儿童惊厥性疾病诊断策略与处理.ppt

病脑与化脑的鉴别 化脑的治疗 一般治疗 ?急性期密切观察生命体征、意识、瞳孔等； ?保证热卡、蛋白质、脂肪、水、电解质、酸碱平衡。 惊厥治疗控制惊厥及惊厥持续状态发作 降低颅内压，预防发生脑疝 抗生素治疗原则：选择敏感抗生素联合用药 、大(足)剂量 、足够疗程和静脉用药。 降颅压治疗辅助治疗 类固醇 (DXM) 单克隆抗体被动免疫 针对 TNF 和IL-1的抗细胞因素抗体 血浆置换治疗 对症治疗 脑膜炎中DXM的应用 化脑的治疗疗程 新生儿: 14 – 21 d Gram 阴性菌脑膜炎: 21 d 肺炎链球菌和流感嗜血杆菌: 14 d 脑膜炎双球菌: 7 d 结脑的化疗 TBM的激素应用 在抗痨前提下并用激素可减轻脑水肿，减少并发症、提高存活率、降低病死率。 存活率（Alzeer AH.Tubercle and Lung Disease,1993） 并用激素 45% 不用激素 25% 病死率（邵平波，中华结核和呼吸系统疾病,1980） 　　　 Ⅱ期 Ⅲ期 并用激素 4.9% 30% 不用激素 　11% 60.9% 病毒性脑炎的治疗 HSV: 阿昔洛韦10mg/kg IV q8h CMV: 更昔洛韦 狂犬病/东方马脑脊髓炎/HSV?病情最重、可能致死或留有后遗症 儿童惊厥常见于以下哪些疾病 A．热性惊厥 B．中枢神经系统感染 C．癫痫 D．甲状腺功能亢进 热性惊厥主要可分为 A．单纯性热性惊厥 B．复杂性热性惊厥 C．高热惊厥 D．低热惊厥 化脓性脑膜炎的抗生素治疗原则是 A．选择敏感抗生素联合用药 B．大剂量 C．足够疗程 D．静脉用药 复习思考题 参考答案： ABC 参考答案： AB 参考答案： ABCD * * Respiratory tract infection was the most common cause of fever and this was present in 79.5% of all admissions for FS.Gastroenteritis was second (5.5%) followed by roseola infantum (2.9%), UTI (1.1%) and bacteraemia (0.9%). Other causes of fever included post vaccination fever, Kawasaki disease, infectious mononucleosis, rubella, chickenpox and other nonspecific viral illnesses. Meningitis: bacterial viral fungal aseptic (Lyme, syphillis) TB Other causes of aseptic meningitis: malignancy NSAID’s chemo abx Sxs appear either slowly over a few days or rapidly with sepsis Fever occurs in 50% of infants, some only fever. 15% of kids with bacterial meningitis present comatose or semi-comatose. 20-30% have seizures prior to admission or during 1st 2 days of treatment. Uncomplicated sz (easily controlled & non-focal) may be treated during hospitalization & then meds d/c. Papilledema usually not seen at presentation. Head CT not indicated unless focal symptoms or herniation Stiffness caused by inflammation of the cervical dura and reflex spasm of the extensor muscles of the neck – uncommon in infants Lateral movement unrestricted In small child, may d