急性上呼吸道感染(英文).ppt

,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,degenerationat1415yearsold-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,lowgradefevervomiting,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,sinu