用于小儿肠炎ppt课件.pptVIP

門 診 處 方 討 論;;;Outline;小兒腹瀉類型;Causative agents and pathogenic mechanisms;World Gastroenterology Organisation practice guideline;小兒腹瀉臨床表徵;小兒腹瀉的治療;藥物治療 ----本院有的藥品品項;★ Toxin binders cholestyramine（Questran ） Adults: 4g qd-bid AC HS, max: 24g/day and 6 doses/day Children: 240mg/kg/day tid ★ 抗菌殺菌劑 Nifuroxazide（Anti-dia ） Adults and children 12yrs: 1 tab qid Children (4-8 yrs): 3 tab/day;★ 其他 ----- Zinc 1、 zinc sulfate 2、zinc acetate 3、zinc gluconate all water-soluble compounds ★ Lactobacillus casei variety rhamnosus Children 3 yrs and adults: 2 cap bid-qid;非藥物治療;;什麼情況下不可給ORS？;Zinc的生理功能;Zinc的生理功能;Zinc用於腹瀉的機轉;腹瀉、鋅缺乏和免疫力降低的三角關係;Zinc用於腹瀉的劑量是否合理;證據（1）;證據（1）;證據（2）;收錄對象： ★The review of trials identified 18 trials involving 6165 children of all ages. ★Children aged between one month and five years with acute or persistent diarrhoea, including dysentery. Reference: Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005436. Review. ; ★ used zinc 5 mg～20 mg/day. ★ two trials administered higher zinc doses: 40 mg/day Reference: Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005436. Review.;★ In areas where diarrhoea is an important cause of child mortality, research evidence shows zinc is clearly of benefit in children aged six months or more. ;病患的衛教;注意事項;結論;★醫師處方分別開立於98/07/11和98/07/18，給予zinc gluconate 10 mg 0.5 tab bid 治療期間各為7天，是屬於合理，然後衛生署所核准的適應症為鋅不足的補充，病患沒有驗鋅的濃度，不知是否缺鋅，所以不符合健保規範，故病患須以自費的方式 ;The end;Zinc 臨床用途;Epidemiology of acute diarrhea;;Zinc acetate;Zinc oxide;Minimal or no dehydration ;Mild to moderate dehydration ;Severe dehydration