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神经肌肉接头和肌肉疾病课件_2

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神经 肌肉 接头 疾病 课件 _2
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As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 重重 症症 肌肌 无无 力力 Myasthenia GravisMyasthenia Gravis As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis 重重 点点 临床表现临床表现 诊断诊断 治疗治疗 危象的抢救危象的抢救 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 重症肌无力是重症肌无力是 AChR AbAChR Ab介导的 介导的 细胞免疫依赖的细胞免疫依赖的 及补体参与的及补体参与的 主要累及神经主要累及神经 肌肉接头突触后膜的肌肉接头突触后膜的 自身免疫性疾病 自身免疫性疾病 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 临床特征临床特征 起病隐袭起病隐袭 症状波动症状波动 缓慢进展缓慢进展 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 药物 感染 精神创伤 过度疲劳药物 感染 精神创伤 过度疲劳 月经 妊娠 分娩 外伤 饮酒 月经 妊娠 分娩 外伤 饮酒 手术等 手术等 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis 发病诱因或加重因素 发病诱因或加重因素 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis 大多起病隐袭大多起病隐袭 首发症状多为眼外肌受累 尤其是首发症状多为眼外肌受累 尤其是 儿童儿童 眼外肌眼外肌83 483 4 肢体肢体 8 4 8 4 咽喉肌咽喉肌 7 2 7 2 面肌面肌 0 8 0 8 危象危象 0 1 0 1 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis OssermanOsserman 分型分型 19 19岁岁岁岁20 20 3939岁岁岁岁 40 40 5959岁岁岁岁 60 60 岁岁岁岁合合计计计计 80 280 2 27 227 2 18 918 9 24 624 6 60 160 1 A A 9 3 9 3 21 121 1 24 624 6 24 624 6 14 014 0 B B 6 8 6 8 30 730 7 33 833 8 33 833 8 15 815 8 1 4 1 4 7 8 7 8 7 6 7 6 3 1 3 1 3 8 3 8 2 2 2 2 12 512 5 12 812 8 13 813 8 5 9 5 9 0 1 0 1 0 6 0 6 0 4 0 4 0 0 0 3 0 3 同济医院同济医院23852385例例MGMG患者临床资料回顾性分析患者临床资料回顾性分析 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 主要临床特征是受累肌肉呈病态疲劳主要临床特征是受累肌肉呈病态疲劳 活动后加重 休息后减轻活动后加重 休息后减轻 晨轻暮重晨轻暮重 疲劳试验有助于确诊疲劳试验有助于确诊 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 右上睑下垂右上睑下垂 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 右眼球外展运动受限右眼球外展运动受限 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 患者延髓支配肌肉和呼吸肌患者延髓支配肌肉和呼吸肌 严重无力 以致不能维持严重无力 以致不能维持换气换气功功 能即为能即为危象危象 危象是重症肌无力最常见的危象是重症肌无力最常见的 死亡原因 死亡原因 感染是诱发危象的常见原因感染是诱发危象的常见原因 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 辅助检查辅助检查 抗胆碱脂酶药物试验抗胆碱脂酶药物试验 疲劳试验 疲劳试验 JollyJolly试验 试验 电生理检查可见特征性异常 电生理检查可见特征性异常 AChRAChR AbAb阳性率阳性率8585 9090 胸腺影像学可发现胸腺异常 胸腺影像学可发现胸腺异常 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 抗胆碱脂酶药物试验抗胆碱脂酶药物试验 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 抗胆碱脂酶药物抗胆碱脂酶药物 注意观察毒蕈碱副作用 心动过缓注意观察毒蕈碱副作用 心动过缓 瞳孔缩小 出汗增多 唾液增多 腹 瞳孔缩小 出汗增多 唾液增多 腹 痛 腹泻等 痛 腹泻等 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis 治治 疗疗 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 病因治疗 病因治疗 肾上腺皮质类固醇类肾上腺皮质类固醇类 免疫抑制剂免疫抑制剂 血浆置换血浆置换 免疫球蛋白免疫球蛋白 胸腺切除胸腺切除 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis 治治 疗疗 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis 泼尼松泼尼松中剂量冲击 小剂量维持中剂量冲击 小剂量维持口服疗法 口服疗法 成人成人60mg 60mg 天 儿童天 儿童1 1 5mg kg d1 1 5mg kg d 分 分3 3 次口服或顿服 连服次口服或顿服 连服1 1周周 再再40 mg 40 mg 天天 连服连服1 1 2 2 周周 再再30 mg 30 mg 天天 连服连服1 1 2 2周周 症状明显改善后逐症状明显改善后逐 渐减量 速度约渐减量 速度约5mg 5mg 月 至月 至5 5 10mg 10mg 天 维持天 维持 至少至少1 1年 儿童维持量为年 儿童维持量为2 52 5 5mg 5mg 天 天 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 危象的处理 危象的处理 警惕危象的发生 警惕危象的发生 识别危象的类型 识别危象的类型 针对不同类型进行治疗针对不同类型进行治疗 重症肌无力重症肌无力 Myasthenia GravisMyasthenia Gravis 治治 疗疗 肌无力危象 最常见 肌无力危象 最常见 9090 以上 以上 胆碱能危象胆碱能危象 反拗危象反拗危象 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 周期性瘫痪周期性瘫痪 Periodic ParalysisPeriodic Paralysis As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 低钾型周期性瘫痪的低钾型周期性瘫痪的 临床表现 诊断及治疗 临床表现 诊断及治疗 周期性瘫痪周期性瘫痪 Periodic ParalysisPeriodic Paralysis 重重 点点 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 周期性瘫痪周期性瘫痪是以是以反复发作性反复发作性的突的突 发的发的骨骼肌弛缓性瘫痪骨骼肌弛缓性瘫痪为特征的一组疾病为特征的一组疾病 发病时大多伴有 发病时大多伴有血清钾血清钾含量的改变 含量的改变 周期性瘫痪周期性瘫痪 Periodic ParalysisPeriodic Paralysis 低低钾钾钾钾型 最多型 最多见见见见 高高钾钾钾钾型 少型 少见见见见 正常血正常血钾钾钾钾型 少型 少见见见见 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 低钾型周期性瘫痪低钾型周期性瘫痪 常染色体显性遗传性钙通道常染色体显性遗传性钙通道 病病 我国以我国以散发者散发者多见多见 周期性瘫痪周期性瘫痪 Periodic ParalysisPeriodic Paralysis As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 临床表现临床表现 男性男性多于女性 约多于女性 约3 3 1 1 首次发病多在首次发病多在2020岁以前岁以前 多在多在晨醒前晨醒前发病 可有发病 可有诱因诱因 四肢四肢对称性弛缓性对称性弛缓性瘫痪 瘫痪 下肢开始 近端重 通常不累及头面部肌肉 呼吸肌 膀胱直下肢开始 近端重 通常不累及头面部肌肉 呼吸肌 膀胱直 肠括约肌规律正常 肠括约肌规律正常 数小时至数天恢复 一般不超过一周 数小时至数天恢复 一般不超过一周 周期性瘫痪周期性瘫痪 Periodic ParalysisPeriodic Paralysis As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 辅辅 助助 检检 查查 血清钾降低血清钾降低 心电图呈低钾改变心电图呈低钾改变 周期性瘫痪周期性瘫痪 Periodic ParalysisPeriodic Paralysis As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 补钾以口服为主 补钾以口服为主 注意监测血清钾 警惕高血钾 注意监测血清钾 警惕高血钾 检查甲状腺功能 检查甲状腺功能 避免诱因 避免诱因 周期性瘫痪周期性瘫痪 Periodic ParalysisPeriodic Paralysis 治治 疗疗
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本文标题:神经肌肉接头和肌肉疾病课件_2
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