七年制-呼吸系统.ppt
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1、Disease of the Respiratory system in Children,Ji Hong,Department of Pediatrics , The first Clinical Hospital , Dalian Medical University,Introduction,The disease of respiratory system is one of the most frequent reasons for hospitalization of infants and children. Basic knowledge of the development
2、and functions of respiratory system are essential,上、下呼吸道,cricoid cartilage 环状软骨,1. characteristics of respiratory system,The upper airway nose; paranasal sinuses; pharynx; larynx; ,Eustachian tube(咽鼓管) naso-lacrymal duct (鼻泪管),鼻窦(paranasal sinuses),Maxillary sinuses appear at 2yrs, develop fully aft
3、er 12yrs. Frontal sinuses appear at 2-3yrs, enlarge at 6yrs Paranasalsinusitis rarely occurs in infants.,咽部(pharynx),Relatively narrow and vertical, rich in lymphoid tissue. tonsils begin to enlarge gradually at the end of 1 yrs develop at 4-10 yrs degenerated gradually after 14-15 yrs. Tonsillitis
4、is often seen in elder children than in infants.,鼻泪管(Eustachian tube),Broad, straight and short in infant; The position horizontal;,So when an infant catches cold, he may be complicated with tympanitis.,喉(larynx),Narrow in infants The mucous membrane is rich in vascularity. Congested and swollen in
5、inflammation dyspnea.,The low airway,Trachea; bronchus; lung;,Trachea and bronchus,The lumen of trachea and bronchus relatively narrow; Mucosa rich in vascularity; Cillium movement poor; So easy to get infection develop obstruction,The right bronchus direct continuation of the trachea; The left bron
6、chus spreads out from the lateral surface of trachea; So foreign body often aspirated into right bronchus,lungs,Interstitial tissue Alveoli Blood Air easy to get inflammationatelectasis,(3) Mediastinum and chest wall,mediastinumrelatively larger in infant than in adult. Surrounding tissue of mediast
7、inumloose and elastic. If the pleural effusion or pneumothorax occurs mediastinal organs are easily displaced.,2.physiological characteristics,(1) Frequency and rhythm of respiration The younger the child, the more rapid the respiration is. The metabolism and oxygen requirement of infants high, but
8、respiratory volume is limited ,(2) Type of respiration In infant abdominal respiration. After the child stands up and walks the diaphragm moves downward the chest cavity increased abdominal-chest respiration appears. abdominal-chest respiration (3)Volume of tidal air 6 ml per kg when the respiration
9、 is peaceful.,3.The immune characteristics,The serum levels of IgA remain low during early childhood infants and children are susceptible to infection of respiratory tract.,Acute upper respiratory infection,急性上呼吸道感染,病 因(etiology),一、病原体 病毒 90%以上 细菌 支原体 二、易患因素 免疫功能低下 营养不良、佝偻病、贫血等疾病 过敏体质、护理不周、环境因素,Have
10、 you ever had a cold? When you catch a cold ,how did you feel ?,上呼吸道感染 俗称“cold”,Clinical manifestations,一般类型上呼吸道感染 两种特殊类型上呼吸道感染 疱疹性咽峡炎(herpangina) 咽结合膜热(pharyngo-conjunctival fever),Clinic manifestation,症状: 局部症状:鼻塞、流涕、干咳、咽部不适 全身症状:发热、头痛、全身不适、乏力 部分患儿有呕吐、腹泻 体征: 咽部充血、扁桃体肿大、淋巴结肿大 肠道病毒感染者可见不同形态的皮疹,特殊类型,疱
11、疹性咽峡炎 咽结合膜热 病原体 柯萨奇A组病毒 腺病毒3、7型 好发季节 夏秋季 春夏季散发活小流行 症状 高热咽痛流涎 高热咽痛眼部刺痛 体征 咽部充血疱疹 咽部白色点块状分泌物 滤泡性眼结合膜炎 病程 1周 1-2周,疱疹性咽峡炎 Herpangina,咽结合膜热 (pharyngo-conjunctival fever),并发症(Complications),The surrounding tissue inflammation(otitis media) Group A hemolytic streptococcus infection: acute glomerulonephriti
12、s, rheumatic fever Some pathogens: rheumatoid,实验室检查(Laboratory),1、血常规 blood examination 2、病原学检查etiology analysis: Virus Bacteria Antigen and antibody detection: immunofluorescence, immunoenzyme Molecular biology techniques 3、CRP,诊断 Diagnosis,Local symptoms are not distinct-URI Inflammation is locali
13、zed on one part-pharyngitis,tonsilitis,鉴别诊断 differential diagnosis,流感 Influenza 急性传染病早期 early peroid of Acute infectious disease 急性阑尾炎 Acute appendicitis 过敏性鼻炎 Allergic rhinitis,治疗 Treatment,一般治疗 General treatment 抗感染治疗 anti-infection treatment 对症治疗 symptomatic treatment (antipyresis,sedative),预防 Pr
14、evention,Enhanced resistance Breastfeeding Avoid passive smoking Dont go to public places Prevention of rickets and malnutrition,肺炎(pneumonia),概 念,不同病原体或其他因素(如吸入羊水、有类或过敏反应)等所引起的肺部炎症。主要临床表现为发热、咳嗽、气促、呼吸困难和非不固定性中、细湿啰音。重症患者可累及循环、消化及神经等系统的临床症状。,肺炎的分类 Classification of pneumonia,概念,不同病原体或其他因素(如吸入羊水、有类或过敏反
15、应)等所引起的肺部炎症。主要临床表现为发热、咳嗽、气促、呼吸困难和非不固定性中、细湿啰音。重症患者可累及循环、消化及神经等系统的临床症状。,分 类,1、病理分类 2、病因分类 3、病程分类 4、病情分类 5、临床表现分类 6、发生肺炎的地区分类,细菌性肺炎 病毒性肺炎 支原体肺炎 衣原体肺炎 真菌性肺炎 原虫性肺炎,按病因分类,感染性肺炎,非感染性肺炎,支气管肺炎 (Bronchopneumonia) 大叶性肺炎 (Lobar or Lobular Pneumonia) 间质性肺炎 (Interstitial Pneumonia),按病理分类,按病程分类,急性肺炎(Acute Pneumoni
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