婴幼儿喘息的诊治市公开课特等奖市赛课微课一等奖PPT课件.pptxVIP

婴幼儿喘息诊治北京儿童医院赵顺英第1页首次喘息诊疗毛细（病毒感染性喘息）喘支哮喘首次发作肺炎支气管异物支气管畸形合并感染第2页迁延或连续或重复喘息诊疗首次病毒感染性喘息治疗不彻底哮喘胃食道反流气道畸形：气管-支气管软化、狭窄血管发育畸形:双主动脉弓等肺结核:肿大淋巴结压迫气道或支气管结核支气管异物免疫功效缺点合并气道、肺部重复感染闭塞性细支气管炎*连续性细菌性支气管（细支气管）炎*第3页气道狭窄支气管异物支气管畸形和血管压迫第4页首次病毒感染性喘息治疗不彻底病毒感染性气道高反应连续合并感染:肺炎和连续性细菌性支气管炎平喘药品停用后重复第5页哮喘早期考虑含有哮喘特征：发作性、可逆性，重复性喘息病情重：家族或个人过敏史除外其它引发喘息性疾病第6页连续性细菌性支气管炎很多诊疗名词：（1）慢性化脓性肺疾病（ChronicSuppurativeLungDisease）（2）连续性支气管内膜感染(PersistentEndobrobchialInfections)（3）迁延性支气管炎（ProtractedBronchitis）（4）慢性支气管炎（ChronicBronchitis）第7页临床表现发病年纪：2岁以内常见诱因：急性上下呼吸道感染表现：连续性湿性咳嗽、喘息吸气相和呼气相粗痰鸣音而不是经典喘鸣第8页影像学表现能够正常最常见异常表现为支气管壁增厚斑片片影可有支气管扩张第9页支气管镜表现传导气道分泌物多，多呈脓性粘膜水肿气道闭塞支气管内膜炎肺泡灌洗液细胞学分析，中性粒细胞为主第10页病原学肺炎链球菌、流感嗜血杆菌最常见卡他汉菌、其它链球菌G-杆菌第11页并存疾病哮喘同时存在哮喘而造成诊疗过程复杂化第12页治疗流感嗜血杆菌、肺炎链球菌等治疗疗程3-6周第13页WheezeinpreschoolageisassociatedwithpulmonarybacterialinfectionandresolvesafterantibiotictherapyBACKGROUND:NeonateswithairwayscolonizedbyHaemophilusinfluenzae,StreptococcuspneumoniaeorMoraxellacatarrhalisareatincreasedriskforrecurrentwheezewhichmayresembleasthmaearlyinlife.Itisnotclearwhetherchroniccolonizationbythesepathogensiscausativeforseverepersistentwheezeinsomepreschoolchildrenandwhetherthesechildrenmightbenefitfromantibiotictreatment.Weassessedtherelevanceofbacterialcolonizationandchronicairwayinfectioninpreschoolchildrenwithseverepersistentwheezingandevaluatedtheoutcomeoflong-timeantibiotictreatmentontheclinicalcourseinsuchchildren.METHODOLOGY/PRINCIPALFINDINGS:Preschoolchildren(n?=?42)withseverepersistentwheezebutnosymptomsofacutepulmonaryinfectionwereinvestigatedbybronchoscopyandbronchoalveolarlavage(BAL).DifferentialcellcountsandmicrobiologicalandvirologicalanalyseswereperformedonBALsamples.Patientsdiagnosedwithbacterialinfectionweretreatedwithantibioticsfor2-16weeks(n?=?29).Ofthe42childrenwithseverewheezin