沈岳良-浙江大学教学信息化平台.pptVIP

发热对机体防御功能的影响 利? 弊? Pathophysiological basis of prevention and treatment for fever Determine and eliminate the cause of a fever Antipyretic therapy High fever Children Pregnant wommen Patients with severe cardiopathy Support measures:fluid and nutrients Physical measures 若体温升高了，你怎么办？ 原因？ 病因治疗 体温升高的程度 个体人群 多补液体 先物理降温 药物治疗 相关专业文献 Anti-inflammatory treatment for carditis in acute rheumatic?fever. (/pubmed The onset of fever: new insights into its mechanism.Blatteis CM.Prog Brain Res. 2007;162:3-14. Review.(/pubmeditool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumordinalpos=1) Endotoxic fever: new concepts of its regulation suggest new approaches to its management.Blatteis CM.Pharmacol Ther. 2006 Jul;111(1):194-223. Epub 2006 Feb 3. Review. (/pubmeditool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumordinalpos=3) Role of the preoptic-anterior hypothalamus in thermoregulation and fever.Boulant JA.Clin Infect Dis. 2000 Oct;31 Suppl 5:S157-61. Review. (/doi/full/10.1086/317521?cookieSet=1) Heat stress contributes to the enhancement of cardiac mitochondrial complex activity.Sammut IA, Jayakumar J, Latif N, Rothery S, Severs NJ, Smolenski RT, Bates TE, Yacoub MH. (/cgi/content/full/158/5/1821)Am J Pathol. 2001 May;158(5):1821-31. * 导言 发烧的原因及机制 发热阶段和特征 发热反应引起的功能和代谢变化 发热预防和治疗病理生理基础 * Fever is a complicated pathological process characterized by a regulated elevation of core body temperature that exceeds the normal daily variation (0.5℃), in which pyrogens cause a temporary upward resetting of the hypothalamic thermostatic setpoint, inducing a complex physiologic and pathophysiologic febrile response. * Pyrogenic activator 发热激活物 Endogenous pyrogen 内生致热原 （一）细菌及其毒素 1．革兰阴性细菌与内毒素 革兰阴性细菌进入体内引起发热，主要是内毒素的作用。内毒素（endotoxin, ET）为革兰阴性细菌的菌壁成分，其活性成分是脂多糖（lipopolysaccharide, LPS），由O-特异侧链、核心多糖和脂质A三个部分组成。脂质A是致热的主要成分。ET是最常见的外致热原，有明显的耐热性，160℃、2小时才能灭活，一般方法难以去除，ET的分子量很大（1000~2000kD），不易透过血脑屏障。体外实验表明，微量的ET与白细胞共同培养，可使后者产生和释放内生