呼吸系统疾病呼吸系统疾病Respiratory System Disease湘雅医院儿科 郑湘榕 l 婴幼儿上感、2种特殊类型上感的特点l 支气管肺炎临床表现、重症肺炎特点 l 支气管肺炎的诊断、治疗l 支气管哮喘的临床表现、诊断和治疗 重点vIn pediatric outpatient, 6o% patients are acute respiratory infections. vIn pediatric ward, 25% patients are Pneumonia. vThe first cause of childrens death in China is Pneumonia. vPneumonia is the worlds leading cause of death among children. It kills nearly two million children under age five every year. Why children are so susceptible to acute respiratory infections?anatomic physiological features The childrens respiratory lumens are narrow,blood flow is abundant. The childrens repertory ability is low. The childrens local immunity is low.Children Respiratory System Physiologic Feature Respiratory rateNeonate 40-44/min3 monthsDeferred：13 monthsOn the etiology Virus RSV(respiratory syncytial virus) Adenovirus Influenza ParainfluenzaBacteria Streptococus pneumoniae Staphylococus aureus Haemophilus influenzae type On theetiologyMycoplasmaChlamydia, parasites ,fungiNoninfections causesOn the severityof illnessMild symptomaticSevere symptomatic Besides symptoms of respiratory system, concomitant manifestations of other organ systems are presenton typicalof clinical manifestationTypical pneumoniauntypical pneumonia Severe acute respiratory syndrome, (SARS) coronavirusOn Occurrence RegionCommunity Acquired Pneumonia CAPHospital Acquired Pneumonia HAP支气管肺炎 BronchopneumoniaEtiologyvirusMain cause of pneumonia in developed country RSVbacteriaMain cause of pneumonia in developing country S. pneumoniaeS. pneumoniae PathologyCommon Broncho- pneumoniahyperaemia、edema、inflammatoryeffution of alveolusInterstitialpneumoniahyperaemia、edema、inflammatoryeffution of bronchia wall、 bronchiole wall、 alveolus wallPathologic physiology气道炎症循环系统神经系统水电解质消化系统肺A压增高中毒性 心肌炎心衰代酸中毒性 肠麻痹胃肠粘膜 屏障功能 脑水肿颅压呼酸K+水钠储留毒血症通气不足 PaO2,PaCO2 换气障碍 PaO2Clinical manifestationMild symptomaticrespiratory systemfeverrespiratory distress nasal flaring, retractions,cyonosistachypnea coughrales5 years RR30次/分Clinical manifestationSeveresymptomaticcircular system symptomCardiac muscle inflammationHeartfailureClinical manifestSeveresymptomaticHeartfailure 呼吸突然加快，60次/分 心率突然增快 婴儿180次/分幼儿160次/分 突然烦躁不安、面色发灰 心音明显低钝，奔马率，颈静脉怒张 肝大肋下3cm以上 尿少、下肢浮肿Clinical manifestnerval systemLight hypoxia： irritability，lethargySever hypoxia： hydrocephalusdigestive system alimentary canal bleedingPoisoning intestine palsySeveresymptomaticClinical manifestDICBp四肢凉，脉速弱， 出血SLADHNa + 130mmol/L渗透压20%,使用支扩剂后增 加20% 可诊断哮喘）Diagnose of childfood asthma gasp recurrent attacks lung wheezing rales bronchodilators is valid exclude other disease that can cause gasp cough1month,antibiotics treat is invalid bronchodilators can relieve cough hypersensitive history or allergia family history airway is hyperreactivity exclude other cough disease Diagnose of cough variant asthmatherapyPrinciple: long-term 、 persistence、standard、 individuationPeriod of onset:antiinflammatory、calm gaspcatabasis:long-term 、 antiinflammatory、avoid trigger factor、self-careto spread Global Initiative for Asthma，GINA(全球哮 喘防治创议)drugglucocorticoid-first selectbronchodilatorsimmunosuppressantother druginhale：beclometasone 100 g，24times/dayoral： prednisone 12 mg/kg/day，17daysevere casepersistent attackanti-asthmatic cannot controlintravenous drip：Cetacort 510 mg/kg/time Medrat 12 mg/kg/ time, BidTidsevere attackglucocorticoid usagedrugbronchodilatorspara-adrenal drug inhale0.5% albuterol 0.010.03 ml/kg/次 atomization q46 htheocin aminofilina 45 mg/kg/次immunosuppressant-methotrexate-cyclosporinother drug-disodium cromoglycate-ketotifenStatus asthmaticusinhale oxygen calm fluid replace,correct acidosis cortine drip bronchodilators,cortine inhale theocin drip respirator preventrelapsev avoid sensitizin and trigger factorv inhale cortin 6 months2yearsv immunotherapy- desensitization v self-management谢 谢 ！