儿科医学课件：风湿热.ppt

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1、Rheumaticfever※Understandtheetiologyandpathologicfeaturesofrheumaticfever.※Mastertheclinicalmanifestationsanddiagnosticcriterionofrheumaticfever.※Masterthetreatmentandpreventivemethodsofrheumaticfever.PurposeandRequirementOutlineRheumaticfeveriscloselyrelatedtoinfectionwithgroupAβ-hemolyticstrept

2、ococci.Rheumaticfeverismostfrequentlyobservedinchildrenfrom5~15yearofage.Twoimmunereaction☆anaphylaxis(变态反应)☆auto-immunereaction（自身免疫反应）Pathogenesis问题？A组乙型溶血性链球菌感染可诱发风湿热已被公认，但在众多的A组乙型溶血性链球菌感染中为什么只有少数人（0.3%~3%）发生本病？Etiology＊Thestrainofinfectingorganism（感染的菌株）＊Hereditysusceptibilityofhost（宿主的遗传易感性）

3、＊Socioeconomicstatus、weather（社会经济状况、气候）PathologyProcessofpathologyweredivideintothreestages:Exudation（渗出期）、proliferation（增殖期）、sclerosis（硬化期）.butpathologicalchangesofeachstagecanexistatthesametime.Basicpathologicalchangesareinflammationandcharacteristic“aschoffbodies”（风湿小体）.ClinicalManifestations△

4、Fever△Carditis（心脏炎）△Polyarthritis（多发性关节炎）△Erythemamarginatum（环形红斑）△Subcutaneousnodules（皮下结节）△Chorea（舞蹈病）急性心脏炎存在依据1.过去未有的器质性杂音2.心脏增大3.充血性心力衰竭4.心包积液Carditis＊Myocarditis（心肌炎）＊Endocarditis（心内膜炎）＊Pericarditis（心包炎）﹡Largejoints﹡Multiple、migratory（游走性）ArthritisChorea（舞蹈病）InvoluntarymovementsDevelopmentof

5、ataxiaSlurringofspeechSubcutaneousNodules（皮下结节）Itusuallyoccursoverthejoints,scalpandspinalcolumnErythemaMarginatum（环形红斑）Rashappearsprimarilyonthetrunkandtheextremitis实验室检查1.血常规：HbWBCN2.血沉3.CRP4.ASO5.EKG:PRDiagnosis☆Ifitisrheumaticfever☆Ifitassociatedwithcarditis☆Judgementforrheumaticactivity主要表现次

6、要表现有前驱的链球菌感染证据心脏炎关节痛咽喉拭子培养或快速链球菌抗原试验阳性链球菌抗体效价升高关节炎发热舞蹈病风湿热既往史环形红斑P-R间期延长皮下结节急性感染反应物表1Jones标准初发风湿热的诊断指标（1992年）下列三种情况可不必严格执行该诊断标准舞蹈病隐匿发病或缓慢发展的心脏炎有风湿病史或现患风湿性心脏病Treatment☆Anti-infectivetherapy☆Anti-inflammatoryagents﹡aspirin(阿司匹林)﹡corticosteroids（皮质类固醇激素）☆Activetreatmentforcurrentlysymptomaticproblem

7、sProphylaxis※Primaryprevention（原发性预防）※Secondaryprevention（继发性预防）Thanks