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1、发热Fever周文华WenhuaZhouPh.DSchoolofMedicine,NingboUniversityContact:whzhou@vip.163.com病案CaseA36-year-oldman,Onedaypriortoadmissionhewasmadeworsebyheadache,dizzy(头昏),achingpainofmuscleandjoint(肌肉和关节酸痛)andfever.Check:T39℃,P100/min,R20/min,Bp100/70mmHg,congestionofthroat(咽喉充血),swellingoftonsil(扁桃体肿大),res
2、piratoryrudeness,nobubblingsoundLabfindings:WBC:13.3×109/L,lymphocyte16%,neutrophil83%。Treatment:Hewasgivenantibiotic(抗生素).Duringtransfusion,thepatientsufferfromchilly,shake,dysphoriaandtempetaturerosetoT41.3℃,P120/min,R24/min,DexamethasoneintravenousinjectionQuestions1.Whatpathogenicmechanismaccou
3、ntforthispatient`sfever?2.Whythepatientshownchilly,shake,dysphoriaandtempreturerosemore?3.Howtotreatandgivemedicalorderofnursing?正常体温NormalAxillarytemperature(腋温)36~37.0CSublingualtemperature(舌下温度)36.7~37.7Crectaltemperature(肛温)36.9~37.9C37℃37℃37℃SetpointBTnormalPyrogenaffectedbodyFeverhappenedF
4、ever:调定点setpointDefinitionFeverisdefinedasaregulatorybodytemperatureelevationresponsetothepyrogen,itisinducedbyanupwardshiftoftheset-pointinthermoregulatorycenter.Anelevationofbodytemperatureisfever?36℃40℃PhysiologicelevationofbodytemperatureApathologicelevationofbodytemperatureisfever?HeatstrokeHy
5、perthyroidism甲状腺机能亢进Centralnervoussystemdamagehyperthermia非调节性体温升高,过热TemperaturehomeostasisCentralthermo-receptorsPeripheralthermo-receptorsPOAHEffectorgansHeatproductionHeatdissipation36℃40℃下丘脑视前区PhysiologictemperatureelevationPathologictemperatureelevationTemperatureelevationFeverHyperthermiaClas
6、sificationHyperthermiaisanunregulatorytemperaturerisingItisapassiveprocessThereisnochangeofthesetpointFeverisaregulatorytemperaturerisingItisanactiveprocessItisthebody’sactivereactiontopyrogenPathogenesisPyrogenicActivator发热激活物Activator:thesubstancecanactivatethecellsthatcanproducethepyrogen.pyroge
7、n:thesubstancecancausefeverMicrobialagents:G+,G-,exotoxins,TB,etc病毒,真菌,螺旋体,疟原虫Non-microbialagents:steroid,antigen-antibodycomplex,uratecrystal,体内组织破坏,ectPyrogenicactivatorEP-producingcellsEP(内生致热原)Endogenou