各区县培训-脊髓灰质炎诊断与鉴别.pptxVIP

首都医科大学附属北京儿童医院-神经内科;;3;;脊髓灰质炎概述;While polio is a distant memory in most of the world, the disease still exists in some places and mainly affects children under five. One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.;We are 99% of the way to eradicating polio globally！;three countries never stopped transmission of polio;polio can be completely eradicated;cheap and effective vaccines available;global effort to eradicate polio is the largest public-private partnership for public health;Large-scale vaccination rounds help rapidly boost immunity;every child must be vaccinated to eradicate polio;Strategies to find and map every child can be applied to other public health initiatives While a vaccination team is in a remote village, they can, for little additional cost, provide other health interventions while they are there. For example, vitamin A has been given alongside polio campaigns. Vitamin A gives a general boost to immunity it allows children to fend off a range of infections, this has averted more than 1.5 million deaths.;We can eradicate polio ！;;全球脊灰疫情;中国脊灰报告发病数与消灭脊灰活动 （1953～2000年）;;;所有15岁以下出现急性驰缓性麻痹症状的病例，和任何年龄临床诊断为脊灰的病例均做为AFP病例 各级医疗机构和人员发现AFP病例后，城市在12小时，农村在24小时内以最快方式报告到当地辖区疾控机构 ;（1）脊髓灰质炎 （2）格林巴利综合症 （3）横贯性脊髓炎 （4）多神经病 （5）神经根炎 （6）外伤性神经炎 （7）单神经炎 （8）神经丛炎 （9）周期性麻痹 （10）肌病 （11）急性多发性肌炎 （12）肉毒中毒 （13）四肢瘫截瘫和单瘫 （14）短暂性肢体麻痹;对AFP监测的理解;;定位诊断;;;详细可靠的病史;神经系统的检查要点; 1、脑脊液：细胞蛋白分离、蛋白细胞分离 2、肌酶：GPT、GOT、CPK、LDH 3、血生化：K、Na、Ca、P 4、肌电图 5、影像学：脑MRI、脊髓MRI 6、粪便病原学检测;脊髓灰质炎 Poliomyelitis;传染源 患者及无症状带毒者为传染源，发病前1周从粪便排毒,病后1-2周排毒率最高(69-100%)。脊灰潜伏期的末期和瘫痪前期传染性最大，热退后传染性减少。约70%患儿粪便中带有病毒1-2周，少数患儿带病毒3-8周 传播途径 粪便污染饮食，经口摄入为本病主要传播途径，人是自然界唯一宿主，直接或间接污染病毒的双手、用品、玩具、衣服及苍蝇等皆可成为传播媒介，饮水污染常引起爆发流行 易感性： 人对脊灰普遍易感，主要是隐性感染，麻痹型患者少，感染后产生持久免疫力 ;季节分布 温带多见本病，一年四季均可发生，夏秋季流行高峰，7-9月发病占全年40%-70% 年龄分布 发病以小年龄为主，我国资料提示，2岁以下73%，3岁以下占88%，儿童中男孩较女孩易患重症，多见瘫痪 ;脊髓灰质炎 Pol