小儿腹泻与液体疗法2013-11-22-临床-教案VIP免费

医师必备的素质医师必备的素质仁爱之心！仁爱之心！爱心！爱心！男，男，1010个月，个月，7.6Kg7.6Kg，因，因吐吐泻泻22天入院。天入院。患儿突起呕吐、腹泻。呕吐频繁，进食则呕，腹患儿突起呕吐、腹泻。呕吐频繁，进食则呕，腹泻水样便泻水样便2020余次，量多，反应差，尿少而急诊入余次，量多，反应差，尿少而急诊入院。体查：院。体查：血压血压7070／／55mmHg55mmHg，，体温体温3838℃℃，，精神精神萎靡，面色发灰，皮肤干燥弹性极差，眼眶前囟萎靡，面色发灰，皮肤干燥弹性极差，眼眶前囟深凹，深凹，咽红，咽红，心率心率160160次次//分，心音钝，分，心音钝，双肺清，双肺清，腹胀、软，无压痛，肠鸣音消失，四肢厥冷，腹胀、软，无压痛，肠鸣音消失，四肢厥冷，双膝反射未引出，肌张力低。大便水样，黄绿色，未引出，肌张力低。大便水样，黄绿色，WBC2WBC2个个/HP/HP。。该患儿的诊断及诊断依据？应如何处理？婴儿腹泻和液体疗法婴儿腹泻和液体疗法InfantilediarrheaInfantilediarrheaandandliquortherapyinchildrenliquortherapyinchildren湘雅医院新生儿科湘雅医院新生儿科岳少杰岳少杰ObjectivesandDemands常握腹泻的病因、发病机制与临床表现常握腹泻的诊断与治疗熟悉腹泻的鉴别诊断了解腹泻的预防ObjectivesandDemands掌握脱水的临床表现、程度及性质熟悉小儿水电解质平衡的特点掌握液体疗法及其计算方法熟悉液疗中常用的液体及应用Diarrhea,increasedintheliquidityand/orfrequencyofstools.Duetotheintestine:ImpairedwaterabsorptionActivewatersecretionIntroductionDefinitionExceptforsymptomsofgastrointestinaltract,thediarrheaisoftenaccompaniedwithwaterandelectrolytedisturbanceinseveretype.IntroductionItisthemajorcausesofmalnutritionanddisordersofgrowthanddevelopmentinchildhood.Childrenbetween6monthsand2yearsaresusceptibilitytodiarrhea.Soitiscalled‘infantilediarrhea’.WHO统计全世界（不包括中国）患腹泻病:10亿人/年(第三世界达5亿/年)第三世界国家死于腹泻病小儿：500万/年我国：为次于呼吸道感染的第二位常见病Itisoneofthemajordeadcausesininfantile.Introduction＜1岁小儿照看人卫生差饭前不洗手既往经常患腹泻病饮用水不洁禽畜放养引起腹泻的高危因素：EpidemiologyEpidemiology年份发病率下降率1986201.46%1987135%32.3%198896.61%51.74%7个妇幼卫生示范县10287例＜5岁儿童（首都儿科研究所，1988）预防前预防后Morbidity12-24%(ininpatients)Mortality1%(ininpatients)HigherthandevelopedcountriesCountrysidethancitiesEpidemiologyEpidemiologyTowpeaktime:SummerdiarrheaautumndiarrheaMonth6,7,810,11,12EtiologyEnteropatho-GenicE.coliBacillusDysenteriaeRotavirusEtiologyDefensefunctionispoorpredisposingfactorDigestivesystemisimmatureGrowanddevelopmentisfastRegulationofnervesystemispoorInfectionfactorsEtiologyVirusEscherichiacoliYersiniacampylobacterjejunistaphylococcalaureusbacilluspyocyaneusbacillusproteusBacteriaRotavirusenterovirusCossacksvirusECHOvirusNorwalkvirusCandidaalbicansAspergillusMucoraceaeFungiInfectionfactorsEtiologyGiardialambliaamebacryptosporidiosisParasiteNon-infectionfactorsEtiologyDigestiveenzymesdeficiencyInadequacydietClimateAllergicdiseasesSymptomaticPathogenesisOsmoticdiarrhea(non-infectiondiarrhea)饮食不当食物积滞于小肠上部酸度↓细菌上移,繁殖内源性感染分解糖发酵产气脂肪短链有机酸肠内渗透压↑胺类产物蛋白质腹泻肠蠕动↑中毒症状激活腺苷酸环化酶激活鸟苷酸环化酶产毒菌不耐热肠毒素耐热肠毒素ATPcAMP↑↑cGMPGTPNa+，H2O，Cl－↑Secretorydiarrhea（enterotoxindiarrhea）Pathogenesis大量水样腹泻PathogenesisMalabsorptiondiarrhea（Viralenteritis）Virus（Rotavirus）小肠粘膜带有绒毛的柱状上皮细胞吸收能力↓双糖酶活性↓细胞变性，坏死，绒毛破坏Na、葡萄糖吸收障碍肠腔内乳糖↑分解成短链有机酸水样腹泻肠内N...