质激素喷鼻剂 - 色甘酸钠 2-4 周后复查 n无症状或几乎无症状,建议 继续治疗 - 糖皮质激素应减量使用(如减半) - 常年性过敏者,症状可复发需要长期治 疗 - 季节性过敏者,根据花粉季节需要短期治 疗(数周) 患者在抗组胺药或色甘酸钠治疗下有持 续性轻度症状,改为鼻内糖皮质激素 n中度到重度症状患 者,升级治疗 中重度持续性鼻炎 - 鼻用糖皮质激素作为一线治疗 - 如果鼻塞很明显: 可加用短期 (1-2周) 口服糖皮质激素, 或鼻 内使用减充血剂(少于10天) 2-4 周后再评估 n如症状改善,降级治 疗持续1月 n如果无效 - 如果主要是鼻塞,加倍使用鼻 内糖皮质激素 - 如果主要是喷嚏、痒、流涕, 加用抗组胺药 - 如果主要是流涕,加用异丙托 溴 - 口服抗组胺药和减充血剂 诊断变应性鼻炎 病史±皮肤点刺试验或血清特异性IgE 避免接触变 应原 间歇症状持续症状 选择 (无先后顺序):口服或眼用抗组胺药、眼用色甘酸钠、 生理盐水;在未作眼部检查 的情况下,不推荐使用眼用糖皮质激素以避免可能引起的严重的短期和长期的并发症 考虑特异性免疫治疗 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ARIA变应性鼻炎的阶梯治疗示意图 轻度 间歇性 轻度 持续性 中重度 间歇性 中重度 持续性 避免变应原和刺激物 免疫治疗 鼻内(少于10天)或口服减充血剂 局部色酮(局部抑制炎症细胞释放类药物) 鼻内皮质类固醇 口服或局部使用非镇静性 H1受体拮抗剂 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 轻度间歇性鼻炎 (不考虑结膜炎) 选择 (无先后顺序) - 口服或鼻用H1受体拮抗剂 - 鼻用减充血剂(少于10天并且1月内不超过2次) - 口服减充血剂 (通常不推荐用于儿童) Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 中重度间歇性鼻炎/轻度持续性鼻炎 (不考虑结膜炎) 选择 (无先后顺序) - 口服或鼻用H1受体拮抗剂 - 口服或鼻用H1受体拮抗剂 + 减充血剂 - 糖皮质激素喷鼻剂 - 色甘酸钠 - 肌肉和鼻内注射糖皮质激素通 常不推荐使用, 以避免严重的 反应 2-4 周后复查 § 无症状或几乎无症状,建议继续治疗 - 糖皮质激素应减量使用(如减半) - 常年性过敏者,症状可复发需要长期治疗 - 季节性过敏者,根据花粉季节需要短期治疗(数周) § 患者在抗组胺药或色甘酸钠治疗下有持 续性轻度症状,改为鼻内糖皮质激素 § 中度到重度症状患者,升级治疗 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. - 鼻内使用糖皮质激素应作为一线治疗 - 如果鼻塞很明显: 可加用短期(1-2周) 口服糖皮质激素 或鼻内使用减充血剂(少于10天) 2-4 周后对患者进行再评估 - 如果主要症状是鼻塞,加倍使用鼻内糖皮质激素 - 如果主要症状是喷嚏、痒、流涕, 加用抗组胺药 - 如果主要症状是流涕,加用异丙托溴铵 中重度持续性鼻炎 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 各种药物循证依据的推荐强度 不同治疗措施的推荐强度 干预措施 季节性 常年性 成人 儿童 成人 儿童 口服H1受体拮抗剂 A A A A 鼻用H1受体拮抗剂 A A A A 鼻用糖皮质激素 A A A A 鼻用色甘酸钠 A A A A 白三烯受体拮抗剂 A A 皮下注射特异性免疫治疗 A A A A 舌下/经鼻特异性免疫治疗 A A A 避免接触变应原 D D D D Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 鼻用糖皮质激素 ——最有效的治疗药物 n2007版指南中明确指出鼻用糖皮质激素 是治疗变应性鼻炎最有效的药物 n2001版中提出的“发展中国家应尽可能 制定一套有效和抵消费的特殊治疗方法 ”的推荐要点在新版指南中没有出现 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 为什么鼻内激素是治疗变应性鼻炎 的最有效治疗药物? Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 抗组胺药主要 作用于 组胺受体 非镇静性抗组胺药的作 用机制 *The precise mechanism through which these agents affect symptoms is not known. Meltzer. Allergy. 1997;52(suppl 36):33-40. 变应原暴露 Mast Cells Basophils T Lymphocytes Neutrophils Eosinophils Immune Response Cells Tryptase Prostaglandins 白三烯 Cytokines 鼻症状 喷嚏流涕鼻痒鼻塞 Chemokines Nasal Symptom Mediators 组胺 暴露于变应原触发 多种炎症介质的释放 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 糖皮制类固醇作用机制 基因途径:经典的皮质激素作用,即 改变促炎性基因的转录,生理上需要数小 时显现用。 非基因途径:血管效应是快速非基因 活性,增加血管收缩节奏,减少炎症组织 中血液过度灌注。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 糖皮质激素对呼吸道炎症的作用 基因性作用 非基因性 作用 抑制促炎相关基因的转录 抑制儿茶酚胺的分解 起效 慢 迅 速 作用靶点 血管新生 充血 减充血 渗出 炎细胞浸润 糖皮制类固醇作用机制 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 糖皮质激素的靶细胞 Barnes,PJ et al.:Am J Respir Crit Care Med Vol 157. pp S1–S53, 1998 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. Antihistamines act primarily on histamine receptor 鼻用喷鼻激素的作用机 制 *The precise mechanism through which these agents affect symptoms is not known. Meltzer. Allergy. 1997;52(suppl 36):33-40. 暴露于变应原触发 多种炎症介质的释放 鼻用喷鼻激素在变态反应 早期和整个过程中都抑制 炎症反应 变应原暴露变应原暴露 Mast Cells Basophils T Lymphocytes Neutrophils Eosinophils Immune Response Cells Tryptase Prostaglandins Leukotrienes Cytokin
展开阅读全文
  麦档网所有资源均是用户自行上传分享,仅供网友学习交流,未经上传用户书面授权,请勿作他用。
0条评论

还可以输入200字符

暂无评论,赶快抢占沙发吧。

关于本文
本文标题:变应性鼻炎诊治指南(2007)及现状课件
链接地址:https://www.maidoc.com/p-15669842.html
关于我们 - 网站声明 - 网站地图 - 资源地图 - 友情链接 - 网站客服 - 联系我们

[email protected] 2018-2020 maidoc.com版权所有  文库上传用户QQ群:3303921 

麦档网为“文档C2C模式”,即用户上传的文档所得金币直接给(下载)用户,本站只是中间服务平台,本站所有文档下载所得的金币归上传人(含作者)所有。
备案号:蜀ICP备17040478号-3  
川公网安备:51019002001290号 


收起
展开