儿科学精品教学（广西医科大学）结核病5+3年制-韩蕴丽-双语.pptVIP

包括 （1）原发综合征：肺原发病灶＋局部淋 巴结病变＋相应的淋巴管炎 （2）支气管淋巴结结核 二、病理： 基本病理变化为渗出、增殖、坏死 典型的原发综合征是“双极”病变 原发型肺结核的病理转归 三、临床表现： 1) 轻者可无症状，体检x-ray发现 2) 一般起病缓慢，结核中毒症状 3) 婴幼儿及症状较重者，可突起高热 2－3周后转低热，结核中毒症状， 轻咳和轻度呼吸困难是最常见症状 症状： 4）婴儿可表现体重不增或生长发育障碍 5）部分高度过敏状态的小儿可有变态反应 的表现 6）胸内肿大淋巴结压迫症状 physical sign Peripheral lymph node enlarge in different degrees The physical signs of primary pulmonary tuberculosis in children are not obviously, and disagrees with the pathological changes in pulmonary. More than 50% of patients with chest x-ray moderate to severe pulmonary Tuberculosis have no physical finding If the parenchymal focus comparatively large, dullness to percussion, decreased breath sounds. A little of dry / moist rales 四、诊断和鉴别诊断 （一）诊断 1.病史 2.体检 卡疤 过敏表现 3.结核菌素试验 强阳性或由阴转阳性者做进一步检查 4.x-ray 诊断小儿肺结核的重要方法之一 原发综合征 支气管淋巴结结核 炎症型、结节型 胸片伴随表现：气管、支气管受压、变形、 移位等 以下征象可提示原发性结核或曾经感染肺结核 ①肺门影增浓，轮廓不清 ②肺野内有钙化点且附近有增粗或 僵直肺纹理 ③ 某些部位肺纹理走向僵直或增粗 CT 5.纤支镜 6.实验室（总论） The most specific confirmation of pulmonary tuberculosis is isolation of M. tuberculosis .But negative cultures never exclude the diagnosis of tuberculosis in a child For most children, the presence of a positive tuberculin skin test, an abnormal chest radiograph consistent with tuberculosis, and history of exposure to an adult with infectious tuberculosis is adequate proof that the disease is present. （二）鉴别诊断 上呼吸道感染，支气管炎，百日咳、 风湿热、伤寒、纵隔良性及恶性肿瘤 气管异物 五、治疗 1.一般治疗（见总论） 2.短程疗法INH+RFP+EMB 2-3M INH+RFP 4-6M How to decide the reactiveness of tuberculosis in children? ① A strong positive of tuberculin skin test ② A positive of skin test in the children 3 year old , especially 1 yr of age and have not been vaccinated the BCG ③ Isolation of M.tuberculosis from discharge ④ radiographic changes means the reactiveness of pr