课件：肺结核病.ppt

* * * * * * * * * Why there is no TB?Peace clean and quiet Thank you! THANK YOU SUCCESS * * 可编辑 Symptoms of skeletal TB may include the following: Back pain or stiffness Lower-extremity paralysis, in as many as half of patients with undiagnosedPott disease Tuberculous arthritis, usually involving only 1 joint (most often the hip or knee, followed by the ankle, elbow, wrist, and shoulder) * Symptoms of genitourinary TB may include the following: Flank pain Dysuria Frequent urination In men, a painful scrotal mass, prostatitis, orchitis, or?epididymitis In women, symptoms mimicking?pelvic inflammatory disease * Multidrug-resistant TB Never add a single new drug to a failing regimen. Administer at least 3 (preferably 4-5) of the following medications, according to drug susceptibilities: * An aminoglycoside: Streptomycin, amikacin, capreomycin, kanamycin A fluoroquinolone: Levofloxacin (best suited over the long term), ciprofloxacin, ofloxacin A thioamide: Ethionamide, prothionamide Pyrazinamide Ethambutol Cycloserine Terizidone Para-aminosalicylic acid Rifabutin as a substitute for rifampin * 3、耐多药（MDR）：同时耐 H、R 两种或以上药物 诊断和治疗均依据药敏实验 一线：SM，EMB，PAS 二线：所有 强化期：4～5 种药物 巩固期：2～5 种药物 疗程： 至少 18～24个月 药物 （五）考核疗效指标 （１）痰菌：连续三次 （２）X 线 失败原因： １、未按化疗原则治疗 ２、原发耐药 ３、非结核分枝杆菌感染 ４、免疫力低下 * 二、对症治疗 （一）毒性症状 一般症状：有效化疗１～２ｗ消退，可不处理 干酪性肺炎 明显症状 血播型 糖皮质激素 或重症结核 如 结脑 浆膜腔结核 ★糖皮质激素：须在有效抗结核基础上用 * ★ 皮质激素应用指征：重症TB、毒性重、大量渗出 ★ 皮质激素应用前提：须在有效抗结核基础上用 ★ 皮质激素应用方法： 强的松 30 ～ 40 mg qd 症状好转、积液消退，立即减量至停药 总疗程：1 个月 (二)咯血 小量：口服止血药，如安络血、云南白药 中大量： １、绝对卧床休息 患侧卧位 ２、垂体后叶素５-10u＋NS 20～40ml缓推 10-20u + 水500ml ivgtt 注意副作用及禁忌症! 立止血 止血芳酸 鱼精蛋白 输 血 * 预防 1、 DOTS 战略 对传染性肺结核病人采用 督导 + 短程化疗的策略（DOTS，directly observed treatment short-course）