泌尿道感染精品课件

泌尿道感染 （Urinary Tract Infections,UTI） 重庆医科大学儿科学院重庆医科大学儿科学院 李李 秋秋 概 述 一、 定义： 又称尿感,是尿路内大量微生物繁殖而引 起的尿路炎症（广义）。临床尿感主要指 尿路的细菌感染（狭义）。 二、 发病情况： 地位 年龄 性别 病因及发病机理 一、 小儿易发生尿感的原因 1.解剖生理特点 （1）尿道平滑肌发育差 （2）尿道口解剖位置 （3）局部防御能力低下 2.尿路畸形及结构异常 先天畸形、肾发育异常 3.膀胱输尿管返流等 二、致病原 1.种类： G-杆菌最常见，其中80-90%大肠杆菌， G+菌少，表皮葡萄球菌、白色葡萄球菌等 三、 细菌毒力 粘附力、毒素、代谢力、抗杀菌力 四、 感染途径 1. 上行性感染：主要途径 2. 血行感染：新生儿、小婴儿常见 3. 淋巴感染 4. 直接感染 5. 尿路侵入性检查 病理 一、 急性膀胱炎 二、 急性肾盂肾炎 三、 慢性肾盂肾炎 临床表现 一、急性尿路感染 1.新生儿：全身症状为主，尿道局部症状缺如。 2.婴幼儿：全身症状明显，泌尿道症状轻微。 3.儿童期（年长儿）： （1） 下尿路感染：局部症状重、全身症状极少 （2） 上尿路感染：全身症状明显、有局部排尿 症状 二、慢性尿路感染 1.病程6月以上； 2.临床症状（全身+局部） 3.肾瘢痕、肾功能受损、肾性高血压。 实验室及其它辅助检查 一、尿常规检测：尿WBC增高或WBC管型 二、 Addis计数：WBC100万/12hr 三、 尿细菌培养及菌落计数：重要诊断依据 清洁中段尿培养菌落计数10万/ml -确诊 膀胱穿刺取尿培养 (+): 确诊 四、 尿液直接涂片找细菌： 五、 亚硝酸盐试验-菌尿辅检 六、 影象学检查 七、 其它：肾功、尿酶 诊断及鉴别 一、诊断： 1.确诊：临床症状+尿培养结果 2.鉴别急、慢性：病程、肾疤痕或肾功能 损伤 3.鉴别上、下尿路感染 4.鉴别有无复杂性尿感的基础：复杂性尿 路感染 上下尿路感染鉴别要点 上下尿路感染鉴别要点 项 目上尿路下尿路 症状：发热易见罕见 中毒症状（全身症状）易见少 腰背疼（年长儿）可见少 辅检：细胞管型可见少 尿白蛋白+-+/- 尿酶N 尿2MGorNN THPorN SRN C-RPN 输尿管导管法取尿培养+- 菌种G+/G-B大肠杆菌 二、与其它疾病鉴别 1.肾结核： 2.白天尿频综合征 3.急性肾小球肾炎 治疗 治疗原则： 积极控制感染、防止复发、祛除病因、纠 正先天或后天尿路结构异常，防止肾功能 损伤 一、 一般治疗：休息、饮水、清洁等 二、 抗菌疗法：本病治疗关键 抗生素选药原则： 根据感染部位、尿培养及药敏结果选药， 肾毒性小的药物。 1.急性下尿路感染： 710日疗法 单剂及三日疗法 2.急性上尿路感染：两种抗生素、2周 3.复发的治疗26周+低剂量长程疗法 三、治疗泌尿系统器质性或功能性疾病 预后 急性预后好；慢性可发生肾功能不全 hxM$8oET+fvK#6mCR)dtJY4kAQ*brHX2iyO%9pFV0gwM$7nDT+euK#6lBR)dsIY4jzP*bqGW2ixN%9pEU0gwL!7nCS-euJZ5lBQ(csIX3jzP&aqGW1hxN$8oEU+fvL!6mCS-dtJZ5kAQ(brHX3iyO&apFV1hwM$8oDT+fvK#6mBR)dtIY4kAP*brHW2iyO%9pFU0gwM!7nDT-euuJZ5lBQ(csIX3jzP&aqGV1hxN$8oEU+fvL!6mCS-dtJZ4kAQ(brHX3iyO&apFV1hwM$8oDT+fuK#6mBR)dtIY4kAP*brHW2iyN%9pFU0gwM!7nDT-euK#5lnDS-euKZ5lBR(csIY3jzP&aqGW1hxN%rGW2iyN%9pFU0gwM!7nDS-euKZ5lBR(csIY3jzP*aqGW1hxN%8oEU0fvL!7mCS- 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