急性上呼吸道感染（英文）课件

RespiratorySystemDisorders Pediatricpulmonarydiseasesaccountforalmost50 ofdeathsinchildrenunderage1yearand20 ofallhospitalizationofchildrenunderage15years Bryceetal WHOestimatesofthecausesofdeathinchildren Lancet2005 Respiratorytractinfectionsrepresentthemostcommoninfectionsofchildhoodandrangefromtrivialtolifethreateningillness Otherdiseasesofthissystemincludeasthma disordersofpleuraorpleuracavity lungtumor congenitalabnormality AnatomyandPhysiologyofRespiratorySystem Theknowledgeofbasicrespiratoryphysiologyandanatomyisoneofthebasicrequirementsforcorrectinterpretationofsymptomsandphysicalsignsandintheattainmentofanageappropriatedifferentialdiagnosis Thereareanumberofsignificantanatomicandphysiologicaldifferencesbetweenchildrenandadultsthathaveimpactonassessmentandmanagement Thechildisnotonlyphysicallysmallerbutalsohasimmaturerespiratorysystemswithfewerreservesthanthoseoftheadult NormalanatomyRespiratorysystemisdividedintoupperrespiratorytractandlowerrespiratorytractbycricoidcartilage upperrespiratorytract nose nasalsinuses pharynx pharyngotympanictube epiglottis larynxlowerrespiratorytract trachea bronchus bronchiole respiratorybrochiole alveolarductules alveolus Nasalpassageisshorter novibrissa mucosahasarichvascularity liabletoinfectionNasalpassageisnarrow liabletoobstruction resulteddyspnea Nasalsinusostiaislarge nasosinusitis pharyngotympanictubeisbroader straighter shorterandhorizontal otitismedia pharyngealtonsils starttoenlargeattheendof1year peakat4to10year old degenerationat14 15yearsold tonsillitisrarelyoccursininfants Larynxisinashapeoffunnelandnarrow cartilageisflexible mucosaistenderandrichofvessel laryngealedemaandnarrow Tracheaandbronchusarenarrowerthanthoseofadult cartilageisflexible lackofelasticitytissue supportingactionisweakAirwaywallaccountfor30 ofAirwaywallareainchildren 15 inadult mucosaistenderandrichofvessel Therightmainbronchusismoreverticalandbroaderthantheleftanditoffersaneasierpassageforaspiratedforeignbodiers Bronchiolehasnotcartilage easytocollapse resulttoretentionofgasandeffecttheexchangeofgas Theamountandsizeofalveolusislessandsmall Chestisshorterandinabarrelshape hasasmallerscopeofactivities Theairwayarelinedwithanepithelialmembranethatgraduallychangesfromciliatedpseudostratifiedcolumnarepitheliuminthebronchitoaciliatedcuboidalepitheliumnearthegas exchangingunits Thethreelobes upper middleandlower ofrightlunghasseparatedbythehorizontalandobliquefissures respectively Theleftlunghastwomajorlobes upperandlower separatedbyanobliquefissure andtheupperlobeisitselfdividedintoupperandlingularlobes Therightlungandtheleftlungprojectlowdownbehindthedomeofthediaphragmandpeakbehindtheclavicles NormalphysiologyTheprincipalfunctionofthelungistocarrythroughgasexchange whichistoenrichthebloodwithoxygenandcleanseitofcarbondioxide Anessentialfeatureofnormalgasexchangeisthatthevolumeanddistributionofventilationareappropriate Theextrathoraciccomponentsoftherespiratorytreetrendtocollapseinwardsduringinspirationandopenduringexpiration Therefore iftheextrathoracicairwayisobstructed theobstructionisfirstevidentduringinspirationand astheairwayfurthernarrows obstructionoccursduringbothphasesofbreathing Bytheactionofrespiratorymusclestheintrathoracicairwaysareactivelyopenedduringinspiration Inaddition surfactantreducesthesurfacetensionofthealveoli therebyreducingtheefforttokeepthealveoliopenduringinspiration Duringexpiration theairwaystendtocollapsebecauseofthenaturalelasticityofthelung Therefore partialobstructionoftheintrathoracicairwayscausesearlierclosureoftheairwaysduringexpirationandresultsinair trappingwitheventualoverinflationofthelung Acuteupperrespiratorytractinfection Theupperrespiratorytractcomprisesthenose throat tonsils pharynx andsinuses Acuteupperrespiratoryinfection alsocalledcommoncoldsyndrome isverycommoninallpaediatricagegroups Thenoseandpharynxarethemostcommonsitesofinfection Etiology Viruses respiratorysyncyticalvirus rhinovirus adenovirus parainfluenzavirus andinfluenzavirus Bacterial streptococcus Clinicalmanifestations Thecommomcold runningnose nasalcongestion sorethroat lacrimation cough andsneezing low gradefevervomiting diarrhea abdomenpainsconvulsion SpecialtypesofAURI 1 herpangian causebycoxsackievirusfever extremeirritability poorappetitesmallblister ulcersonthelips gumsandtongue 2 pharyngo conjunctivalfever causedbyadenovirustype3ortype7 fever pharyngitis conjunctivitisswollenlymphnodes glandgastrointestinalsymptoms Complication OtitismediaInfectiouslaryngitisPeritonsillarabscessPneumoniaPost streptococcalglomerulonephritisRheumaticfever Laboratorytest Virus whitebloodcellcountisusuallynormaltolow virusisolationandserumtestcanconfirmtheagent Bacteria whitebloodcellcountmayincrease Pathogenicbacteriacanalsobeculturedfrompharyngealswabsorthroatwashings ASOtiterisincreasedafterstreptococcusinfection Diagnosisanddifferentialdiagnosis Diagnosisismadebyclinicalmanifestation Butthefollowingmaybeconsideredfordifferentialdiagnosis 1 Influenza influenzainfectioniseasiyrecognizedduringepidemics Inolderchildrenproducesasyndromeofsuddenonsetofhighfever severemyalgia headache andchills Parainfluenzavirusorinfluenzaviruscouldbefound 2 Earlierperiodofacueinfectiousdisease Epidemics clinicalmanifestations andlaboratoryfindingsmaybearrivedatthediagnosis Payattentiontostateoftheillness 3 Acuteappendicitis Abdominalpainmaypresentbeforefever Localizationofpaintothehypogastricregion Abdominalmuscleistensewithfixedtenderness Whitebloodcellcountsmayincrease Treatment Generaltherapy rest ensureanadequatefluidintake andpreventcomplication Pathogenictherapy Antivirus Clinicallyusedanti virusdrugsincludevirazole ribavirin persantineandinterferon Thedrugcouldbeusedfor3to5day Ifitiscausedbyhemolyticstreptococci penicillinshouldbeusedfor10to14days Symptomaticmanagement Feveriscontrolledbyantipyretics suchascompoundaminopyrine andparacetamol Alcoholspongingalsoisused Someorallaryngopharynxdrugcouldbegiventocontrolsorethroat Chineseherb banlangen daqingyeandsooncanantivirusandrelievetoxicitysymptom AcuteBronchitis Acutebronchitisisaninfectionofhebronchialmucousmembranes Itmaybecomplicationofacuteupperrespiratoryinfection orclinicalsituationofacuteinfectiondisease Becausetracheaisusuallyinvolvedatthesametime soitisalsodefinedasacutetacheobronchitis Thisdisorderappearstobemorecommoninyoungerchildren EtiologybacteriaVirusRhinitis s