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流行性腮腺炎 田金娜免费3天课件

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流行性腮腺炎流行性腮腺炎 田金娜田金娜 流行性腮腺炎田金娜
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 流行性腮腺炎 田金娜 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 【概述】 l l 感受腮腺炎时邪引起的一种急性传染病感受腮腺炎时邪引起的一种急性传染病 ;; l l 临床以发热、耳下腮部漫肿疼痛为主要临床以发热、耳下腮部漫肿疼痛为主要 特征特征 ;; l l 中医学称本病为中医学称本病为““痄腮痄腮””,,痄腮的病名 首见于金代,古代又称“虾蟆瘟”、“ 鸬鹚瘟”。 l l 本病传染性较强,一般预后良好本病传染性较强,一般预后良好 ,少数,少数 可出现邪陷心肝,毒窜睾腹;可出现邪陷心肝,毒窜睾腹; With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 现代医学认识 l本病是由腮腺炎病毒引起的急性呼吸道传染病,以腮 腺的非化脓性肿胀和疼痛为特征 ; l流行季节:一年四季都可发生,冬春两季易流行; l传染源:病人及隐性感染者; l传染途径:主要通过直接接触、飞沫、唾液污染食具 和玩具等途径传播; l发病年龄:好发于3~5岁的小儿,传染性强,容易在幼 儿园及低年级儿童中流行; l传染期:腮腺肿大前24小时至消肿后3天; l预后:本病预后良好,患病后可获终生免疫。但本病 易出现一些并发症,脑膜脑炎为儿童期最常见并发症 ,青春期男孩易并发睾丸炎,青春期后女性可并发卵 巢炎,合并胰腺炎者也较常见。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 病因病机 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 【病因病机】 l本病原因为感受腮腺 炎病毒; l病位在足少阳胆经和 足厥阴肝经。 l病机风温邪毒蕴结少 阳经脉,与气血相搏 ,凝滞于耳下腮部。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 常证 l1.邪犯少阳 风温邪毒从口鼻而人,首犯肺卫。肺卫失 宣,卫阳郁遏,故初起可见发热、恶寒、头痛 、咽痛等肺卫表证;邪毒入里,内犯少阳经脉 ,循经上攻,与气血相搏,结于耳下腮部,则 腮腺肿胀疼痛。 l2.热毒壅盛 若感邪较重,或素体虚弱,正不胜邪,邪从 火化。毒热炽盛,壅阻少阳经脉,气血凝滞, 则致腮部胀甚疼痛,坚硬拒按,张口咀嚼不便 ;热毒炽盛,则高热不退;邪热扰心,则烦躁 不安;热毒内扰脾胃,则致纳少,呕吐;热邪 伤津,则致口渴欲饮,尿少而黄。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 变证 l1.邪陷心肝 足少阳胆经与足厥阴肝经互为表里。热毒炽 盛者,邪盛正衰,邪陷厥阴,扰动肝风,蒙蔽 心包,可见高热、抽搐、昏迷等证,此为邪陷 心肝之变证。 l2.毒窜睾腹 足厥阴肝经循少腹络阴器,邪毒内传,引睾 窜腹,可见睾丸肿胀、疼痛,或少腹疼痛等证 ,此为毒窜睾腹之变证。 若邪毒循胸过肋,入脘腹,结阳明者,则可 出现上腹疼痛剧烈、恶心呕吐等证。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 【临床诊断】 1.诊断要点 (1)流行性腮腺炎流行期间,发病前2~3周有流行 性腮腺炎接触史。 (2)初病时可有发热、头痛、咽痛。腮腺肿大以耳 垂为中心,向前、后、下扩大,边缘不清,触之疼痛 ,有弹性感,皮色不变。常一侧先肿大,2~3天后对 侧亦出现肿大。腮腺管口红肿,或同时有颌下腺肿大 。 (3)可并发脑膜脑炎、睾丸炎、卵巢炎、胰腺炎等 。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society (4)血象检查 (5)血清和尿淀粉酶测定:血清及尿中淀粉 酶活性增高,与腮腺肿胀相平行,2周左右恢 复至正常。 (6)病原学检查:从患儿唾液、脑脊液、尿 或血中可分离出腮腺炎病毒。抗体包括抗V和S 抗体。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 2.鉴别诊断 (1)化脓性腮腺炎(发颐) l 腮腺肿大多为一侧;局部疼痛剧烈,拒 按,红肿灼热明显; l 成脓时局部有波动感,按压腮部可见口 腔内腮腺管口有脓液溢出; l 无传染性,常继发于猩红热、伤寒等细 菌感染性疾病之后; l血白细胞总数及中性粒细胞增高。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society (2)其他病毒性腮腺炎 l流感病毒、副流感病毒、巨细胞包涵体 病毒、艾滋病毒等都可引起腮腺肿大; l对再次发生腮腺炎的病例,应作抗体测 定,如为阴性,应考虑其他病毒引起的 腮腺炎; l可依据病毒分离加以鉴别。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society (3)急性淋巴结炎 l 耳前、颈部、颌下淋巴结炎,有时易与腮腺炎 、颌下腺炎相混淆; l 淋巴结发炎时,局部疼痛较重,肿胀的淋巴结 边缘清楚,质地较硬,不以耳垂为中心,局部红 肿灼热明显;表浅者活动良好,无传染性。 l 腮腺管口无红肿;常继发于急性扁桃体炎、急 性咽喉炎等疾病过程中,局限于颈部或耳前区; l 周围血象白细胞总数及中性粒细胞增高。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 【辨证论治】 1.辨证思路 l 本病辨证,以经络辨证为主,根据全身及局 部症状,以区别常证、变证; l常证以少阳经脉病变为主,有轻、重之别; l轻证属温毒在表,以轻微发热、恶寒、咽痛、 腮部肿胀略痛、触之不硬为特点; l重证因热毒炽盛,蕴结于内,故初起即见高热 烦躁、头痛呕吐、口渴引饮、腮部肿痛剧烈、 触之坚硬、张口困难等。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 变证 l病在少阳、厥阴两经; l临床表现除腮部肿痛外,属邪陷心肝者 ,伴见高热、神昏、项强、肢抽等;属 邪毒内窜睾腹者,则见睾丸肿痛,或脘 腹、少腹疼痛等。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 2. 治疗原则 l本病治疗总以清热解毒,软坚散结为基本法则 ; l轻证以疏风清热为主,重证以清热解毒为先; l无论轻证、重证,都应佐以软坚散结之品,以 期邪散毒解,壅滞疏通,肿消痛止之目的; l变证者,又当施以开窍熄风、清肝泻火、活血 通络等法。 l本病治疗在内服药物的同时,配合外治疗法, 有助于腮部肿胀的消退。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 3.证治分类 (1)常证 ①邪犯少阳 证候 轻微发热恶寒,一侧或两侧耳下腮 部漫肿疼痛,触之痛甚,咀嚼不便,或 有头痛、咽红疼痛、纳少,舌质红,苔 薄白或薄黄,脉浮数。 治法 疏风清热,散结消肿。 方药 柴胡葛根汤加减。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society l常用药:柴胡、黄芩清利少阳;牛蒡子、葛根 、桔梗疏风利咽;金银花、连翘清热解毒;板 蓝根专解温毒;夏枯草、赤芍疏肝散结;僵蚕 祛风通络消肿。 l 热甚加石膏清热;咽喉肿痛加马勃、玄参 、甘草清热利咽;纳少呕吐加竹茹、陈皮清热 和胃;发热恶寒加白芷、苏叶疏风解表;咳嗽 加前胡、浙贝母宣肺化痰止咳。 方药 柴胡葛根汤加减 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society ②热毒壅盛 证候 高热,一侧或两侧耳下腮部 漫肿胀痛,范围大,坚硬拒按,张口咀 嚼困难,或有烦躁不安,面赤唇红,口 渴欲饮,头痛呕吐,咽红肿痛,颌下肿 块胀痛,纳少,尿少而黄,大便秘结, 舌质红,舌苔黄,脉滑数。 治法 清热解毒,软坚散结。 方药 普济消毒饮加减。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society l常用药:柴胡、黄芩清利少阳;黄连、连翘、 升麻清热解毒;板蓝根、蒲公英专解温毒;牛 蒡子、马勃、桔梗、玄参、薄荷清热利咽,消 肿散结;夏枯草清热散结消肿;陈皮理气,疏 通壅滞;僵蚕解毒通络。 l 热甚者加生石膏、知母清热泻火;腮部肿 胀甚,坚硬拒按者加海藻、昆布、牡蛎软坚散 结,赤芍、丹皮凉血解毒,活血消肿;呕吐加 竹茹清热和胃止呕;大便秘结加大黄、玄明粉 通腑泄热;口渴唇燥伤阴者,重用玄参加天花 粉清热养阴生津。 方药 普济消毒饮加减 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society (2)变证 ①邪陷心肝 证候 高热不退,耳下腮部漫肿疼痛 ,坚硬拒按,头痛项强,烦躁,呕吐剧 烈,神昏嗜睡,反复抽搐,舌红,苔黄 ,脉弦数。 治法 清热解毒,熄风开窍。 方药 清瘟败毒饮加减。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society l常用药:栀子、黄连、连翘、板蓝根清热解毒 ;水牛角、生地、生石膏、丹皮、赤芍清热凉 营;竹叶、玄参、芦根清热生津;钩藤、全蝎 、僵蚕平肝熄风。 l 头痛剧烈者加用龙胆草、石决明清肝泻火 ;恶心呕吐甚者加竹茹、代赭石清热降逆止呕 ;神志昏迷者加服至宝丹清热镇惊开窍;抽搐 频作者加服紫雪丹解毒平肝熄风。 方药 清瘟败毒饮加减 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society ②毒窜睾腹 证候 腮部肿胀同时或腮肿渐消时 ,一侧或双侧睾丸肿胀疼痛,或脘腹疼 痛,少腹疼痛,痛时拒按,或伴发热、 呕吐,溲赤便结,舌红,苔黄,脉数。 治法 清肝泻火,活血止痛。 方药 龙胆泻肝汤加减。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society l常用药:龙胆草、栀子清泻肝胆实火;黄芩、 黄连、蒲公英清热解毒;柴胡、川楝子疏肝利 胆;荔枝核、延胡索理气散结止痛;桃仁、赤 芍活血消肿止痛。 l睾丸肿大明显者加青皮、莪术、皂刺理气活血 消肿;伴腹痛呕吐者加郁金、竹茹、半夏清肝 和胃止呕;少腹痛甚者加香附、木香、红花行 气活血止痛;伴腹胀便秘者加大黄、枳壳理气 通腑。 l若邪入胁胁肋脘腹,少阳、阳明同病,脘腹痛甚 ,胀满胀满 拒按,呕吐频频繁,大便秘结结者,选选用 大柴胡汤汤加减,外解少阳之热热,内泻阳明热热 结结。 方药 龙胆泻肝汤加减。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 【药物外治】 (1)如意金黄散、青黛散、紫金锭(即玉 枢丹)、玉露膏、大黄粉:任选1种,适 量,以醋或茶水调,外敷患处。1日1~2 次。用于腮部肿痛。已破溃者禁用。 (2)新鲜仙人掌:每次取1块,去刺,洗 净后捣泥或切成薄片,贴敷患处。1日2 次。用于腮部肿痛。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 【预预防与调护调护 】 l流行期间,易感儿应少去公共场所,以避免传染; l未曾患过本病的儿童可给予腮腺炎免疫r球蛋白,被动免 疫; l生后14个月可给予减毒腮腺炎活疫苗进行预防; l发发病期间应间应 隔离治疗疗,直至腮部肿胀肿胀 完全消退后3天为为 止,并发发睾丸炎者适当延长长卧床休息时间时间 ; l密切观察病情,及时发现并发症,并给予必要的处置。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 病案分析 l章某,男,12岁,腮部肿胀5~6日,今 稍有减轻,昨起小腹部胀痛不适,睾丸 疼痛,身有低热,精神疲乏,不思饮食 ,舌苔淡黄腻,舌质红,脉滑。 l就本例患儿写出中医病、证诊断,西医诊断,病机分析,提出治 法、主方,开出处方 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 谢谢 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 *28 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