风湿热(年制)讲述.ppt

结缔组织（ Connective Tissue ）：固有结缔组织：疏松结缔组织 致密结缔组织 脂肪组织 网状组织 液状的血液、较坚固的骨组织具有连接、支持、营养、保护等多种功能。 风湿性疾病 （?Rheumatic Diseases ， Connective Tissue Diseases, Collagen Vascular Diseases) 是一组与免疫反应有关的人体多器官、多系统结缔组织的炎症性疾病 儿童期常见风湿性疾病 血管炎 过敏性紫癜 川崎病 多发性大动脉炎 结节性多动脉炎 系统性红斑狼疮 幼年特发性关节炎 风湿热 皮肌炎 硬皮病 干燥综合征 混合性结缔组织病 Brief Summary There is considerable evidence to support the link between group A streptococcus upper respiratory tract infections and acute rheumatic fever and rheumatic heart disease. Several theories of the pathogenesis of acute rheumatic fever and rheumatic heart disease have been proposed, but only two are seriously considered: the cytotoxicity theory and the immunologic theory. Brief Summary The diagnosis of acute rheumatic fever can be established by the Jones criteria when a patient fulfills two major criteria or one major and two minor criteria and meets the absolute requirement， recent group A streptococcal infection. All patients with acute rheumatic fever should be placed on bed rest and monitored closely for evidence of carditis. Patients with carditis require longer periods of bed rest. Brief Summary Patients with typical migratory polyarthritis and those with carditis without cardiomegaly or congestive heart failure should be treated with oral salicylates. Patients with carditis and cardiomegaly or congestive heart failure should receive corticosteroids. Prevention of both initial and recurrent episodes of acute rheumatic fever depends on controlling group A streptococcal infections of the upper respiratory tract. 鉴别诊断 关节炎的鉴别： 幼年特发性关节炎 感染性关节炎 过敏性紫癜 SLE 急性白血病 发热，伴骨关节疼痛 明显贫血 出血倾向 肝、脾及淋巴结肿大 周围血可见幼稚白细胞 骨髓检查可鉴别 病毒性心肌炎 较少发生心内膜炎 杂音不明显 心律失常（如早搏等）较多出现 病毒感染的证据 心脏炎的鉴别 一般治疗和护理： 无心脏炎患儿卧床休息2周 心脏炎无心衰患儿卧床休息4周 心脏炎伴心衰患儿卧床休息至心功能恢复后3～4周 治疗 清除链球菌感染 青霉素 静滴2-3周 抗风湿治疗 ： 阿斯匹林 适用于无心脏炎者， 急性期 80～100 mg/（kg·d）（最大3g/d），至体温正常、关节症状消失、实验室活动指标正常，逐渐减量，疗程4～8周； 肾上腺皮质激素 适用于心脏炎、高热、严重