• / 65
  • 下载费用:25 金币  

精品小儿呼吸系统解剖生理特点课件_12

关 键 词:
精品 小儿 呼吸系统 解剖 生理 特点 课件 _12
资源描述:
Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 第一节 小儿呼吸系统解剖生理特点 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial n 一 上呼吸道 n 1 鼻 鼻腔相对狭窄 位置较低 婴 幼儿鼻粘膜柔嫩并富于血管 感染时粘 膜肿胀 易造成堵塞 导致呼吸困难或 张口呼吸 一 解剖特点 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 鼻窦 n新生儿上颌窦和筛窦极小 2岁以后迅速 增大 至12岁才充分发育 额窦2 3岁 开始出现 12 13岁时才发育 蝶窦3岁 时才与鼻腔相通 6岁时很快增大 由于 鼻窦粘膜与鼻腔粘膜相连续 鼻窦口相 对大 故急性鼻炎常累及鼻窦 易发生 鼻窦炎 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 鼻泪管和咽鼓管 n婴幼儿鼻泪管短 开口接近于内眦部 且瓣膜发育不全 故鼻腔感染常易侵入 结膜引起炎症 婴儿咽鼓管较宽 且直 而短 呈水平位 故鼻咽炎时易致中耳 炎 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 4 咽部 n咽部较狭窄且垂直 扁桃体包括咽及腭 扁桃体 前者6个月已发育 后者1岁末 才逐渐增大 4 10岁发育达高峰 14 15岁则渐退化 故扁桃体炎常见于年长 儿 婴儿则少见 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 5 喉 n以环状软骨下缘为标志 喉部呈漏斗形 喉腔较窄 声门狭小 软骨柔软 粘 膜柔嫩而富有血管及淋巴组织 故轻微 炎症即可引起声音嘶哑和呼吸困难 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 二 下呼吸道 n1 气管 支气管 婴幼儿的气管 支气管较成 人短且较狭窄 粘膜柔嫩 血管丰富 软骨柔 软 因缺乏弹力组织而支撑作用差 因粘液腺 分泌不足而气道较干燥 因纤毛运动较差而清 除能力差 故婴幼儿容易发生呼吸道感染 而 一旦感染易于发生充血 水肿导致呼吸道阻塞 左支气管细长 由气管向侧方伸出 而右支 气管短而粗 为气管直接延伸 故异物较易进 入右支气管 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 肺 n肺泡数量较少 弹力纤维发育较差 血 管丰富 间质发育旺盛 致肺含血量多 而含气量少 易于感染 感染时易致粘 液阻塞 引起间质炎症 肺气肿和肺不 张等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 婴幼儿胸廓较短 呈桶状 肋骨呈 水平位 膈肌位置较高 呼吸肌发 育差 呼吸时胸廓运动不充分 肺的扩张 受到限制 不能充分通气 换气 纵隔大 松软有弹性 3 胸廓和纵隔 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 二 生理特点 呼吸节律与频率 年龄越小频率越快 呼吸节律不齐 呼吸型式 腹式呼吸 胸腹式呼吸 呼吸功能的特点 血液气体分析 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 各年龄阶龄阶 段小儿呼吸和脉搏频频率 次 min 年龄龄 呼吸 脉搏 呼吸 脉搏 新生儿 40 45 120 140 1 3 1岁以下 30 40 110 130 1 3 1 4 2 3岁 25 30 100 120 1 3 1 4 4 7岁 20 25 80 100 1 4 8 14 岁 18 20 70 90 1 4 二 生理特点 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 二 呼吸型 n 婴幼儿呼吸肌发育不全 呈腹膈式呼 吸 随年龄增长 膈肌和腹腔脏器下降 肋骨由水平位变为斜位 逐渐转化为 胸腹式呼吸 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 三 呼吸功能特点 n 1 肺活量 小儿肺活量约为50 70ml kg 按单位体表面积计算 成人大于 小儿3倍 说明其潜在力差 呼吸功能储 备较低 发生呼吸障碍时其代偿呼吸量 最大不超过正常的2 5倍 而成人可达 10倍 因此易发生呼吸衰竭 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial n2 潮气量 年龄越小 潮气量越小 死 腔 潮气量比值大于成人 n3 气道阻力 由于气道管径细小 小儿 气道阻力大于成人 随年龄增大气道管 径逐渐增大 从而阻力递减 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 项项目新生儿 2岁岁2岁岁以上 pH7 35 7 457 35 7 457 35 7 45 PaO2 mmHg 60 9080 10080 100 PaCO2 mmHg 30 3530 3535 45 HCO3 mmol L 20 2220 2222 24 BE mmol L 6 2 6 2 4 2 SaO20 90 0 9650 95 0 970 955 0 977 小儿动脉血气分析正常值 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 呼吸道免疫特点 n小儿呼吸道的非特异性和特异性免疫功 能均较差 如咳嗽反射及纤毛运动功能 差 难以有效清除吸人的尘埃和异物颗 粒 肺泡吞噬细胞功能不足 婴幼儿辅 助性T细胞功能暂时性低下 使分泌型 IgA IgG 尤其是IgG2亚类含量低微 此外 乳铁蛋白 溶菌酶 干扰素及补 体等的数量和活性不足 故易患呼吸道 感染 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 第二节 急性上呼吸道感染 急性上呼吸道感染 acute upper respiratory infection AURI 简称上 感 俗称感冒 主要是指鼻 鼻咽和咽 部的急性感染 本病是小儿时期最常见 的疾病 常诊断为 急性鼻咽炎 急性咽炎 急性扁桃体炎 等 一 年四季均可发生 以冬春季节及气候骤 变时多见 多散发 偶见流行 主要是 空气飞沫传播 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 90 以上是病毒感染 少数有细菌引起 肺炎支原体也可引起感染 营养不良 环境因素可诱发 一 病因 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 一般类型的上感 全身症状 大多数患儿有发热 重症患儿可 出现畏寒 头痛 食欲不振 乏力 婴幼儿常 伴有呕吐 腹泻 腹痛 烦躁不安 甚至高热 惊厥 局部症状和体征 鼻塞 流涕 喷嚏 流 泪 咽部不适 发痒 咽痛等 咽部充血 淋 巴滤泡 扁桃体可肿大 充血并有渗出物 颌 下淋巴结肿大 触痛 二 临床表现 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 两种特殊类型的上感 疱疹性咽峡炎 由柯萨奇病毒A组引起 好 发于夏秋季 起病急 高热 咽痛 咽充血 咽腭弓 悬雍垂 软颚等处可见数个直径2 4mm疱疹 周围有红晕 疱疹破溃后形成小溃 疡 疱疹也可发生在口腔其他部位 病程1周 左右 二 临床表现 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 两种特殊类型的上感 咽 结合膜热 由腺病毒引起 常发生于 春 夏季 是一种以发热 咽炎 结合膜炎为 特征的急性传染病 可在集体儿童机构中流行 临床主要表现为发热 咽痛 一侧或双侧眼 结合膜炎及颈部或耳后淋巴结肿大 病程1 2 周 二 临床表现 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 鼻窦炎 中耳炎 喉炎 咽后壁脓肿 颈淋巴结炎 支气管炎 肺炎 心肌炎 溶血性链球菌感染者可引起急性肾炎 风湿 热 三 并发症 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 四 辅助检查 病毒感染时 白细胞计数偏低或正 常 细菌感染时 白细胞计数和中性粒 细胞增高 病毒分离和血清学检查可明确病因 第二节 急性上呼吸道感染 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 五 治疗要点 自限性疾病 无须特殊治疗 一般治疗 休息 多饮水 做好呼吸 道隔离 预防并发症的发生 抗感染治疗 抗病毒和 或抗菌药物 对症治疗 高热者降温 高热惊厥者 镇静 止惊处理 咽痛者服咽喉片 第二节 急性上呼吸道感染 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肺肺 炎炎 Pneumonia Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 分类 病理分类 支气管肺炎 大叶性肺 炎 间质性肺 炎 病因分类 病毒性 支原体 细菌性 病程分类 急性 迁延性 慢性 病情分类 轻症 重症 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 一 支气管肺炎 bronchopneumonia 一 概述 是小儿时期最常见的肺炎 多见于3岁以下 一年四季均可发生 低出生体重 营养不良 VD缺乏 先心病易发 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 二 病因 内在因素 CNS发育不完善 免疫功能 不健全 RS特点 环境因素 居室拥挤 通风不良 空气 污浊 阳光不足 冷暖失调 病原体 常见的是病毒和细菌 一 支气管肺炎 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 三 病理生理 细菌 病毒 呼吸道 血行 低出生体重 营养不良 支气管粘膜充 血水肿 管腔狭窄 呼吸膜增厚 RSV 肺炎链球菌 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 支气管黏膜水肿 变窄 呼吸膜增厚 通气换气功能障碍PaO2 PaCO2 呼吸心率增快 鼻翼扇动 三凹征 呼吸功能衰竭 毒素炎症产物吸收 循环 消化 神经 酸碱平衡失调 三 病理生理 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 循环系统 中毒性心肌炎 肺动脉高压 神经系统 颅高压脑水肿 消化系统 中毒性肠麻痹 消化道出血 酸碱失衡 呼吸性酸中毒 代谢性酸中毒 缺氧 CO2潴留 毒血症 心衰 三 病理生理 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 四 临床表现 1 轻症 呼吸系统症状为主 发热 多为不规则热 弛张热或稽留热 早产儿 重度营养不良儿可不发热 咳嗽 较频 初为刺激性干咳 极期咳 嗽略减轻 恢复期咳嗽有痰 新生儿 早产儿仅为口吐白沫 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 四 临床表现 1 轻症 气促 呼吸加速 每分钟可达40 80次 可有鼻翼扇动 点头呼吸 三凹征 重者唇周发绀 肺部固定的中细湿啰音 以背部两肺下 方脊柱旁较多 吸气末更为明显 新生 儿 小婴儿不易闻及 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 四 临床表现 2 重症肺炎 呼吸系统循环系统 消化系统 神经系统 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 循环系统 心肌炎 面色苍白 心动过速 心音低钝 心律不齐 ST段下移和T波低平 倒置 四 临床表现 2 重症肺炎 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 循环系统 心力衰竭 呼吸突然 60次 分 心率突然 180次 分 极度烦躁不安 发绀 面色发灰 心音低钝 奔马律 肝脏迅速增大 尿少或无尿 四 临床表现 2 重症肺炎 呼吸心率突增快 烦躁不安面色灰 心音低钝奔马律 肝脏增大尿却少 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 神经系统 精神萎靡不振 嗜睡或烦躁不安 脑水肿 时出现惊厥 昏迷 呼吸不规则等 消化系统 食欲不振 呕吐 腹泻 腹胀等 重者出 现中毒性肠麻痹或消化道出血 并发症 脓胸 脓气胸 肺大泡 四 临床表现 2 重症肺炎 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 五 实验室检查及辅助 检查 血象 病原学 检查 X线检查 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 外周血检查 n病毒性肺炎白细胞 细菌性肺炎白细胞 病原学检查 n病毒分离鉴定 咽拭子 气管分泌物 胸水 血液细菌培养 抗原检测 抗体 检测 X线检查 n双肺下野中内带大小不等的斑片状阴影 五 实验室检查及辅助 检查 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 治疗 一 一般治疗 室温 饮食 重者给静脉输 液 及时清除上呼吸道分泌物 定时更换体位 以利排痰 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 二 抗感染治疗 1 抗生素使用原则 根据病原选用敏感药物 在用药之前 送 支气管分泌物 血液及 或胸水等细菌培养及 药敏试验 早期治疗 选用的药物在肺组织中有较高浓度 联合用药 如金葡萄菌 G 杆菌肺炎 应 同时2种 足量 足疗程 重症由静脉给药 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 抗生素的选择 肺炎双球菌 青霉素 耐药金葡萄菌 苯唑青霉素 万古霉素 流感嗜血杆菌 阿莫西林加克拉维酸 或 舒巴坦 大肠杆菌和肺炎杆菌 头孢曲松或头孢噻 肟 绿脓杆菌 头孢他定 肺炎支原体和衣原体 红霉素 罗红霉素 阿奇霉素 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 用药时间 体温正常后5 7日 临床症 状消失后3天 支原体肺炎用药2 3w 葡萄球菌 体温正常后2 3w 总疗程6w Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 三 抗病毒治疗 1 三氮唑核苷 病毒唑 可抑制多种DNA及 RNA 病毒 10 15mg kg d 肌注或静滴 也可滴 鼻或雾 化吸入 2 干扰素 可阻断病毒的繁殖和复制 提高巨 噬 细胞的吞噬能力 治疗病毒性肺炎主要用人 干扰素 3 岁以下用2万u 5岁以上剂量加 倍 肌注或雾化吸入 疗程3 5天 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 四 对症治疗 1 氧疗 具有低氧血症者 如呼吸困难 喘憋 口唇发绀 面色苍灰 烦躁不安 应给氧 2 高热的治疗 物理降温 35 酒精擦浴 冷敷 冰袋 口服布洛芬 烦躁不安可用镇静剂 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 3 保持呼吸道通畅 保持呼吸道通畅 雾化吸入 糜蛋白酶 喘憋严重可用支气管扩张剂 保持足够液体量 勤翻身 拍背 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 五 心力衰竭的治疗 1 镇静 吸氧 10 水合氯醛0 5 1ml kg次 口服 或灌肠 苯巴比妥钠 5mg kg肌注 冬眠灵 非那梗各1mg kg肌注或静注 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 洋地黄制剂的应用 常用快速洋地黄制剂 西地兰 毒K 西地兰 饱和量2岁以下0 03 0 04mg kg 2岁 以上0 02 0 03mg kg 首次用饱和量1 2余量分2 次 每4 6小时给一次 毒K 剂量0 007 0 01mg kg 按病情需要6 12小 时后重复使用 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肺炎合并心衰多为急性心衰 经快速洋地 黄制剂治疗后1 2天即可缓解 一般不用维持量 如伴有先心或严重心衰 常需用维持量 一般用 地高辛 饱和量2岁以下0 05 0 06mg kg 2岁以上 0 03 0 05每日维持量用饱和量的1 5 洋地黄制剂不易与钙剂同时使用 若合并 低钙抽搐必须用时应间隔4 6h Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 4 利尿剂 常用速尿 每次1mg kg 每日1 2次 并注意补钾 5 血管扩张剂的应用 降低前 后负荷可使心脏做功减少 耗氧量 降低 减轻肺水肿和周围组织灌注不良 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 6 营养心肌 1 6 二磷酸果糖 该药是机体糖代谢的中 间产物 可调节葡萄糖代谢中多种酶的活性 提高细胞内三磷酸腺苷和磷酸肌酸的浓度 从 而促进K 内流 增加红细胞内二磷酸甘油酸 的含量 抑制氧自由基和组胺释放 减轻组织 因缺血 缺氧造成的损伤 用量 250mg kg Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 六 中毒性脑病的治疗 改善通气 供氧 镇静及减轻脑水肿 降 低颅内压 1 供氧 脑组织对缺O2最敏感 严重缺氧 可导致不可逆性脑细胞损害 应及时恰当供氧 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 控制惊厥 苯巴比妥 负荷量10 15mg kg 维持量为 5mg kg 安定0 1 0 3mg kg静脉或灌肠 3 脱水脑水肿 甘露醇0 5 1g kg静脉快速滴入 注意给药时间 速尿 0 5 1mg kg静注 每日2 3次 4 促进脑细胞恢复 ATP 辅酶A 胞二磷胆碱 等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 七 酸碱平衡失调的处理 1 呼吸性酸中毒 清除呼吸分泌物 保持呼吸道 通畅 改善通气功能 2 代谢性酸中毒 较重者可用 5 NaHCO3按3 5ml kg 或BE 0 3 1 6 体重 所需 5 NaHCO3 毫升数 先用1 2 1 3量并稀释成1 4 等渗液输 入 3 低钠血症 SIADH 3 氯化钠12ml kg可提 高血钠 10 mmol L 先给1 2量于2 4h静脉 注射 必要时4h重复一次 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 七 腹胀的治疗 1 伴低钾者 应给补钾 2 中毒性肠麻痹 应禁食 胃肠减压 可联合用酚妥拉明0 5mg kg溶于10 G S 20 30ml静注 3 可肛管排气或穴位封闭 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 八 肾上腺皮质激素的应用 1 严重喘憋或呼吸困难 2 全身中毒明显症状 3 合并感染中毒性休克 中毒性心肌 炎 4 出现脑水肿 5 胸膜有渗出 在足量抗生素应用的 同时 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 九 并存症及并发症的治疗 1 并存佝偻病 营养不良 贫血应给相应处理 2 并发脓胸 脓气胸应穿刺抽脓或做闭式引 流 十 物理治疗 慢性或病程迁延者可使用超声波理疗 热 疗 等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 几种不同病原菌肺炎的特 点 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 呼吸道合胞病毒肺炎呼吸道合胞病毒肺炎 临床特点临床特点 2 6个月内婴儿多见 喘憋 喘鸣音 喘憋性肺炎 n中低度发热 n喘憋明显 n肺部体较早 哮鸣音 呼吸音减弱 湿罗音 n全身中毒症状明显 X X线特点线特点 肺间质病变为主肺间质病变为主 肺气肿肺气肿 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 腺病毒肺炎腺病毒肺炎 临床特点临床特点 多见于多见于6 6月月 2 2岁岁 稽留高热稽留高热 咳嗽较剧咳嗽较剧 喘憋喘憋 全身中毒症状重全身中毒症状重 肺部体征出现晚肺部体征出现晚 X X线特点线特点 X X线改变早于肺部体征线改变早于肺部体征 片状阴影或融合成大病灶片状阴影或融合成大病灶 肺气肿 病灶吸收肺气肿 病灶吸收 较慢较慢 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 葡萄球菌肺炎葡萄球菌肺炎 临床特点临床特点 起病急起病急 弛张高热 弛张高热 猩红热样皮疹 猩红热样皮疹 中毒症状明显 中毒症状明显 肺部体征出现早肺部体征出现早 双肺有中细湿双肺有中细湿 罗音 罗音 易并发脓胸 脓气胸 易并发脓胸 脓气胸 X X线特点线特点 小片浸润影小片浸润影 小脓肿小脓肿 肺大泡肺大泡 胸腔积液 胸腔积液 金黄色葡萄球菌 皮肤烫伤样综合 症 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肺炎支原体肺炎 n起病缓慢 n热型不定 热程1 3周 n刺激性干咳为突出表现 n肺部体征不明显 中毒症状不重 n三痛 咽 胸 肌痛 n多系统损害 nX线4种改变 肺门阴影增浓为突出表现 支气管肺炎改变 间质性肺炎改变 均一的实变影 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 支原体肺炎 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 65 B0y v s pXlUiRfNcK8H5E2A x u rZnWkThPeMbJ7G4C1z w t qYmVjRgOdL9I6F3B0y v s oXlUiQfNbK8H5D2A x u qZnWkShPeMaJ7F4C1z w t pYmVjRgOcL9I6E3B0y v r oXlTiQfNbK8G5D2A x u qZnVkShPdMaJ7F4C0z w s pYmUjRfOcL9H6E3B y u r oWlTiQeNbK8G5D1A x t qZnVkSgPdMaI7F4C0z v s pXmUjRfOcK9H6E2B y u rZoWlThQeNbJ8G4D1A w t qYnVjSgPdLaI7F3C0z v s pXmUiRfOcK9H5E2B x u rZoWkThQeMbJ8G4D1z w t qYnVjSgOdLaI6F3C0y v s pXlUiRfNcK8H5E2A x u rZnWkThPeMbJ7G4D1z w t qYmVjSgOdL9I6F3B0y v s oXlUiQfNcK8H5D2A x u rZnWkShPeMaJ7G4
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:精品小儿呼吸系统解剖生理特点课件_12
链接地址:https://www.maidoc.com/p-16696900.html

当前资源信息

范文库

编号: 20181015152312908240

类型: 共享资源

格式: PPT

大小: 234.50KB

上传时间: 2020-05-23

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 

本站提供办公文档学习资料考试资料文档下载


收起
展开