湘雅儿科精品课件-measles（可编辑）

湘雅儿科精品课件MEASLES第十章第一节1麻疹中南大学儿科学教研室3/26/20141目的要求23/26/2014概述OVERVIEW33/26/2014概述OVERVIEWKOPLIKCLINICALFEATURESFEVER,UPPERRESPIRATORYINFLAMMATION,CONJUNCTIVITIS,KOPLIKSSPOTSANDGENERALIZEDMACULOPAPULARRASH43/26/2014病原ETIOLOGYMEASLESVIRUSRNACONTAININGVIRUSOFTHEPARAMYXOVIRUSFAMILY,ONLYONESEROTYPE53/26/2014病原ETIOLOGYMEASLESVIRUSMEASLESVIRUSARERAPIDLYINACTIVATEDBYHEAT,LIGHT,ANDALLKINDSOFDESINFECTANT,BUTCANBESTOREDINDEFINITELYATLOWTEMPERATURE63/26/2014病原ETIOLOGYMEASLESVIRUSDURINGTHEPRODROMALPERIODANDERUPTIONPERIOD,ITISFOUNDINSECTIONSOFCONJUNCTIVA,NOSE,PHARYNX,TRACHEAANDSOON73/26/2014麻疹的发病机制83/26/2014病理PATHOGEYHYPERPLASIAOFALLLYMPHOIDTISSUEUSUALLYOCCURS,MULTINUCLEATEDGIANTCELLSMAYBEFOUND93/26/2014病理PATHOGEY多核巨细胞MULTINUCLEATEDGIANTCELLS多个巨噬细胞融合形成的具有核内外包涵体的巨细胞网状内皮巨细胞也称华佛细胞RETICULOENDOTHELIALGIANTCELLSORWARTHINFINKELDEYCELLS存在于全身淋巴组织和肝、脾等脏器中上皮巨细胞EPITHELIALGIANTCELLS主要位于皮肤、眼结合膜、呼吸道和消化道粘膜等处103/26/2014病理PATHOGEYPROLIFIERATIONOFMONONUCLEARCELLSISFOUNDINTHESKIN,INTHECONJUNCTIVAEANDINTHEMUCOUSMEMBRANESOFTHENASOPHARYNX,BRONCHI,ANDINTESTINALTRACT,MULTINUCLEATEDGIANTCELLSOCCURAROUNDTHECAPILLARIESHYPERPLASIAOFLYMPHOIDTISSUEOCCURS113/26/2014病理PATHOGEY123/26/2014病理PATHOGEY133/26/2014病理PATHOGEY麻疹皮疹的病理改变真皮毛细血管内皮增生、血浆渗出、红细胞相对增多形成淡红色斑丘疹MACULOPAPULARRASHCONSISTSOFPROLIFERATIONOFCAPILLARYENDOTHELIALCELLSINSKIN,SEROUSEXUDATEANDRELATIVEINCREASEOFREDCELLS疹退后,表皮细胞坏死、角化形成脱屑。皮疹处红细胞裂解,疹退后形成棕色色素沉着。143/26/2014临床表现典型麻疹TYPICALMEASLESINCUBATIONSTAGE10141ITLASTSUSUALLY1014DAYSAFTERCONTACT,MAYBEASSHORTAS1WEEKTHETEMPERATUREMAYINCREASEDSLIGHTLY153/26/2014临床表现典型麻疹PRODROMALSTAGEFROMFEVERTORASHAPPEARANCE,USUALLYLASTS34DAYS163/26/2014临床表现典型麻疹PRODROMALSTAGESTIMSONFEVER,UPPERRESPIRATORYINFLAMMATION,CONJUNCTIVITISKOPLIKSSPOTS173/26/2014临床表现KOPLIKSSPOTS麻疹粘膜斑24482448HOURSBEFORETHEAPPEARANCEOFTHERASHINITIALLYOPPOSITETHELOWERMOLARSBUTMAYSPREADTHERESTOFTHEBUCCALANDLIPMUCOSA183/26/2014临床表现KOPLIKSSPOTS麻疹粘膜斑1GRAYISHWHITEDOTSWITH1MMINDIAMETER,USUALLYASSMALLASGRAINSOFSAND,THATREDDISHAREOLAE1THEYSPREADRAPIDLYWITHINONEDAYANDDISAPPEARGRADUALLYAFTERTHEAPPEARANCEOFTHERASH193/26/2014203/26/2014典型麻疹临床表现出疹期ERUPTIONSTAGE在发热35天后出现,持续35天出疹顺序INITIALLYOCCURRINGBEHINDTHEEARSANDHAIRLINEANDSPREADINGDOWNFROMTHEFOREHEADANDFACETONECK,THETRUNKANDTHEEXTREMITIES213/26/2014临床表现典型麻疹223/26/2014233/26/2014临床表现典型麻疹243/26/2014并发症COMPLICATIONS253/26/2014并发症COMPLICATIONS263/26/2014诊断DIAGNOSIS麻疹接触史EXPOSURETOMEASLESPREVIOUSLY典型临床表现TYPICALCLINICALMANIFESTATIONS273/26/2014诊断DIAGNOSIS前驱期鼻咽部找多核巨细胞及尿中检测包涵体细胞DURINGTHEPRODROMALSTAGE,MULTINUCLEATEDGIANTCELLSAREFOUNDINNASOPHARYNX,INTRANCUCLEARANDINTRACYTOPLASMICINCLUSIONBODIESCELLSAREFOUNDINURINE283/26/2014诊断DIAGNOSIS293/26/2014鉴别诊断34RUBEOLAKOPLIKRUBELLA35EXANTHEMASUBITUM612SCARLETFEVER1303/26/2014麻疹的流行病学及预防313/26/2014麻疹的流行病学及预防“”323/26/2014麻疹的流行病学及预防333/26/2014治疗TREATMENTTHEREISNOSPECIFICANTIVIRALTHERAPYTREATMENTISENTIRELYSUPPORTIVEANDSYMPTOMATICTREATMENT343/26/2014治疗353/26/2014治疗BEDREST,KEEPINGCOMFORTABLYH