发热待查2.ppt

病因诊断 “一个、常见、多发、可治、器质性疾病” 1、病史询问：起病缓急、热程、热度、热型、中毒症状（畏寒、寒战） 伴随症状、药物使用情况、既往史、个人史、家族史 2、体查：全面、系统、反复，“从头到脚” 重要的体征：皮疹、出血点，淋巴结、肝、脾肿大，关节肿大、 畸形、功能障碍，局部隆起、肿块，新出现的心脏杂音， 肺部罗音，局部叩痛等 3、选择性的实验室检查 发热待查 中南大学湘雅医院感染病科 Definition Temperature in the anus (rectum/rectal) is at or over 37.5–38.3 °C Temperature in the mouth (oral) is at or over 37.7?°C Temperature under the arm (axillary) or in the ear (otic) is at or over 37.2?°C Fever is a common medical sign characterized by an elevation of temperature above the normal range of 36.5–37.5 ℃ due to an increase in the body tempreture regulatory set-point. Types Intermittent fever Continuous fever Remittent fever Recurrent fever Irregular fever Persistent fever that cannot be explained after repeated routine clinical inquiries . Fever Of Unknown Origin FUO extrogenous endogenous going through the blood-brain barriers activating arachidonic acid pathway PGE2 the ultimate mediator of the febrile response acts on the hypothalamus generates a systemic response back to the rest of the body Pathophysiology skin vasoconstriction decrease heat loss rigor、hormones like epinephrine produce body heat Usefulness Increased mobility of leukocytes Enhanced leukocytes phagocytosis Endotoxin effects decreased Increased proliferation of T cells 常见引起发热的疾病 发热性质 病 因 疾 病 各种病原体（病毒、细菌、 急性、慢性全身或局灶感染 感染性 支原体、衣原体、螺旋体、 发热 立克次体和寄生虫等） 血液病 淋巴瘤、恶组、噬血细胞综合征、 白血病等 风湿热、药物热、SLE、皮肌炎、 变态反应及结缔组织病 多肌炎、结节性多动脉炎、结节性 脂膜炎、成人Still病等