肝细胞破裂课件

疟 疾 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 疟疾（Malaria）是疟原虫经按蚊 叮咬传播的传染病，临床特点为间 歇性定时发作的寒战、高热、继以 大汗而缓解，常有脾肿大与贫血。 多发生在热带、亚热带和温带地区 ，病原治疗首选氯喹和伯氨喹啉联 合治疗。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 病原学 寄生于人类的疟原虫有4种，即间 日疟原虫、三日疟原虫、恶性疟原虫 和卵形疟原虫。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 疟原虫的发育过程分两个阶段、有 两个宿主。蚊为终末宿主，人为中 间宿主。4种疟原虫的生活史相似。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （一）疟原虫在人体内的发育阶段 1.红细胞外期 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 子孢子蚊唾液血液肝细胞内裂殖体一 周裂殖子（肝细胞破裂） 被吞噬细胞消灭 或重进血液红细胞小滋养体（环状 体） 大滋养体 裂殖体 裂殖子 红细胞胀破大量裂殖子、疟色素代 谢产物进入血液引起临床症状； 小部分侵入其他红细胞重复增殖，间 歇发作： 部分裂殖子发育成雌雄配子体 吸入 雌 性按蚊胃内 合子 动合子雌蚊胃壁 囊 合子 孢子囊 逸出 子孢子蚊虫叮咬 入人体 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 疟原虫子孢子多型性假说 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2.红细胞内期 （1）裂体增殖 （2）配子体形成 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （一）疟原虫在蚊体内发育阶段 有性生殖 孢子增殖 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 流行病学 （一）传染源 （二）传播途径 中华按蚊 微小按蚊 雷氏按蚊 巴拉巴按蚊 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （三）人群易感性 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （四）流行特征 l1.地区分布 l2.季节性 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 发病机理和病理变化 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 疟疾的凶险发作主要见于大量疟原 虫感染和进入高疟区的无免疫力的 居民。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 疟疾的病理改变主要是单核巨噬细 胞系统增生。 脾脏 肝脏 脑 骨髓 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 其他器官如胃肠、肺、心、肾上腺 等亦有不同程度的疟色素沉着。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 临床表现 潜伏期：间日疟13周，三日疟34 周，恶性疟12周，卵形疟2周左右 。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （一）典型发作 1.间日疟 即间日定时的寒战发作， 两次典型发作之间可无任何症状。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （1）寒战期：突然发病，寒战、面色苍 白、唇指发绀、四肢发凉、脉速有力。 持续10分钟到2小时。 （2）高热期：体温迅速上升，常达40 或更高。头痛、全身酸痛、口渴、烦躁 、面色潮红、皮肤干热、脉快有力，持 续26小时。 （3）大汗期：高热后期大汗淋漓，体温 迅速下降至正常，症状明显缓解，疲乏 无力即入睡。持续23小时。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2.三日疟 寒热为三日发作一次， 每次发作时间较间日疟略长，周期 较规则。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 3.卵形疟 与间日疟相似，症状多较 轻。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 4.恶性疟 临床表现多样化，起病多 急骤，发热前可仅低热、畏寒、头 痛等症状，继以弛张热或持续高热 ，可每日或间日发作，常无明显的 缓解间歇，严重者可致脑型疟疾。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （二）其他临床表现 1.脾脏 早期轻度肿大、质软。反复 多次发作后脾明显肿大、质较硬。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2.肝脏 轻度肿大、质软、有压痛、 血清ALT可增高。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 3.贫血 反复多次发作后，常有贫血 ，恶性疟疾贫血较显著。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （一）凶险发作 主要见于恶性疟。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 1.脑型 起病急、高热、剧烈头痛 、呕吐、谵妄和抽搐、脑膜刺激征 、反射亢进、失语、瘫痪等。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2.过高热型 持续高热可达42 ，谵妄、继之昏迷、抽搐，可在数 小时内死亡。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （四）复发与复燃 间日疟及卵形 疟病人常有复发。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （五）输血疟疾 由输入带疟原虫的 血液而引起。潜伏期约710日，亦 可长达一月左右，临床发作与蚊传 疟疾相同。此型只有红细胞内期疟 原虫，治疗后一般无复发。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 并发症 （一）黑尿热 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （二）肾损害 1.急性肾小球肾炎 2.肾病综合征 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 实验室检查 （一）血象 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （二）疟原虫涂片检查 1.血液涂片 2.骨髓涂片 3.血清学检查 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 诊断 （一）流行病学资料 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （二）临床表现 间歇性定时寒战 、高热发作，间日或三日一次，发 作时有明显的寒战、高热和大汗， 继之缓解，也可不规则发热、脾肿 大与贫血。脑型疟疾可表现为急起 高热、寒战、昏迷与抽搐。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （三）实验室检查 1.血象 2.疟原虫检查 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （四）诊断性治疗 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 鉴别诊断 （一）一般疟疾应与下列疾病鉴别 ： 1.败血症 2.伤寒 3.钩端螺旋体病 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （二）脑型疟疾应与下列疾病鉴别 ： 1.流行性乙型脑炎 2.中毒性菌痢 （三）黑尿热应与其他急性溶血性 贫血鉴别 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 预后 间日疟与三日疟预后良好。恶性疟 常有凶险发作，死亡率较高。黑尿 热预后亦较差。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 治疗 一.一般治疗 1.一般疟疾 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2.凶险型疟疾 （1）体温过高者 （2）低分子右旋糖酐 （3）抽搐 （4）脑水肿与呼吸衰竭 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 3.黑尿热 （1）立即停用可疑药物 （2）控制溶血反应 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 二.抗疟原虫治疗 （一）常用的抗疟药物 1.控制临床发作的药物 （1）氯喹 (第1、天4次/日，第三天次日) （2）青蒿素（蒿甲醚首剂mg、第天mg, 疗程天） （3）奎宁 （4）哌喹 （5）磺胺类与甲氧苄氨嘧啶 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2.控制复发和传播的药物 磷酸伯氨喹（伯喹片日，疗程天） 3.主要用于预防的药物 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （二）一般疟疾的治疗 首选氯喹和 伯氨喹啉联合治疗。第13日两药同 服，均为一次顿服，第4日单服伯氨 喹啉；如需改用其他药物时，也应 同时用伯氨喹啉，且其剂量和用法 不变。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （三）凶险型疟疾 1.氯喹 可肌注或加在5%葡萄糖 500ml中静滴，成人第1日0.3（基质 ），每8小时1次，第2、3日各0.3（ 基因）静滴。由于恶性疟原虫对氯 喹的耐药性很高，故已较少应用。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2