(精选)【医学课件课件】儿童重症肠病毒感染救治教学课件.pptVIP

Lungs are congested Red blood cells are found in small airways and alveoli, Parameters Sequence Around PE Parameters Sequence (2) 第三B期：低血壓：心臟衰竭 持續約二至七天 心搏速率漸降但血壓可能更低 肺水腫出血漸好轉但仍需呼吸器，自呼能力差 血糖正常化 神經症狀之變化：垂直眼震顫、斜視、肢體無力、抽筋…等，此期間腦灌流可能變差造成缺氧缺血性腦病變。 第四期：逐漸恢復 持續？月？年 心臟功能幾乎完全恢復 肺功能可能不好但足堪負擔換氣，然而病人自呼、吞嚥功能不好有嚴重影響，所以仍需呼吸器支持。 漸漸甦醒，神經可能有嚴重後遺症 可能發生反覆性肺炎。 I. Outbreaks II. 臨床分期及其表現 III. 呼吸衰竭的病生理學 IV. 治療的考量 V. 結論 Pathophysiology of Pulmonary Oedema Starling’s formula Flow=K(Pc－Pis) －Π (Oncpl－Oncis) Interstitium Alveolus Lymphatics Pulmonary capillary Pc Pis K Oncpl Oncis O2 Π Hypotheses of the Mechanism of pulmonary oedema SIRS/ARDS Neurogenic pulmonary edema Cardiogenic ↑Capillary permeability ↑Systemic/pulmonary vasculer resistence LV systolic dysfunction LV diastolic dysfunction Evidence Supporting SIRS Group Encephalitis with Pulmonary Oedema (N=8) Encephalitis (N=8) Uncomplicated (N=170) Normal Control (N=21) P-value* WBC(109/L) 28.3+7.6 15.5+6.8 12.3+4.7 -- 0.0001 CRP(mg/L) 18.5+16.3 31.0+35.8 15.9+29.1 -- 0.49 Glucose (mg/dL) 501+186 165+117 103+15 -- 0.0001 IL-1(pg/ml) 48.4+85.2 4.9+10.1 1.6+0.9 1.8+1.0 0.006 IL-6(pg/ml) 947+1239 4.9+3.1 2.8+1.9 1.9+0.5 0.0001 TNF-α (pg/ml)) 22.4+29.5 5.3+1.0 5.6+1.6 6.8+1.5 0.004 Lin et al. Evidences Related to Neurogenic Pulmonary Oedema CNS involvement preceeds pulmonary oedema Increased cortisol level and clinical evidences suggested an autonomic nervous system dysfunction(increased sympathetic tone) Lack of study of pulmonary capillary permeability Systemic vascular resistence does not increase significantly. Diffuse inflammatory cell infiltration in Cerebrum, midbrain and brain stem Perivascular cuffing was also common Cortisol Level vs. Vital Signs Evidences Related to Cardiogenic Increased pulmonary artery wedge pressure? Echo revealed systolic and diastolic dysfunction Hypertension associated Inappropriate tachycardia associated Increased cardiac enzymes However, autopsy findings are against myocarditis Initi