儿童常见疾病的防治(2015-6-5常熟)课稿.ppt

临床表现 （一）主要症状： ⒈发热：最先出现的症状，持续发热，体温在39～40℃，持续5～20天，稽留热或弛张热；抗生素治疗无效。 ⒉皮肤改变：皮疹 本病的第二个特征，发热后2～5天出疹， 皮疹以向心性、多形性，顺序为四肢、胸腹、躯干，最常见的皮疹形态为遍布全身的荨麻疹样皮疹，无水泡及结痂。肛周皮肤发红、脱皮 皮疹及斑丘疹最多见 ⒊口唇及口腔粘膜表现：口咽部改变明显，充血为特征而非化脓性，表现为口唇干裂、潮红、口腔粘膜弥漫充血、杨梅舌、扁桃体可肿大但无渗出物、无口腔溃疡 ⒋球结合膜充血: 常于病后2～5天出现,无脓性分泌物和流泪。 热退后消散 ⒌四肢末端变化：在急性发热早期一周左右手足出现水肿，指趾呈梭形肿胀疼痛与类风湿关节炎相似，继之手掌、脚底弥漫性红斑和膜样脱皮，重者指甲脱落，甲床处亦可发生横沟。 硬性水肿 ⒍淋巴结肿大：一般在发热同时或发热后三天内出现，常为颈部单侧，少数为双侧，坚硬有触痛，拇指至鸡蛋大小，表面不红，无化脓热退消散 。 * Slide 8. Can Asthma Be Predicted in Children? Two indices for the prediction of asthma in school-aged children were developed using data from the Tucson Children’s Respiratory Study. A stringent index requires frequent wheezing in the first 3 years of life plus 1 of 2 major criteria (parental diagnosis of asthma, diagnosis of eczema in the child) or 2 of 3 minor criteria (diagnosis of allergic rhinitis in the child, eosinophilia, wheezing apart from colds). A loose index for the prediction of asthma requires any wheezing during the first 3 years of life plus 1 of 2 major criteria or 2 of 3 minor criteria. Children with a positive loose index were up to 5.5 times more likely to have active asthma between 6 and 13 years of age compared with children with a negative loose index. Children with a positive stringent index were up to 9.8 times more likely. More than 95% of children with a negative stringent index never had active asthma between 6 and 13 years of age. Castro-Rodríguez JA, Holberg CJ, Wright AL, Martinez FD. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med. 2000;162:1403-1406. * * 疱疹沿一定的神经干分布，不对称，不超过躯干中线，局部显著的灼痛 * 好发于鼻唇周围或四肢暴露部位，初为疱疹继发脓疱，然后结痂，无分批出现特点，可见粘膜处，无全身症状 * * * * * * * △对症、隔离、至全身皮疹干痂为止，卧床休 息，勤换衣被，皮肤清洁，剪短指甲△阿昔洛韦：5～10mg/kg/d，疗程7d，轻型口 服，2岁每次0.1，2岁每次0.2，每日5次 重型 静脉，每日10～15mg/kg1天，分2次， 重型早期使用干扰素可减轻症状及防止恶化 治疗 △病儿必须隔离，至全部结痂，但不少于病后 2周。污染物要通风曝晒等方法消毒，接触的易感者留检3周。对免疫缺陷、孕妇和母亲现患水痘的新生儿注射水痘特异性免疫球蛋白 预防 川崎病 口唇干裂 杨梅舌 川 崎 病 面 容 膜 样 脱 屑 趾端脱皮 冠状动