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2012伤寒副伤寒课件

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2012 伤寒 副伤寒 课件
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Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 伤寒及副伤寒伤寒及副伤寒 平阴县人民医院 熊泽香 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 发病机制 l两次菌血症 l全身单核—巨噬细胞系统的增生性反应 l内毒素的作用 l肠出血、肠穿孔 l Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 病理特点 l全身单核-巨噬细胞系统增生性反应 l病变部位:回肠下段 l病理变化: 第一周淋巴组织增生肿胀 第二周淋巴结坏死 第三周坏死组织脱落,形成溃疡 第四周后溃疡愈合 脾肿大、肝肿大 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 临床表现 ◆潜伏期:7~23日,一般为10~14日 ◆病程4-5周,可分四期 l初期 l极期 l缓解期 l恢复期 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 初期:病程第1周,起病缓慢、症状无 特异性,发热—阶梯形上升,可畏寒 、少寒战,有全身不适,酸痛,乏力 ,5-7天体温达到39-40度。 临床表现 临床表现 l极期:病程第2-3周、并发症多在本期出现 l发热:稽留热、持续发热 l消化道症状:纳差、腹部不适、便秘 l神经系统症状:与病情轻重密切相关 l循环系统症状:相对缓脉或重脉 l肝脾肿大:脾肿大较肝肿大更常见 l玫瑰疹:出现时间、部位、大小、数量、 色泽、分批出现 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 典型伤寒自然病程示意图 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. •缓解期:第四病周,体温呈弛张热, 逐渐下降,病情开始好转,患者消瘦虚弱 ,同时容易发生各种并发症。 临床表现 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 恢复期:4、5病周,细菌被消灭,症状 逐渐消失,组织逐步修复。1个月左右完全 恢复。 临床表现 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 不典型伤寒 轻 型:临床症状轻,典型症状少见,发热低, 病程短。 顿挫型:初期症状重,但病程短。 迁延型:症状轻,但病程可迁延数月。 消遥型:正常工作,因肠出血、肠穿孔而发现。 暴发型:骤发高热,神经系统、心血管系统中毒症状 重。可出现循环衰竭、昏迷、中毒性心肌炎 、 全身出血症状。可在1- 2周内死亡。 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 再燃和复发 l再燃(recrudescence):患者在缓解期时,体 温未稳定下降至正常,又再发热。 l复发(relapse):退热后1-3周,由于潜伏于病 灶中巨噬细胞内的病原体再度繁殖至一定程度 ,使初发病的症状再度出现。可多次复发,病 情一般较轻,病程短,并发症少。 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 并发症 complication l肠出血:多见于第二、三病周,消化道出血症 状,严重时可出现低血容量休克,体温骤降后 回升。腹泻者易发生。 l肠穿孔:右下腹痛,伴有恶心、呕吐、休克。 可有高热、腹膜炎症状。白细胞总数升高。 l中毒性肝炎:以ALT升高为主,黄疸1-3%,肝 功能异常程度与肝肿大程度无关。 l精神神经系统症状:感染性精神病、虚性脑膜 炎、神经根炎等。 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 并发症 complication l中毒性心肌炎:伤寒患者有心电图异常表现者 34-80%,儿童多表现为心动过速。 l支气管肺炎:发病率 1.5-12%,合并其它细菌 感染。 l肾炎:由于内毒素或免疫复合物引起的肾小球 肾炎。 l溶血-尿毒综合症:溶血性贫血,急性肾功能 衰竭。 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 一般检查 l血象:WBC↓ EC↓或消失 l尿液检查:轻度蛋白尿,偶见管型 l粪便检查:肠出血时有血便或潜血 试验阳性 l骨髓涂片:可查见伤寒细胞 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 细菌学检查 l血培养:确诊依据,第一周阳性率可达 90%,第三周降为30~40%,第四周时常 阴性。用含胆汁的培养基,已用抗生素 的患者可取血凝块做培养 l骨髓培养:阳性率高,用抗菌素后有效 l尿、粪便培养 l十二指肠引流液(胆汁)培养 l玫瑰疹的刮出物或活检切片培养 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 免疫学检查 ◆肥达反应:“O” “H” 肥达反应诊断 伤寒的价值是有限的 ◆其他免疫学检查: l被动血凝试验(PHA) l对流免疫电泳(CIE) l协同凝集试验(COA) l免疫荧光试验(IFT) l酶联免疫吸附试验(ELISA) Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 分子生物学诊断方法 lDNA探针(DNA probe):特异性 高、敏感性低,一般用于菌种鉴定 和分离。 l聚合酶链反应(PCR):具有高度 敏感性和特异性。易受产物污染。 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 一般治疗及护理 l卧床休息 l注意卫生 l保持大便通畅 l胃肠道隔离 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 注意要点 l高热者不宜药物降温 l便秘者禁用泻药 l腹泻者忌用止泻药 l腹胀者忌用胃肠动力药 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 抗菌治疗 l氟喹诺酮类药物,首选。孕妇、幼儿不宜用 l头孢菌素疗效好,但价格高 l氯霉素。可致再障 l磺胺类 复方新诺明(SMZ-TMP)耐药较多 l氨苄青霉素,羟氨苄青霉素。用于敏感菌株 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 主要并发症的治疗 l肠出血 l肠穿孔 l溶血尿毒综合症,按急性溶血和急 性肾衰处理。 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 慢性带菌者的治疗 l氧氟沙星、环丙沙星 l氨苄青霉素加丙磺舒 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 副伤寒特点 l包括副伤寒甲、乙、丙 l副伤寒甲、乙的症状与伤寒相似,但一般病情较 轻,病程较短,病死率较低。 l副伤寒丙的临床表现复杂、多变。可表现为轻型 伤寒,急性胃肠炎或脓毒血症 l副伤寒的流行病学、发病机制、诊断、治疗及预 防,基本与伤寒相同。 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 伤寒副伤寒的诊断 l带菌者 l无任何临床表现、从粪便中分离到伤寒 沙门菌或副伤寒沙门菌。 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 伤寒副伤寒的诊断 疑似病例 *有流行病学史+不明原因持续发热 *不明原因持续发热+特殊中毒面容(表情 淡漠、呆滞),相对缓脉,皮肤玫瑰疹 ,肝脾肿大中任何一项。 *不明原因持续发热+嗜酸性粒细胞减少或 消失、白细胞总数正常或低下 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 伤寒副伤寒的诊断 临床诊断病例 *不明原因持续发热,特殊中毒面容(表情 淡漠、呆滞),相对缓脉,皮肤玫瑰疹 ,肝脾肿大中任何一项+嗜酸性粒细胞减 少或消失、白细胞总数正常或低下 *不明原因持续发热,特殊中毒面容(表情 淡漠、呆滞),相对缓脉,皮肤玫瑰疹 ,肝脾肿大中任何一项+肥大反应阳性。 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B. 伤寒副伤寒的诊断 确诊病例 *不明原因持续发热+ 恢复期血清中特异性 抗体效价较急性期血清特异性抗体效价 增高4倍以上 *不明原因持续发热+血、骨髓、粪便、胆 汁中任一种标本分离到伤寒沙门菌或副 伤寒沙门菌 Set up safety production leading group and provide Party A with copies of job certificate, operation certificate and ID card of the responsible person on site, safety responsible person and all employees. Party B shall be responsible for the personal safety, construction equipment, living facilities, mechanical and electrical equipment and construction safety of Party B.
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