fever-发热英语课件.ppt

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1、FeverZhouYunTheAffiliatedHospitalofMedicalCollegeofNingboUniversityEmergencyDepartmentObjectiveDefinitionPathophysiologyPathogenesisEtiologyandclassificationClinicalmanifestationDefinitionDefinitionoffever:AtemperatureabovethenormalrangeNormalbodytemperature36

2、-37℃(setpoint)Circadianvariation：<1℃：36.3-37.2℃RectalT0.5℃>OralT0.5℃>AxillaryTFeverPyrogensElevatedset-pointMaintaininganabnormallyelevatedTemperatureBMR(basalmetabolicrate)increasesT=Elevatedset-pointBMR10%=T0.6oCHyperthermiaFeverduetoadisturbanceofthermal

3、regulatorycontrolExcessiveheatproduction(e.g.statusepilepticus,hyperthyroidism)Decreaseddissipationofheat(e.g.extensiveskindisease)Lossofregulation(e.g.injuryofthehypothalamicregulatorycenter)HyperthermiaExcessiveheatproductionTDecreaseddissipationLossofregul

4、ationPathophysiologyHeatproductionShiveringBasalmetabolicrate↑HeatisproductedbytissuesAbsorbedfromtheenvironment↑Dermalvasoconstriction↑HeatlossThevolumeofbloodflowingtoskin’ssurface↑Vaporization(sweating)↑TransfertheheattothesurroundingmediumDermalvasodilatio

5、n↑PathophysiologyRegulatedbythecentralnervoussystemThebodytemperatureisundercontrolofthePreopticareaoftheanteriorhypothalamus370C390CHeatProductionHeatLossHeatProductionHeatLossShiveringMetabolicactivityvasoconstrictionSweatingVasodilationSet-pointcoolingeleva

6、tingPathophysiologyHypothalamicthermostatInherentSetPoint:37oCLowest:4a.m;Peak:8~10p.mFeverfollowthispatternFactorsaffectbodytemperatureExerciseMenstrualcycleEnvironmentaltemperaturePathogenesisoffeverWhatwillmakethehypothalamuschangethesetpoint?PyrogensSubsta

7、ncesthatcancausefeverEitherexogenousorendogenousExogenousPyrogensFromoutsidethehostMostofthemarewithhighmoleculeweightCouldnotpenetrateblood-brainbarrierStimulatingmonocytesandmacrophagestoinducetheformationofendogenouspyrogenExogenousPyrogensMajorityaremicroo

8、rganism,theirproductsortoxinsGram-:Endotoxin(lipopolysaccaride,LPS)Gram+:LipoteichoicacidPeptidoglycanExotoxinsandenterotoxinsExogenousPyrogensOthersSteroidhormonemetabolitesAntige