以病程分期為依據之兒童腸病毒重症治療课件.ppt

以病程分期為依據之兒童腸病毒重症治療 The Stage Based Therapy ofCritically Ill Children with EV 71 Infection ;A Cardiopulmonary disaster requiring multidisciplinary treatment;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 ;Outbreaks (1);Outbreaks (2);Outbreaks (3);Enetrovirus type 71 腸病毒七十一型分別在糞便、咽喉、及腦脊髓液檢體中被培養出來。 ;EV 71 Outbreaks;1998 腸病毒流行之統計;腸病毒的傳染途徑;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 ; EV71(174) non71 EV(241);Table 1:Demographic and clinical characteristics of 154 patients;Table 4: Risk factors associated with pulmonary oedema ;Skin and Mucosa Lesions;;;;;Phases Based Therapy of Critical EV-71 Infection腸病毒重症之臨床分期;分期標的;Results;Table A Severe Hypertension Criteria by Age ;Table B. Normal Blood Pressure by Age;第一期：手足口病;重症病例之前趨症狀及危險因子 I;重症病例之前趨症狀及危險因子 II;第二期：腦膜腦炎;第三A期：高血壓—肺水腫出血─自主神經失調？;;;Lungs are congested;Parameters Sequence Around PE;Parameters Sequence (2);第三B期：低血壓：心臟衰竭;第四期：逐漸恢復;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 ;;Hypotheses of the Mechanism of pulmonary oedema;Evidence Supporting SIRS;Evidences Related to Neurogenic Pulmonary Oedema;Diffuse inflammatory cell infiltration in Cerebrum, midbrain and brain stem;;Cortisol Level vs. Vital Signs;Evidences Related to Cardiogenic;Initial Swan-Ganz Monitor Data;Echocardiography Evidences;Diastolic Function;Cardiac Enzymes;Grossly, the heart is hypertrophic;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 ;When Patient Becomes Very Critical;Virus;Virus;StageⅠ Hand, foot mouth disease and treatment;Stage Ⅱ CNS InvolvementGeneral Treatment;Stage Ⅱ CNS InvolvementSpecific Treatment for CNS;Stage ⅢA: Treatment;Stage ⅢA: Treatment;0 0.2 0.4 0.6 0.8 1.0 1.2 1.4;;Stage ⅢB Hypotension: treatment;Stage ⅢB Hypotension: treatment;Stage Ⅳ Convalescence--Treatment;;;Outcome(2000-2001);Gr 1 2 3 4 p-value;Gr 1 2 3 4 p-value;Conclusions(1);Conclusions(2);Conclusion(3);