江米足_婴儿腹泻与补液.PPT

Infantile diarrhea and fluid therapy Mizu Jiang What is diarrhea? Definition: increased total daily stool output ( 10g/kg/d)， is usually associated with increased stool water content. Loose consistency(性状改变):watery diarrhea, mucous diarrhea, bloody diarrhea Increased stool frequency(次数增多，＞3次/日） Duration Acute ( 14 d) Persistent (14 d to 2 m) Chronic ( 2 m) High Childhood Morbidity High Childhood Mortality Major Contributor to Malnutrition Enteropathogens of diarrhea Epidemiology Viruses Rotavirus Enteric adenovirus Norwalk virus Astrovirus Echo virus Coxsackis virus Coronary virus 致泻性大肠埃希菌（Diarrheagenic E.coli, DEC) 肠致病性大肠埃希菌（Enteropathogenic E.coli, EPEC) 肠产毒性大肠埃希菌（Enterotoxigenic E.coli,ETEC) 产志贺毒素大肠埃希菌（Shiga toxin-producing E.coli,STEC):一般为O157：H7血清型 肠侵袭性大肠埃希菌（Enteroinvasive E.coli,EIEC) 肠聚集性大肠埃希菌（Enteroaggregative E.coli,EAEC) Bacteria Campylobacter jejuni, Yersinia, Others:Salmonella, Aeromonas hydrophila, Clostridium difficile, Staphylococcal aureus, Bacillus pyocyaneus, Bacillus proteus Parasites and Fungus Parasites: Giardia lamblia Cryptosporidium parvum Strongyloides stercoralis Blastocystishominis Fungus: Candida albicans Cryptosporidium infection in children with diarrhea in Zhejiang Province Table Sex and age distribution of cryptosporidium infection Age(y) Positive rate% (positive cases/checked cases) Male Female Total 0 ~ 6.2 (13/ 209) 4.9 (6/ 123) 5.7 (19/ 332)* 1 ~ 16.3 (17/ 104) 20.0 (12/ 60) 17.7 (29/ 164) 4 ~ 10 16.6 (6/ 36) 18.7 (3/ 16) 17.3 (9/ 52) Total 10.3 (36/ 349) 10.6 (21/ 199) 10.4 (57/ 548) *, P0.01 （陆绍红，等. 中国人兽杂志 2000） Enteropathogens that cause Diarrhea in Infants and Children Enteropathogens that cause Diarrhea in Infants and Children 病毒性腹泻发病机制 发病机制尚不清楚。大多认为病毒侵袭小肠绒毛上皮刷状缘（含双糖酶），引起细胞变性坏死和脱落，影响肠上皮的吸收功能，大量水份、电解质在腔内积聚，导致吸收障碍性腹泻。 由于双糖酶大量破坏，造成双糖吸收不良，并引起渗透性腹泻 。 细菌性腹泻发病机制 依据病原体对肠黏膜的侵袭程