儿科麻疹医学知识讲座培训课件.ppt

1、儿科麻疹医学知识讲儿科麻疹医学知识讲座座目的要求目的要求熟悉熟悉麻疹的病因及流行病学麻疹的病因及流行病学 了解了解麻疹的发病机理与组织病理麻疹的发病机理与组织病理掌握掌握典型麻疹的临床特点和诊断要点。典型麻疹的临床特点和诊断要点。掌握麻疹常见并发症掌握麻疹常见并发症掌握掌握麻疹与其他小儿常见出疹性疾病的鉴别诊断麻疹与其他小儿常见出疹性疾病的鉴别诊断掌握麻疹的防治原则及方法掌握麻疹的防治原则及方法 了解不典型麻疹的临床特点了解不典型麻疹的临床特点2儿科麻疹医学知识讲座儿科麻疹医学知识讲座DEFINITIONDEFINITION（定义）（定义）Measles is an acute highly

2、contagious Measles is an acute highly contagious viral disease caused by viral disease caused by measles measles virusvirus.由由麻疹病毒麻疹病毒引起的急性出疹性呼吸道传引起的急性出疹性呼吸道传染病。染病。3儿科麻疹医学知识讲座儿科麻疹医学知识讲座DEFINITIONDEFINITION（定义）（定义）It is characterized by fever,URT It is characterized by fever,URT catarrhal catarrhal i

3、nflamation,Koplikspots and inflamation,Koplikspots and maculopapularmaculopapular.临床特征：临床特征：发热发热、流涕、结膜炎、咳嗽、流涕、结膜炎、咳嗽、麻疹黏膜斑、麻疹黏膜斑、全身全身斑丘疹、斑丘疹、疹退后疹退后糠麸样脱屑糠麸样脱屑并留有棕色并留有棕色色素沉着。色素沉着。4儿科麻疹医学知识讲座儿科麻疹医学知识讲座ETIOLOGYETIOLOGY（病原学（病原学)Paramyxovirus(病毒属副粘液病病毒属副粘液病毒科毒科)It is spherical in appearance,It is spherica

4、l in appearance,about 100about 100250nm in diameter.250nm in diameter.球形或多形性颗粒球形或多形性颗粒,直径直径100100250nm250nm5儿科麻疹医学知识讲座儿科麻疹医学知识讲座ETIOLOGYETIOLOGY（病原学（病原学)It has an outer envelope composed of six protein and internal core is RNA.外层脂蛋白膜外层脂蛋白膜 有有6种不同作用蛋白种不同作用蛋白 H：血凝作用血凝作用 F：溶血作用溶血作用 M：蛋白缺陷与蛋白缺陷与SSPS关系关系

5、6儿科麻疹医学知识讲座儿科麻疹医学知识讲座ETIOLOGYETIOLOGY（病原学（病原学)Measles virus is sensitive to Measles virus is sensitive to heat or disinfectant,it is heat or disinfectant,it is also inactived by ultraviolet also inactived by ultraviolet light easilylight easily 体外生活力弱，对热、体外生活力弱，对热、一般消毒剂一般消毒剂,紫外线敏感紫外线敏感 低温下可保存数月至低温下可

6、保存数月至数年数年 7儿科麻疹医学知识讲座儿科麻疹医学知识讲座ETIOLOGYETIOLOGY（病原学（病原学)measles virus can be detected from blood,measles virus can be detected from blood,urine,urine,nasal and pharyngeal secretions.nasal and pharyngeal secretions.病毒存在于眼结膜、口腔、鼻咽、气管分泌物，血和病毒存在于眼结膜、口腔、鼻咽、气管分泌物，血和尿中尿中(前驱期和出疹早期前驱期和出疹早期)，白细胞内也有此病毒，白细胞内也有此

7、病毒8儿科麻疹医学知识讲座儿科麻疹医学知识讲座EPIDEMIOLOGY(EPIDEMIOLOGY(流行病学流行病学)Source of infectionSource of infection The patients are the only source The patients are the only source of infectionof infection传染源：传染源：患者（眼鼻咽分泌物、血、尿）患者（眼鼻咽分泌物、血、尿）出疹前出疹前5 5天天-出疹后出疹后5 5天天 并发肺炎：出疹后并发肺炎：出疹后1010天天9儿科麻疹医学知识讲座儿科麻疹医学知识讲座EPIDEMIOLO

8、GY(EPIDEMIOLOGY(流行病学流行病学)Routes of transmissionRoutes of transmission -airborne -airborne传播途径：传播途径：飞沫飞沫 间接：日用品、玩具间接：日用品、玩具 10儿科麻疹医学知识讲座儿科麻疹医学知识讲座Susceptibility of populationSusceptibility of population All age person is susceptible;the permanent All age person is susceptible;the permanent immunity a

9、cquire after diseaseimmunity acquire after disease流行特征：流行特征：冬春多见，目前季节高峰、周期性流行的特征消失冬春多见，目前季节高峰、周期性流行的特征消失 8 8个月之前的婴儿发病和大年龄麻疹的出现是近来麻疹个月之前的婴儿发病和大年龄麻疹的出现是近来麻疹流行的新变化流行的新变化-与疫苗使用有关与疫苗使用有关EPIDEMIOLOGY(EPIDEMIOLOGY(流行病学流行病学)11儿科麻疹医学知识讲座儿科麻疹医学知识讲座EPIDEMIOLOGY(EPIDEMIOLOGY(流行病学流行病学)Morbidity and mortality are

10、 high in Morbidity and mortality are high in countries with substandard living countries with substandard living conditions and poor nutritionconditions and poor nutritionincluding including 12儿科麻疹医学知识讲座儿科麻疹医学知识讲座PATHOGENSIS AND PATHOLOGYPATHOGENSIS AND PATHOLOGYMeasles virus respiratory tract epith

11、elial cells lymphoid tissue blood(first virusemia)MPS(multiply)blood(second virusemia)general toxic symptoms13儿科麻疹医学知识讲座儿科麻疹医学知识讲座发病机理发病机理(1)(1)麻疹病毒麻疹病毒飞沫飞沫鼻、口咽、眼结膜鼻、口咽、眼结膜2 23 3天天粘膜细胞和局部淋巴结粘膜细胞和局部淋巴结第一次病毒血症第一次病毒血症全身淋巴组织，网状内皮系统全身淋巴组织，网状内皮系统第二次病毒血症第二次病毒血症 全身组织，出现症状全身组织，出现症状14儿科麻疹医学知识讲座儿科麻疹医学知识讲座发病机理发

12、病机理(2)(2)机体免疫反应机体免疫反应 The antibody IgM appeared early,it disappeared 1 The antibody IgM appeared early,it disappeared 1 month later when the antibody IgG appeared.month later when the antibody IgG appeared.IgM抗体，早期诊断指标抗体，早期诊断指标;IgG抗体，终身免疫。抗体，终身免疫。15儿科麻疹医学知识讲座儿科麻疹医学知识讲座发病机理发病机理(3)(3)麻疹感染时对机体免疫系统有暂时抑制

13、麻疹感染时对机体免疫系统有暂时抑制 免疫反应受抑制免疫反应受抑制 变态反应变态反应受抑制受抑制 易发生细菌性感易发生细菌性感 染染(鼻窦炎、中耳鼻窦炎、中耳炎、支气管肺炎）炎、支气管肺炎）使结核复燃，使结核复燃，PPDPPD由阳性由阳性变成阴性变成阴性可使湿疹、哮可使湿疹、哮喘、肾病综合征喘、肾病综合征患儿病情得到暂患儿病情得到暂时缓解时缓解16儿科麻疹医学知识讲座儿科麻疹医学知识讲座PATHOLOGY(PATHOLOGY(病理病理)17儿科麻疹医学知识讲座儿科麻疹医学知识讲座口腔粘膜：口腔粘膜：充血，充血，麻疹粘膜斑麻疹粘膜斑(KoplikspotKoplikspot)形成形成呼吸道：呼吸道

14、：粘膜充血，水肿，肺间质性改变粘膜充血，水肿，肺间质性改变皮肤：皮肤：真皮毛细血管内皮细胞增生、血浆渗出，真皮毛细血管内皮细胞增生、血浆渗出，形成形成斑丘疹斑丘疹(Maculopapular)(Maculopapular)色素沉着色素沉着(Pigmentation)(Pigmentation)糠麸样脱屑糠麸样脱屑(Desquamation)(Desquamation)PATHOLOGY(PATHOLOGY(病理病理)18儿科麻疹医学知识讲座儿科麻疹医学知识讲座PATHOLOGY(PATHOLOGY(病理病理)脑：脑：弥漫性充血，水肿，点状出血，脱髓鞘改变弥漫性充血，水肿，点状出血，脱髓鞘改变胃

15、肠道：胃肠道：粘膜卡他性改变粘膜卡他性改变,消化道症状消化道症状心心 肝肝 肾：肾：细胞混浊肿胀，脂肪变性和灶性坏死细胞混浊肿胀，脂肪变性和灶性坏死19儿科麻疹医学知识讲座儿科麻疹医学知识讲座CLINICAL MANIFESTATIONS(CLINICAL MANIFESTATIONS(临床表现）临床表现）Typical measlesTypical measles（典型麻疹）（典型麻疹）Atypical measlesAtypical measles（非典型麻疹）（非典型麻疹）20儿科麻疹医学知识讲座儿科麻疹医学知识讲座CLINICAL MANIFESTATIONS(CLINICAL MAN

16、IFESTATIONS(临床表现）临床表现）Typical measles(Typical measles(典型麻疹典型麻疹)Incubation stage(Incubation stage(潜伏期潜伏期)6-186-18天天10 days is the most common.10 days is the most common.21儿科麻疹医学知识讲座儿科麻疹医学知识讲座CLINICAL MANIFESTATIONS(CLINICAL MANIFESTATIONS(临床表现）临床表现）Prodromal stageProdromal stage （前驱期）（前驱期）3 34 4天天 Th

17、is usually lasts 3-4 days.It is marked by This usually lasts 3-4 days.It is marked by fever,malaise,anorexia,and 3Cs:fever,malaise,anorexia,and 3Cs:Cough,Cough,Coryza,Conjunctivitis,Coryza,Conjunctivitis,Kopliks spots.Kopliks spots.中度发热，呼吸道炎症与上呼吸道感染不易区别中度发热，呼吸道炎症与上呼吸道感染不易区别结膜充血、流泪、畏光及眼睑水肿结膜充血、流泪、畏光及

18、眼睑水肿pic3pic3早期诊断依据早期诊断依据22儿科麻疹医学知识讲座儿科麻疹医学知识讲座CLINICAL MANIFESTATIONS(CLINICAL MANIFESTATIONS(临床表现）临床表现）Kopliks spotsKopliks spots在发疹前在发疹前24244848小时出现，开始仅在对着小时出现，开始仅在对着下臼齿相对应的颊黏膜上，可见直径约下臼齿相对应的颊黏膜上，可见直径约1.0mm1.0mm灰灰白色小点白色小点(tiny white spots like grains of(tiny white spots like grains of salt)salt)，外有

19、红色晕圈，常在，外有红色晕圈，常在1-21-2天内迅速增多，天内迅速增多，可累及整个颊黏膜并蔓延至唇部黏膜，于出疹可累及整个颊黏膜并蔓延至唇部黏膜，于出疹后后1 12 2天迅速消失，可留有暗红色小点。天迅速消失，可留有暗红色小点。Pic1Pic123儿科麻疹医学知识讲座儿科麻疹医学知识讲座CLINICAL MANIFESTATIONS(CLINICAL MANIFESTATIONS(临床表现）临床表现）Eruption stage(Eruption stage(出疹期出疹期)this stage lasts 3-5 days24儿科麻疹医学知识讲座儿科麻疹医学知识讲座CLINICAL MANI

20、FESTATIONS(CLINICAL MANIFESTATIONS(临床表现）临床表现）Identified by a typically blotchy,Identified by a typically blotchy,bright red maculopapular eruption,it bright red maculopapular eruption,it may be come confluent and blanches may be come confluent and blanches under pressure.under pressure.皮疹特点皮疹特点 红色斑丘

21、疹、压之褪色、疹红色斑丘疹、压之褪色、疹 间正常皮肤间正常皮肤,不伴痒感不伴痒感pic4pic425儿科麻疹医学知识讲座儿科麻疹医学知识讲座CLINICAL MANIFESTATIONS(CLINICAL MANIFESTATIONS(临床表现）临床表现）Sequence:behind the ear along the Sequence:behind the ear along the hairline face neck chest back hairline face neck chest back abdomen limbs hand and feetabdomen limbs han

22、d and feet 出疹顺序出疹顺序 耳后耳后发际发际额面部额面部颈部颈部躯干躯干 四肢四肢手心、足底手心、足底pic5pic526儿科麻疹医学知识讲座儿科麻疹医学知识讲座CLINICAL MANIFESTATIONS(CLINICAL MANIFESTATIONS(临床表现）临床表现）The temperature rise continuously and compaThe temperature rise continuously and companied with the toxic symptoms exaggeratenied with the toxic symptoms e

23、xaggerate全身症状全身症状 加重加重,体温升至体温升至0 040.540.5 肝、脾、淋巴结肿大，肺部罗音肝、脾、淋巴结肿大，肺部罗音X X线表现线表现 可见肺纹理增多或不同程度弥漫性可见肺纹理增多或不同程度弥漫性 肺部浸润肺部浸润pic6pic627儿科麻疹医学知识讲座儿科麻疹医学知识讲座CLINICAL MANIFESTATIONS(CLINICAL MANIFESTATIONS(临床表现）临床表现）Convalescent stage(Convalescent stage(恢复期恢复期 )The rash fades downward in the same seqThe ras

24、h fades downward in the same sequence which it appeared,as the rash fades,uence which it appeared,as the rash fades,brownish staining and branny desquamation brownish staining and branny desquamation occuoccured.red.Disease courseDisease course:10:1014 days14 days28儿科麻疹医学知识讲座儿科麻疹医学知识讲座非典型麻疹非典型麻疹(Aty

25、pical measles)(Atypical measles)轻型麻疹轻型麻疹(mild measles)(mild measles)重型麻疹重型麻疹(severe measles)(severe measles)异型麻疹异型麻疹(variant measles)(variant measles)29儿科麻疹医学知识讲座儿科麻疹医学知识讲座轻型麻疹轻型麻疹 见于有一定免疫力的患儿见于有一定免疫力的患儿潜伏期长、前驱期短、临床症状轻潜伏期长、前驱期短、临床症状轻常无常无KoplikKoplik斑，皮疹稀疏、色淡斑，皮疹稀疏、色淡,无色素沉无色素沉着或脱着或脱屑屑pic7pic7病程约病程约1

26、1周周无并发症无并发症30儿科麻疹医学知识讲座儿科麻疹医学知识讲座重型麻疹重型麻疹见于体弱多病、免疫力低下或继发感染见于体弱多病、免疫力低下或继发感染者者中毒症状重：中毒症状重：T T持续持续40,40,伴惊厥、昏迷伴惊厥、昏迷皮疹密集融合、常有粘膜出血皮疹密集融合、常有粘膜出血黑麻疹黑麻疹pic8pic8有循环不良的表现有循环不良的表现易并发肺炎、心力衰竭等并发症易并发肺炎、心力衰竭等并发症死亡率高死亡率高31儿科麻疹医学知识讲座儿科麻疹医学知识讲座 非典型麻疹综合征非典型麻疹综合征 接受过灭活或减毒麻疹疫苗接受过灭活或减毒麻疹疫苗 非典型皮疹非典型皮疹 无麻疹粘膜斑无麻疹粘膜斑 较重的临床

27、综合征较重的临床综合征 血清麻疹血凝抑制抗体有助于诊断血清麻疹血凝抑制抗体有助于诊断32儿科麻疹医学知识讲座儿科麻疹医学知识讲座并发症并发症(complications)(complications)pneumonia(pneumonia(肺炎肺炎)Pneumonia can be caused purely to the Pneumonia can be caused purely to the measles virus itself,but occurs more measles virus itself,but occurs more often because of added in

28、fection of often because of added infection of the damaged airways and lung surfaces the damaged airways and lung surfaces by other viruses or bacteria.by other viruses or bacteria.Pneumonia becomes evident through Pneumonia becomes evident through rapid,difficult breathing,worsening rapid,difficult

29、 breathing,worsening cough and chest pain cough and chest pain 最常见的并发症，引起死亡主要原因最常见的并发症，引起死亡主要原因 33儿科麻疹医学知识讲座儿科麻疹医学知识讲座并发症并发症(complications)(complications)Myocarditis(Myocarditis(心肌炎心肌炎)心功能不全的表现心功能不全的表现 心电图心电图T T波、波、S ST T段的改变段的改变laryngitis(laryngitis(喉炎喉炎)多见于多见于2 23 3岁小儿岁小儿 典型的犬吠样咳嗽典型的犬吠样咳嗽 严重时出现喉梗阻

30、严重时出现喉梗阻pic9pic934儿科麻疹医学知识讲座儿科麻疹医学知识讲座并发症并发症(complications)(complications)Encephalitis occurs in about 1/1 000 cases Encephalitis occurs in about 1/1 000 cases of measles.of measles.there is no correlation between the there is no correlation between the severity of the measles and the risk of severi

31、ty of the measles and the risk of encephalitis.encephalitis.At least 10 percent of children with At least 10 percent of children with measles encephalitis die and some are measles encephalitis die and some are left with mental retardation,deafness,left with mental retardation,deafness,paralysis or e

32、pilepsy.paralysis or epilepsy.Encephalitis(Encephalitis(脑炎脑炎)脑实质炎症的表现脑实质炎症的表现pic10pic1035儿科麻疹医学知识讲座儿科麻疹医学知识讲座并发症并发症(complications)(complications)Late complications(Late complications(远期并发症远期并发症)：Two rare complications are bronchiectasis aTwo rare complications are bronchiectasis and subacute scleros

33、ing panencephalitisnd subacute sclerosing panencephalitis36儿科麻疹医学知识讲座儿科麻疹医学知识讲座并发症并发症(complications)(complications)Subacute sclerosing pan-encephalitis(SSPE)is Subacute sclerosing pan-encephalitis(SSPE)is an extremely rare but dreaded condition,an extremely rare but dreaded condition,usually occurri

34、ng many years after measles.usually occurring many years after measles.SSPSSSPS（亚急性硬化性全脑亚急性硬化性全脑炎）炎）潜伏期潜伏期1717年，先出现智力和行为异常，数月年，先出现智力和行为异常，数月后出现阵发性肌抽搐，进行性加重，最后昏迷，后出现阵发性肌抽搐，进行性加重，最后昏迷，去大脑强直。去大脑强直。与缺乏对麻疹病毒的蛋白抗体有与缺乏对麻疹病毒的蛋白抗体有关关37儿科麻疹医学知识讲座儿科麻疹医学知识讲座并发症并发症(complications)(complications)结核恶化或播散结核恶化或播散 营养不

35、良与维生素营养不良与维生素A A缺乏症缺乏症38儿科麻疹医学知识讲座儿科麻疹医学知识讲座Laboratory findingsLaboratory findings（实验室检查）（实验室检查）Blood routine:WBC is relative lowBlood routine:WBC is relative low 周围血象改变周围血象改变 WBCWBC正常或正常或降低，淋巴细胞增高。淋降低，淋巴细胞增高。淋巴细胞严重减少提示预后不好。巴细胞严重减少提示预后不好。39儿科麻疹医学知识讲座儿科麻疹医学知识讲座Laboratory findingsLaboratory findings（实

36、验室检查）（实验室检查）Serum Ab measurement Serum Ab measurement specific antibody IgMspecific antibody IgM测定麻疹病毒抗体测定麻疹病毒抗体 血凝抑制抗体血凝抑制抗体双份血清，四倍增长双份血清，四倍增长 检测麻疹病毒检测麻疹病毒IgMIgM抗体（可用抗体（可用ELISAELISA方法）方法）40儿科麻疹医学知识讲座儿科麻疹医学知识讲座Laboratory findingsLaboratory findings（实验室检查）（实验室检查）Other Ag and multinucleated giant Othe

37、r Ag and multinucleated giant cellscellsThe separation of virusThe separation of virus早期诊断早期诊断 鼻咽分泌物找多核巨细胞或测鼻咽分泌物找多核巨细胞或测麻疹麻疹病毒抗原病毒抗原 分离病毒分离病毒41儿科麻疹医学知识讲座儿科麻疹医学知识讲座诊断诊断(DIAGNOSIS)(DIAGNOSIS)Epidemiologic data(Epidemiologic data(流行病学资料流行病学资料)Clinical manifestations(Clinical manifestations(各期典型临床特征各期典

38、型临床特征)前驱期前驱期 卡他征，麻疹黏膜斑卡他征，麻疹黏膜斑 出疹期出疹期 出疹顺序及形态，疹出热高特点出疹顺序及形态，疹出热高特点 恢复期恢复期 糠麸样脱屑和色素沉着糠麸样脱屑和色素沉着laboratory findings(laboratory findings(实验室检查实验室检查)多核巨细胞、血清抗体（特异性多核巨细胞、血清抗体（特异性 IgMIgM或或IgG4IgG4倍倍 ）、病毒分离、病毒抗原和基因检测）、病毒分离、病毒抗原和基因检测 42儿科麻疹医学知识讲座儿科麻疹医学知识讲座出疹性疾病的鉴别诊断（1）疾病疾病病原病原全身症状全身症状及其他特及其他特征征 皮疹特点皮疹特点发热与

39、皮发热与皮疹的关系疹的关系麻疹麻疹麻疹麻疹病毒病毒呼吸道卡他呼吸道卡他症状，结膜症状，结膜炎，口腔粘炎，口腔粘膜斑膜斑斑丘疹，自头面部斑丘疹，自头面部颈部颈部躯干躯干四四肢，退后有色素沉肢，退后有色素沉着及脱屑着及脱屑发热发热34天天出疹，出疹出疹，出疹期热更高期热更高风疹风疹Rubella风疹风疹病毒病毒全身症状轻，全身症状轻，耳后、枕部耳后、枕部淋巴结肿大淋巴结肿大并触痛并触痛斑丘疹，自面部斑丘疹，自面部躯干躯干四肢，退疹四肢，退疹后无色素沉着及脱后无色素沉着及脱屑屑发热后半天发热后半天到到1天出疹天出疹幼儿幼儿急疹急疹人疱人疱疹病疹病毒毒6型型一般情况好，一般情况好，耳后、枕部耳后、枕部

40、也可淋巴结也可淋巴结肿大肿大红色斑丘疹，红色斑丘疹，颈及颈及躯干部多见，一天躯干部多见，一天出齐，次日消退出齐，次日消退高热高热35天，天，热退疹出热退疹出43儿科麻疹医学知识讲座儿科麻疹医学知识讲座出疹性疾病的鉴别诊断（2）疾病疾病病原病原全身症状全身症状及其他特及其他特征征 皮疹特点皮疹特点发热与皮发热与皮疹的关系疹的关系猩红猩红热热乙型乙型溶血溶血性链性链球菌球菌高热、中高热、中毒症状重，毒症状重，咽峡炎、咽峡炎、杨梅舌，杨梅舌，扁炎扁炎皮肤弥漫充血、密皮肤弥漫充血、密集针尖样疹，持续集针尖样疹，持续35天，天，1周后全身周后全身大片脱皮大片脱皮发热发热12天天出疹，出疹出疹，出疹时高热

41、时高热肠道肠道病毒病毒感染感染埃可、埃可、柯萨柯萨奇病奇病毒毒发热，呼发热，呼吸和消化吸和消化道症状，道症状，淋巴结肿淋巴结肿大大散在散在斑丘疹，很少斑丘疹，很少融合，融合，13天消退，天消退，不脱屑，有时呈紫不脱屑，有时呈紫癜样或水泡样皮疹癜样或水泡样皮疹发热时或热发热时或热退后出疹退后出疹药物药物疹疹原发病症原发病症状状皮疹痒感，皮疹痒感，斑丘疹、斑丘疹、疱疹、猩红热样皮疱疹、猩红热样皮疹荨麻疹，疹荨麻疹，与用药与用药有关有关发热、服药发热、服药史史44儿科麻疹医学知识讲座儿科麻疹医学知识讲座Treatment(Treatment(治疗治疗)There is no specific tre

42、atment There is no specific treatment although symptoms can be relievedalthough symptoms can be relievedGeneral therapy:rest,stay in bed General therapy:rest,stay in bed and dietand diet一般治疗和护理一般治疗和护理 隔离隔离 一般麻疹一般麻疹5 5天，有并发症天，有并发症1010天天 通风，空气新鲜，保持口、眼、鼻通风，空气新鲜，保持口、眼、鼻清洁清洁45儿科麻疹医学知识讲座儿科麻疹医学知识讲座Treatmen

43、t(Treatment(治疗治疗)Symptomatic therapy:fever and coughSymptomatic therapy:fever and cough Support therapy:traditional chinese herbs Support therapy:traditional chinese herbs may be usedmay be used 对症治疗对症治疗 退热（可予物理降温或小剂量退热剂）退热（可予物理降温或小剂量退热剂）镇静，祛痰止咳，补充多种维生素镇静，祛痰止咳，补充多种维生素 中医中药治疗中医中药治疗46儿科麻疹医学知识讲座儿科麻疹医学知

44、识讲座The management of complications is The management of complications is determined by their nature and severitydetermined by their nature and severity并发症治疗并发症治疗 肺炎肺炎 抗生素抗生素 喉炎喉炎 抗生素，激素，必要时气管切开抗生素，激素，必要时气管切开 心肌炎或心功能不全心肌炎或心功能不全 能量合剂、能量合剂、利尿、强心利尿、强心 脑炎脑炎 止痉、降颅压，保护脑细胞，防止止痉、降颅压，保护脑细胞，防止 呼吸衰竭呼吸衰竭Treatmen

45、t(Treatment(治疗治疗)47儿科麻疹医学知识讲座儿科麻疹医学知识讲座Prevention(Prevention(预防）预防）Control source of infection(Control source of infection(控制传染控制传染源源)早发现，早隔离、早治疗早发现，早隔离、早治疗 病儿病儿 隔离至隔离至出疹后出疹后5-105-10天天 接触者接触者 隔离隔离21-2821-28天天 Interruption of transmission(Interruption of transmission(切断传切断传播途径播途径)呼吸道隔离，避免交叉感染呼吸道隔离，避免

46、交叉感染48儿科麻疹医学知识讲座儿科麻疹医学知识讲座Prevention(Prevention(预防）预防）Protection of the susceptible person(Protection of the susceptible person(保护易感人群保护易感人群)Active immunization(Active immunization(主动免疫主动免疫)Lived attenuated measles vaccine(Lived attenuated measles vaccine(麻疹减毒活疫苗麻疹减毒活疫苗)应急接种应急接种 易感者可在接触病人后易感者可在接触病人后

47、2 2天内接种天内接种禁忌症禁忌症 发热，急慢性疾病，活动性肺结核发热，急慢性疾病，活动性肺结核,免疫缺陷者免疫缺陷者49儿科麻疹医学知识讲座儿科麻疹医学知识讲座Prevention(Prevention(预防）预防）Passive immunization(Passive immunization(被动免疫被动免疫)丙种球蛋白丙种球蛋白 接触接触5 5天内注射可制止发病，天内注射可制止发病，prevent onsetprevent onset 5 59 9天注射可减轻症状天注射可减轻症状 relieve symptomsrelieve symptoms50儿科麻疹医学知识讲座儿科麻疹医学知识

48、讲座2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 保护保护 减轻症状减轻症状 效力减少效力减少 无效无效麻疹的病程及被动免疫效果麻疹的病程及被动免疫效果被动免疫时间被动免疫时间及效果及效果病程日数病程日数37383940潜伏期潜伏期前驱期开始前驱期开始出疹期开始出疹期开始典典型型肺炎肺炎并发症并发症改变型改变型51儿科麻疹医学知识讲座儿科麻疹医学知识讲座思考题思考题1 1、麻疹的诊断应包括哪些？、麻疹的诊断应包括哪些？2 2、如何鉴别麻疹、猩红热、幼儿急疹和药物疹？、如何鉴别麻疹、猩红热、幼儿急疹和药物疹？3 3、怎样预防麻疹？、怎样预防麻疹？52儿科麻疹医

49、学知识讲座儿科麻疹医学知识讲座54儿科麻疹医学知识讲座儿科麻疹医学知识讲座1 1岁半男孩患麻疹和右侧中耳炎，耳镜岁半男孩患麻疹和右侧中耳炎，耳镜检查见：检查见：鼓膜显著凸出鼓膜显著凸出 血管明显充血血管明显充血55儿科麻疹医学知识讲座儿科麻疹医学知识讲座56儿科麻疹医学知识讲座儿科麻疹医学知识讲座1 1岁半男孩患轻型麻疹岁半男孩患轻型麻疹检查见：躯干和肩部明显的融合性、色较淡的皮疹检查见：躯干和肩部明显的融合性、色较淡的皮疹57儿科麻疹医学知识讲座儿科麻疹医学知识讲座58儿科麻疹医学知识讲座儿科麻疹医学知识讲座1 1 岁半男孩患麻疹，胸部岁半男孩患麻疹，胸部 X X 线检查见：线检查见：心脏附

50、近双侧及心后大片阴影心脏附近双侧及心后大片阴影 下野下野 心脏旁片状浸润心脏旁片状浸润59儿科麻疹医学知识讲座儿科麻疹医学知识讲座1 1 岁个月龄女岁个月龄女孩患麻疹并发孩患麻疹并发喉炎，喉镜喉炎，喉镜检检查见查见 ：喉部明显红喉部明显红会厌和咽部会厌和咽部也显著充血也显著充血60儿科麻疹医学知识讲座儿科麻疹医学知识讲座61儿科麻疹医学知识讲座儿科麻疹医学知识讲座10 10 岁女孩患麻疹，口腔检查：岁女孩患麻疹，口腔检查：KoplikKoplik斑斑（箭头）（箭头）62儿科麻疹医学知识讲座儿科麻疹医学知识讲座10 10 岁男孩患麻疹，岁男孩患麻疹，检查见：检查见：斑丘疹斑丘疹 注意：典型的最初