1、赣南医学院第一附属医院儿科赣南医学院第一附属医院儿科 刘小生刘小生 QQ:619541197定义定义上呼吸道上呼吸道:包括鼻、鼻窦、咽、包括鼻、鼻窦、咽、咽鼓管、会厌及喉咽鼓管、会厌及喉鼻鼻:鼻黏膜嫩而血管丰富,易感:鼻黏膜嫩而血管丰富,易感染且易引起黏膜肿胀,从而易堵染且易引起黏膜肿胀,从而易堵塞,导致呼吸困难塞,导致呼吸困难鼻窦鼻窦:由于鼻窦黏膜与鼻腔黏膜:由于鼻窦黏膜与鼻腔黏膜相连续,急性鼻炎常累及鼻窦相连续,急性鼻炎常累及鼻窦咽泪管和咽鼓管咽泪管和咽鼓管:鼻泪管短、咽:鼻泪管短、咽鼓管较宽,故鼻腔感染时易引起鼓管较宽,故鼻腔感染时易引起结膜炎及中耳炎结膜炎及中耳炎咽部、扁桃体:咽部、扁
2、桃体:扁桃体炎常见年扁桃体炎常见年长儿,婴儿少见长儿,婴儿少见喉:喉:喉黏膜嫩而富有血管及淋巴喉黏膜嫩而富有血管及淋巴组织,轻微炎症易引起声音嘶哑组织,轻微炎症易引起声音嘶哑和吸气性呼吸困难和吸气性呼吸困难系由各种病原体引起的上呼吸道系由各种病原体引起的上呼吸道的急性感染(简称的急性感染(简称上感上感),俗称),俗称“感冒感冒”主要侵犯主要侵犯鼻、鼻咽和咽部鼻、鼻咽和咽部急性上呼吸道感染就是急性上呼吸道感染就是上呼吸道上呼吸道局部感染的说法并不确切局部感染的说法并不确切急性上呼吸道感染急性上呼吸道感染(Acute Upper Respiratory Infection)病因病因病毒病毒:占:占
3、90%以上以上细菌细菌:溶血性链球菌常见:溶血性链球菌常见肺炎支原体肺炎支原体:既可引起肺炎,也可引:既可引起肺炎,也可引起上感起上感婴幼儿上呼吸道婴幼儿上呼吸道解剖和免疫特点易患解剖和免疫特点易患本病本病营养障碍性疾病、免疫缺陷病、被动营养障碍性疾病、免疫缺陷病、被动吸烟、护理不当、气候和环境吸烟、护理不当、气候和环境等因素等因素临床表现临床表现局部症状局部症状:鼻塞、流涕、喷嚏鼻塞、流涕、喷嚏、干咳、干咳、咽部不适和咽痛咽部不适和咽痛全身症状全身症状:发热发热、烦燥不安、烦燥不安、头头痛、痛、全身不适、全身不适、乏力乏力、亦伴有食、亦伴有食欲不振、呕吐腹泻、欲不振、呕吐腹泻、腹痛腹痛等症状
4、等症状体征体征:咽部充血、:咽部充血、扁桃体肿大,扁桃体肿大,化脓,化脓,淋巴结肿大、淋巴结肿大、皮疹皮疹等等疱疹性咽峡炎疱疹性咽峡炎为为柯萨奇柯萨奇A组病毒组病毒,好发于,好发于夏秋季夏秋季起病起病急、高热、咽痛急、高热、咽痛、流涎、厌食、流涎、厌食、呕吐呕吐等等咽部充血、咽峡部可见咽部充血、咽峡部可见灰白色疱疹,灰白色疱疹,周边无红晕,之后形成周边无红晕,之后形成小溃疡小溃疡,疱,疱疹也可在口腔部疹也可在口腔部病程为病程为1周周咽结合膜热咽结合膜热腺病毒腺病毒3、7型型,好发,好发春夏春夏季节季节发热、咽炎、结膜炎发热、咽炎、结膜炎为特征为特征,病程病程12周周临床表现临床表现:高热高热、
5、咽痛咽痛、眼部刺痛眼部刺痛,有时伴消化道症状有时伴消化道症状体征体征:咽部充血咽部充血、可见点状分泌物、可见点状分泌物;一侧或双侧一侧或双侧眼结合膜炎眼结合膜炎,可伴球结合可伴球结合膜出血膜出血;颈及耳后颈及耳后淋巴结增大淋巴结增大并发症并发症婴幼儿婴幼儿:中耳炎、鼻窦炎、中耳炎、鼻窦炎、咽后壁脓肿、扁桃体周围脓咽后壁脓肿、扁桃体周围脓肿、颈淋巴结炎、喉炎、支肿、颈淋巴结炎、喉炎、支气管炎及肺炎气管炎及肺炎年长儿年长儿:可急性肾小球肾炎:可急性肾小球肾炎和风湿热等和风湿热等实验室检查实验室检查病毒感染者病毒感染者:WBC正常或偏正常或偏低,低,N#减少,减少,L#相对增高,相对增高,病毒分离和
6、血清学可明确病病毒分离和血清学可明确病原原细菌感染者:细菌感染者: WBC可增高,可增高,N#增高,增高,CRP升高升高治疗治疗一般治疗一般治疗:注意休息、保注意休息、保持良好的环境、多饮水持良好的环境、多饮水和补充大量维生素和补充大量维生素C等等抗感染:抗感染:抗病毒、抗感抗病毒、抗感染染对症治疗对症治疗高热高热可口服对乙酰氨基酚或布洛可口服对乙酰氨基酚或布洛芬,也可用冷敷、温湿敷或酒精芬,也可用冷敷、温湿敷或酒精浴降温浴降温高热惊厥高热惊厥者给予镇静、止惊等处者给予镇静、止惊等处理理咽痛咽痛可含服咽喉片可含服咽喉片中成药中成药有较好的效果有较好的效果8WBg&Jo2RwaZEi)Mq5Uy
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11、t7WBf&Jn2RvaZDi)Lq5Tyd!Gk+Os7WAf&In2QvaYDi(Lq4Txc!Fk+Ns7VAf%In1Qv9YDh(Lp4Sxc#Fk-Ns6VAe%Im1Qu9YCh(Kp3Sxb#Fj-Nr6Vze%Hm1Pu9XCg*Ko3Swb#Ej-Mr6Uze$Hm0Pu8XBg*Jo3RwbZEj)Mr5Uzd$Hl0Lq5Tyd!Gl+Os7WAf&In2QvaYDi(Lq4Tyc!Fk+Ns7VAf%In1Qv9YDh(Lp4Txc#Fk-Ns6VAe%Im1Qu9YCh(Kp4Sxb#Fj-Nr6Vze%Hm1Pu9XCh*Ko3Swb#Ej-Mr6Uze$Hm0P
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16、Di(Lq4Tyc!Gk+Os7WAf%In1Qv9YDh(Lp4Txc!Fk+Ns7VAe%Im1Qu9YCh(Kp4Sxc#Fk-Ns6Vze%Hm1Pu9XCh*Kp3Sxb#Fj-Mr6Uze$Hm0Pu8XCg*Ko3Swb#Ej)Mr5Uzd$Hl0Pt8XBg*Jo3RwbZEi)Mq5Uyd$Gl0Ot8WBg&Jo2RvaZDi)Lq5Tyd!Gl+Ot7WBf&Jn2QvaYDi(Lq4Tyc!Gk+Os7WAf%In1Qv9YDh(Lp4Txc!Fk+Ns7VAe%Im1Qu9YCh(Kp4Sxc#Fk-Ns6Vze%Hm1Pu9XCh*Kp3Sxb#Fj-Mr6Uze$
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19、Jn2RvaZDi(Lq4Tyc!Gk+Os7WAf&In2QvaYDh(Lp4Txc!Fk+Ns7VAf%In1Qv9YCh(Kp4Sxc#Fk-Ns6VAe%Im1Pu9XCh*Kp3Sxb#Fj-Nr6Vze%Hm0Pu8XCg*Ko3Swb#Ej-Mr6Uze$Hl0Pt8XBg*Jo3RwbZEj)Mr5Uyd$Gl0Ot8WBg&Jo2RwaZEi)Mq5Tyd!Gl+Ot7WBf&Jn2RvaZDi(Lq4Tyc!Gk+Os7WAf&In2QvaYDh(Lp4Txc!Fk+Ns7VAb#Fj-Nr6Vze%Hm1Pu8XCg*Ko3Swb#Ej-Mr6Uze$Hm0Pt8XBg*
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