急性上呼吸道感染英文實用教案

1、 Pediatric pulmonary diseases account for almost 50% of deaths in children under age 1 year and 20% of all hospitalization of children under age 15 years. 第1頁/共32頁第一頁，共33頁。Bryce et al. WHO estimates of the causes of death in children. Lancet 2005第2頁/共32頁第二頁，共33頁。 Respiratory tract infections represe

2、nt the most common infections of childhood and range from trivial to life threatening illness. Other diseases of this system include asthma, disorders of pleura or pleura cavity, lung tumor, congenital abnormality.第3頁/共32頁第三頁，共33頁。Anatomy and Physiology of Respiratory System The knowledge of basic r

3、espiratory physiology and anatomy is one of the basic requirements for correct interpretation of symptoms and physical signs and in the attainment of an age appropriate differential diagnosis. There are a number of significant anatomic and physiological differences between children and adults that h

4、ave impact on assessment and management. The child is not only physically smaller but also has immature respiratory systems with fewer reserves than those of the adult.第4頁/共32頁第四頁，共33頁。 Normal anatomy Respiratory system is divided into upper respiratory tract and lower respiratory tract by cricoid c

5、artilage. upper respiratory tract: nose, nasal sinuses, pharynx, pharyngotympanic tube , epiglottis , larynx lower respiratory tract: trachea, bronchus, bronchiole , respiratory brochiole, alveolar ductules , alveolus 第5頁/共32頁第五頁，共33頁。 Nasal passage is shorter, no vibrissa , mucosa has a rich vascul

6、arity-liable to infection Nasal passage is narrow-liable to obstruction, resulted dyspnea. Nasal sinus ostia is large-nasosinusitis. pharyngotympanic tube is broader, straighter, shorter and horizontal-otitis media . pharyngeal tonsils :start to enlarge at the end of 1 year, peak at 4 to 10 year-old

7、, degeneration at 1415 years old-tonsillitis rarely occurs in infants. Larynx is in a shape of funnel and narrow, cartilage is flexible, mucosa is tender and rich of vessel-laryngeal edema and narrow第6頁/共32頁第六頁，共33頁。 Trachea and bronchus are narrower than those of adult; cartilage is flexible, lack

8、of elasticity tissue, supporting action is weak Airway wall account for 30% of Airway wall area in children, 15% in adult. mucosa is tender and rich of vessel. The right main bronchus is more vertical and broader than the left and it offers an easier passage for aspirated foreign bodiers. Bronchiole

9、 has not cartilage- easy to collapse, result to retention of gas and effect the exchange of gas. The amount and size of alveolus is less and small. Chest is shorter and in a barrel shape, has a smaller scope of activities 第7頁/共32頁第七頁，共33頁。 The airway are lined with an epithelial membrane that gradua

10、lly changes from ciliated pseudostratified columnar epithelium in the bronchi to a ciliated cuboidal epithelium near the gas-exchanging units. The three lobes (upper, middle and lower) of right lung has separated by the horizontal and oblique fissures, respectively.第8頁/共32頁第八頁，共33頁。 The left lung ha

11、s two major lobes (upper and lower) separated by an oblique fissure, and the upper lobe is itself divided into upper and lingular lobes. The right lung and the left lung project low down behind the dome of the diaphragm and peak behind the clavicles.第9頁/共32頁第九頁，共33頁。 Normal physiology The principal

12、function of the lung is to carry through gas exchange, which is to enrich the blood with oxygen and cleanse it of carbon dioxide. An essential feature of normal gas exchange is that the volume and distribution of ventilation are appropriate.第10頁/共32頁第十頁，共33頁。 The extrathoracic components of the resp

13、iratory tree trend to collapse inwards during inspiration and open during expiration. Therefore, if the extrathoracic airway is obstructed, the obstruction is first evident during inspiration and, as the airway further narrows, obstruction occurs during both phases of breathing. 第11頁/共32頁第十一頁，共33頁。

14、By the action of respiratory muscles the intrathoracic airways are actively opened during inspiration. In addition, surfactant reduces the surface tension of the alveoli, thereby reducing the effort to keep the alveoli open during inspiration. During expiration, the airways tend to collapse because

15、of the natural elasticity of the lung. Therefore, partial obstruction of the intrathoracic airways causes earlier closure of the airways during expiration and results in air-trapping with eventual over inflation of the lung.第12頁/共32頁第十二頁，共33頁。 Acute upper respiratory tract infection第13頁/共32頁第十三頁，共33

16、頁。 The upper respiratory tract comprises the nose, throat, tonsils, pharynx, and sinuses. Acute upper respiratory infection (also called common cold syndrome) is very common in all paediatric age groups. The nose and pharynx are the most common sites of infection.第14頁/共32頁第十四頁，共33頁。Etiology Viruses:

17、 respiratory syncytical virus, rhinovirus, adenovirus, parainfluenza virus, and influenza virus. Bacterial: streptococcus第15頁/共32頁第十五頁，共33頁。Clinical manifestations The commom cold :running nose, nasal congestion, sore throat, lacrimation, cough, and sneezing, low grade fever vomiting, diarrhea, abdo

18、men pains convulsion 第16頁/共32頁第十六頁，共33頁。 Special types of AURI:1)herpangian: cause by coxsackievirus fever, extreme irritability, poor appetite small blister , ulcers on the lips, gums and tongue. 第17頁/共32頁第十七頁，共33頁。2) pharyngo-conjunctival fever: caused by adenovirus type 3 or type 7. fever, pharyn

19、gitis, conjunctivitis swollen lymph nodes/gland gastrointestinal symptoms第18頁/共32頁第十八頁，共33頁。Complication Otitis media Infectious laryngitis Peritonsillar abscess Pneumonia Post-streptococcal glomerulonephritis Rheumatic fever第19頁/共32頁第十九頁，共33頁。Laboratory test Virus: white blood cell count is usually

20、 normal to low; virus isolation and serum test can confirm the agent. Bacteria: white blood cell count may increase. Pathogenic bacteria can also be cultured from pharyngeal swabs or throat washings. ASO titer is increased after streptococcus infection.第20頁/共32頁第二十頁，共33頁。Diagnosis and differential d

21、iagnosis Diagnosis is made by clinical manifestation. But the following may be considered for differential diagnosis:1.Influenza: influenza infection is easiy recognized during epidemics. In older children produces a syndrome of sudden onset of high fever, severe myalgia, headache, and chills. Parai

22、nfluenza virus or influenza virus could be found.第21頁/共32頁第二十一頁，共33頁。2. Earlier period of acue infectious disease: Epidemics, clinical manifestations, and laboratory findings may be arrived at the diagnosis. Pay attention to state of the illness.第22頁/共32頁第二十二頁，共33頁。3.Acute appendicitis: Abdominal pa

23、in may present before fever. Localization of pain to the hypogastric region. Abdominal muscle is tense with fixed tenderness. White blood cell counts may increase.第23頁/共32頁第二十三頁，共33頁。Treatment General therapy: rest, ensure an adequate fluid intake, and prevent complication. Pathogenic therapy: Antiv

24、irus: Clinically used anti-virus drugs include virazole (ribavirin), persantine and interferon. The drug could be used for 3 to 5 day. If it is caused by hemolytic streptococci, penicillin should be used for 10 to 14 days.第24頁/共32頁第二十四頁，共33頁。 Symptomatic management: Fever is controlled by antipyreti

25、cs, such as compound aminopyrine, and paracetamol. Alcohol sponging also is used. Some oral laryngopharynx drug could be given to control sore throat. Chinese herb: banlan gen, daqing ye and so on can antivirus and relieve toxicity symptom.第25頁/共32頁第二十五頁，共33頁。Acute Bronchitis Acute bronchitis is an

26、infection of he bronchial mucous membranes. It may be complication of acute upper respiratory infection, or clinical situation of acute infection disease. Because trachea is usually involved at the same time, so it is also defined as acute tacheobronchitis. This disorder appears to be more common in

27、 younger children.第26頁/共32頁第二十六頁，共33頁。 Etiology bacteria Virus Rhinitis, sinusitis, rickets, malnutrition can promote the illness progress.第27頁/共32頁第二十七頁，共33頁。 Clinical manifestations cough sputum production, vomiting, malaise, fever, diarrhea. dyspnea and cyanosis are rare. Infant: tachypnea, recession, apnea. physical sign: i