同学们好！,呼吸系统疾病 Respiratory System Disease,湘雅医院儿科 郑湘榕,婴幼儿上感、2种特殊类型上感的特点 支气管肺炎临床表现、重症肺炎特点 支气管肺炎的诊断、治疗 支气管哮喘的临床表现、诊断和治疗,重点,Introduce,In pediatric outpatient, 6o% patients are acute respiratory infections. In pediatric ward, 25% patients are Pneumonia. The first cause of childrens death in China is Pneumonia. Pneumonia 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,?,breathed in (inspired) breathed out (expired) Nasopharynx Orapharynx Larynx Epiglottis Trachea Right bronchi Left bronchi Alveoli,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 rate,Neonate 40-44/min 1year 30/min 2-3years 24/min 4-7years 22/min 8-14years 20/min,Children Respiratory System Physiologic Feature,Respiratory type,Abdominal respiration Thoracic abdominal respiration,hysical examination inspection Change of respiratory rate Cyanosis Three depressions sign uscultation,Examine Method,uscultation 吸气喘鸣（inspiratory strider） 呼气喘息（expiratory wheeze） 哮鸣音 中、粗湿罗音 细湿罗音,Examine Method,急性上呼吸道感染（AURI） Acute Upper Respiratory Infection,Etiology,irus： ccupy 90% acteria： econdary Streptococus pyogens Pneumococcu aemophilus influenzae,Common AURI,Local symptom is mild,In infant and toddler,Systemic symptom is severe,Complications are common,Clinical Manifestations,School age,Tympanitis, sinusitis,Abscess of pharynx posterior-wall,Laryngitis, bronchitis,Infant , toddler,Pneumonia,Glomerulonephritis,Rheumatic fever,Complications,Common AURI,hysical examination,Congestion of pharyngeal portion, antiadoncus (咽部充血，扁桃体肿大) Lymphadenectasis in submaxilla (有时下颌、淋巴结肿大) Rash when enterovirus infection (肠道病毒感染时可出现皮疹),Clinical Manifestations,Special AURI,柯萨奇病毒A组感染 夏秋好发 高热、咽痛、流涎 咽腭弓、软腭处有疱疹 疱疹破溃后可形成溃疡 病程 1 周左右,Clinical Manifestations,Herpangina 疱疹性咽峡炎,Pharyngo- conjunctival fever 咽结合膜热,腺病毒 3，7 型所致 春夏发病，可小流行 发热、咽炎、结合膜炎 咽部充血、结合膜充血，颈部、 耳后淋巴结肿大 病程 12 周,Clinical Manifestations,Special AURI,Antivirus drugs,中药,Ribovirin,3-5 days,Antibiotics,Penicillin,Cephalosporin Macrocyclic lactone,3-5 days,Sever symptomatic;,Secondary bacteria affection,Treatment,Defervesce,Drugs：对乙酰氨基酚，布洛芬,Physics methods,Febril convulsion,Calm,Stop convulsion,Defervesce,Treatment,中国0-5岁儿童急性发热诊断处理指南 2008,婴幼儿上感、2种特殊类型上感的特点 支气管肺炎临床表现、重症肺炎特点 支气管肺炎的诊断、治疗 支气管哮喘的临床表现、诊断和治疗,重点,Pneumonia,肺 炎,Children familiar disease,Introduction,Pneumonia affects 156 million children under the age of 5 yrs Leading cause of mortality in under 5 yrs Most of these deaths preventable Most effective intervention-Early diagnosis and appropriate management The hospitalization number of infant and toddler is 39.5 times of school age,Williams et al. Lancet Infect Dis, 2002,Worlds biggest killer,Introduction,Pneumonia (18%) and diarrhea(15%) are the leading killers in children. They took nearly 3 million children lives in 2008 alone. (两种疾病在2008年一年就夺走三百万儿童的生命) In children ages 0-59 months: 0-59月的儿童 Pneumonia caused nearly 1.6m deaths Diarrhea caused more than 1.3m deaths,Black et al, Lancet 2010,Pneumonia is an inflammation of the parenchyma of the lungs,It is caused by microorganisms or noninfectious causes,Manifested by fever,cough, tachypnea , respiratory distress and rales,Definition,On course of illness,Acute： 3 months Deferred：13 months,Classification 1,On the etiology,Mycoplasma,Chlamydia, parasites ,fungi,Noninfections causes,Classification 3,On the severity of illness,Mild symptomatic,Severe symptomatic Besides symptoms of respiratory system, concomitant manifestations of other organ systems are present,Classification 4,on typical of clinical manifestation,Typical pneumonia,untypical pneumonia Severe acute respiratory syndrome, (SARS) coronavirus,Classification 5,On Occurrence Region,Community Acquired Pneumonia CAP,Hospital Acquired Pneumonia HAP,Classification 6,支气管肺炎,Bronchopneumonia,Etiology,virus,Main cause of pneumonia in developed country RSV,bacteria,Main cause of pneumonia in developing country S. pneumoniae,Pathology,Pathologic 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 PaO2,Clinical manifestation,Mild symptomatic,respiratory system,fever,respiratory distress nasal flaring, retractions,cyonosis,tachypnea,cough,rales,5 years RR30次/分,Rapid breathing,Clinical manifestation,5 years RR30次/分,Clinical manifestation,Severe symptomatic,circular system symptom,Cardiac muscle inflammation,Heart failure,Clinical manifest,Severe symptomatic,Heart failure,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 manifest,nerval system,Light hypoxia： irrita