卡介苗接种异常反应

卡介苗接种异常反应 一、接种卡介苗反应有哪些,(妈妈们一定要仔细观察) (一)淋巴结炎 1、临床 表 关于同志近三年现实表现材料材料类招标技术评分表图表与交易pdf视力表打印pdf用图表说话 pdf 现:(1)卡介苗接种后同侧局部淋巴结肿大超过1cm或发生脓疡破溃，淋巴结可一个或数个肿大。(2)分泌物涂片检查可发现抗酸杆菌，培养可阳性，菌型鉴定为卡介苗株，淋巴结组织病例检查为结核病变。 2、处理:(1)可局部热敷。若局部淋巴结继续增大，可口服异烟肼或加用利福平。早期也可手术切除。(2)脓疡有破溃趋势，应及早切开，用20%对氨基水杨酸油膏纱条或利福平纱条引流。若脓疡自发破溃，用20%对氨基水杨酸软膏或利福平粉剂涂敷。 (二)骨髓炎:卡介苗骨髓炎是一种罕见的并发症，其发生率在世界范围估计为0.39/100万。 1、临床表现:本病好发部位以四肢长骨，尤以股骨、胫骨、骨骺及股骨颈为多见，可单发也可多发，有的病例可形成脓肿。呈慢性良性过程，症状一般轻微，可有轻度发热、病变部位肿胀、轻度疼痛与功能障碍，患儿全身健康状况良好。卡介苗骨髓炎需手术得到细菌学与病理学证实。 2、处理原则用INH和RFP治疗，疗程至少6个月。因为卡介苗菌株对吡嗪酰胺存在天然耐药性，故联用时不加吡嗪酰胺。 real, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not required by the guest rating credit management objective, impartial ratings of credit, resulting in credit decision-making errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resulting in credit decision-making errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by the investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then record, counter-current process operations such as operation prior to approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false information. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, optimize the structure of assets, promotion of (三)全身播散性卡介苗感染是卡介苗接种极罕见的并发症，发生率在在世界范围估计为0.18/100万。在国内外报道的因播散性卡介苗病死亡的患者中，绝大多数有先天性的免疫缺陷病如先天性低丙种球蛋白血症、联合免疫缺陷病、慢性肉芽肿病及细胞免疫缺陷病，极少数免疫功能正常，称特发性播散性卡介苗感染，可能存在潜在的免疫疾患。 1、临床表现:卡介苗接种后出现局部淋巴结肿大破溃、愈合慢、同时合并全身淋巴结结核、肺结核和/或肝脾结核、腹腔结核和/或脑膜炎等其它部位结核。一般表现长期发热、体重下降或不增、易合并机会性感染。诊断依赖于体液标本培养有结核杆菌生长，组织活检可查到结核杆菌和结核病变，菌型鉴定为卡介苗株。 2、处理原则联合抗结核治疗，一经发现，转上级有关医疗单位诊治。 (四)卡介苗接种差错的处理接种卡介苗时将皮内接种误种皮下或肌肉事故，以及超剂量接种引起的反应最为多见。 1、临床表现:(1)接种局部在2~5天内出现红肿，以后发生硬结，发展成中心软化、破溃而成脓肿。接种部位同侧腋窝、锁骨下可伴有淋巴结肿大。(2)可有体温升高，伴有乏力、烦躁、食欲减退，个别儿童肺部可闻及干性或湿性罗音。(3)X线检查可见肺纹理增加和肺异常阴影，但极少引起肺部结核。 by the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous her substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approachss at on and inspection and due diligence evaluations or providing false information. (12) other violations result in credit busineo approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervisicurrent process operations such as operation prior t-s, after the first credit investigation, credit first and then record, counterthat others not involved in the investigation business, issued by the investigators. (10) without the approval of authoritiemaking errors. (I) the orders, directives, orders, suggest -ting in credit decisionmaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-ratings of credit, resulting in credit decisionrtial it risk management system to provide false information, is not required by the guest rating credit management objective, impaons of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credevant provisireal, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the rel2timize the structure of assets, promotion ofan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, ops, Jinedit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business linerom the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal crein f 2、处理:(1)全身治疗?口服异烟肼，儿童8~10mg/kg，1次顿服，每日总量不得超过300 mg，至局部反应消失。同时口服维生素C、维生素B6,以减少异烟肼反应。如在服异烟肼的同时加服利福平，则效果更好。?反应严重者可肌肉注射异烟肼，儿童每天40,60mg/kg，分1~2次注射，疗程1个月。(2)局部治疗?立即异烟肼50mg加于0.5%普鲁卡因溶液中，作局部环形封闭，每日1次，连续3天后改为每3天1次，共计8~10次。?已发生溃疡者，在用异烟肼液冲洗后，再用异烟肼粉撒于溃疡面，并可用时用利福平有广谱抗菌作用。 二、接种卡介苗的禁忌有哪些? 1、疑似已得结核病及疑似已被结核菌感染的人，应先经结核菌素测验，确定没有被结核菌感染，才可接种卡介苗。 2、罹患急性热病、发烧、皮肤病、严重湿疹、慢性病，及早产儿或体重在2500克以下之新生儿，都暂时不要接种卡介苗。 3、先天及后天免疫不全的人，绝对不可接种卡介苗。 婴儿在医院出生二十四小时后，已经接种了卡介苗，但未留下任何痕迹，是何原因?如何处理?已经接种卡介苗，但未留下痕迹，其可能性为: 1、纪录错误，已纪录接种其实是遗漏未接种; 3order to improve the quality of individual credit business, optimize the structure of assets, promotion of ranch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: inent bon of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk managemthe interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmissi le forth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsibnformation. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixrketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false icurrent process operations such as operation prior to approval. (11) article does not meet the risk management Department, Ma-d, counterorthe investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then recmaking errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by -ionting in credit decismaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-red by the guest rating credit management objective, impartial ratings of credit, resulting in credit decisionrequicertificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not ge failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents,real, in each pen business lending Qian not for by pen query, led to mortga 2、发生反应时间未到，有时反应是在平均发生反应期间稍后才开始; 3、操作技术上发生误差，如:未注入足量的疫苗。可以在接种后三个月作结核菌素测验，如为反应阴性，则再接种卡介苗一次。 三、接种卡介苗的禁忌人群有哪些, 患有结核病、急性传染病、心肾脑等疾病、极度营养不良、湿疹及其它皮肤病、HIV感染者不予接种。使用前须先作结核菌素皮试，呈阴性者方可接种。还有以下人群不适宜注射卡介苗: 1、早产、难产、伴有明显的先天性畸形的新生儿。 2、发热、腹泻等急性传染病的患儿。 3、心、肺、肾等慢性疾病、严重皮肤病、过敏性皮肤病、神经系统疾病的患者、以及对预防接种有过敏反映者。 BCG)是一种经过人工培养的无毒牛型结核杆菌(卡介菌)悬液制成的减毒活疫苗。因为它含菌量和接种途径的不同，可分为口服、皮上划痕和皮内注射三种剂型;又根据制造方法的不同，分为液体和冻干BCG两种，但目前仅保留生产和使用一种冻干剂型皮内注射用BCG，其含量规定为0.5mg/ml。每次剂量皮内注射0.1ml即可。我市现用BCG ein fby the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous her substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approachss at on and inspection and due diligence evaluations or providing false information. (12) other violations result in credit busineo approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervisicurrent process operations such as operation prior t-s, after the first credit investigation, credit first and then record, counterthat others not involved in the investigation business, issued by the investigators. (10) without the approval of authoritiemaking errors. (I) the orders, directives, orders, suggest -ting in credit decisionmaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-ratings of credit, resulting in credit decisionrtial it risk management system to provide false information, is not required by the guest rating credit management objective, impaons of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credevant provisireal, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the rel4timize the structure of assets, promotion ofan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, ops, Jinedit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business linerom the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal cr 为0.5ml/支。 BCG经过70余年在世界各地的应用证明，它是预防和控制结核病的有效预防制剂之一，特别对结核性脑膜炎、粟粒性结核有较好的预防效果。新生儿出生后立即要进行BCG的接种，因复种效果不理想，已于1999年取消BCG对有关年龄对象的复种。BCG接种后一般不会引起严重反应，仅在个别情况下引起局部溃疡和淋巴结肿大、化脓，罕见卡介苗骨髓炎、卡介苗全身播散等严重异常反应。 一、一般反应和强烈反应 (一)一般反应 1、发生原因 BCG接种实际上是一次轻度的人工感染，因此可出现由卡介菌毒力生物学活性所引起的相应反应。 2、临床表现皮内BCG接种后2~3日内，接种处皮肤略有红肿，可隆起一凸痕，约30min后可消失，为非特异性反应。特异性反应要在接种后2~3周才出现，局部发生红肿、丘疹状浸润硬块，平均直径10mm左右，逐渐软化成白色脓疱可自行破溃直径3~5mm，8~12周后大部分愈合，痂脱落后可在局部形成一稍凹陷的瘢痕。整个过程持续2~3个月。BCG接种一般无全身反应，少数人在接种后1~3个月内，接种侧腋下淋巴结(少数在锁骨上或对侧腋下淋巴结)可出现轻微肿大，但不超过10mm，有时出现溃破化脓。广东省广州市结防所1972年观察淋巴结肿大 on of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk managemthe interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmissi le forth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsibnformation. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixrketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false icurrent process operations such as operation prior to approval. (11) article does not meet the risk management Department, Ma-d, counterorthe investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then recmaking errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by -ionting in credit decismaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-red by the guest rating credit management objective, impartial ratings of credit, resulting in credit decisionrequicertificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not ge failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents,real, in each pen business lending Qian not for by pen query, led to mortga5order to improve the quality of individual credit business, optimize the structure of assets, promotion of ranch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: inent b 率，接种后4周为1.9,，6周为2.9%，8周后消失。 3、治疗 (1)一般不需处理。但要注意局部清洁，防止继发感染。为避免接触水或用手搔抓，可用干燥消毒纱布包扎。(2)脓疱或浅表溃疡可涂1,甲紫(龙胆紫)，使其干燥结痂，有继发感染者,可在创面撒布消炎药粉，不要自行排脓或揭痂。 (二)强烈反应局部脓肿或长期不愈(大于12周)。BCG接种后，脓疱和溃疡直径超过10mm，愈合时间超过12周，称为BCG加重反应或强烈反应。近年来，由于BCG质量和接种技术都有了很大的提高，BCG接种引起的加重反应，特别是淋巴结化脓者显著减少。 1、发生原因(1)疫苗活力:疫苗活力主要与活菌数有关，目前规定冻干BCG活菌数应在100万/mg以上。根据有关研究观察，活菌数太高可引起淋巴结肿大等反应，BCG活力还与制备菌株有一定联系，自1993年起，我国统一规定生产BCG均用丹麦2株。目前一人次用量为5万个活菌数。(2)注射剂量:BCG皮内注射剂量虽已统一，但是疫苗稀释后静置时菌体下沉，使用时或吸入注射器未能充分摇匀，或有摇不散的颗粒注入体内，均会出现加重反应或强烈反应。许多观察证实，上述反应存在着剂量依赖关系，即注射剂量增加1倍，局部反应发生率亦增加1倍。(3)注射技术:皮内注射过深，注入皮下或肌内，局部反应会加重。Edwalds报道接种BCG 6timize the structure of assets, promotion ofan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, ops, Jinedit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business linerom the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal crein fby the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous her substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approachss at on and inspection and due diligence evaluations or providing false information. (12) other violations result in credit busineo approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervisicurrent process operations such as operation prior t-s, after the first credit investigation, credit first and then record, counterthat others not involved in the investigation business, issued by the investigators. (10) without the approval of authoritiemaking errors. (I) the orders, directives, orders, suggest -ting in credit decisionmaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-ratings of credit, resulting in credit decisionrtial it risk management system to provide false information, is not required by the guest rating credit management objective, impaons of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credevant provisireal, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the rel 注射过深，局部脓肿的发生率可达13.4%。Fillastre报道，熟练专业人员接种BCG，化脓性淋巴结炎的发生率为0.44%，而非熟练专业人员接种的发生率可达3.92%。(4)接种部位:Sanada观察，如将BCG接种在肩上或三角肌上面，则容易形成凸起的瘢痕，而接种在三角肌外侧下缘，则反应轻微。所以接种部位一定要掌握好。(5)继发感染:在接种过程中由于注射器、针头消毒不严，或在炎症阶段洗澡，接种局部用手搔抓，可加重反应。(6)个体因素:被接种者的免疫状态和年龄等因素可影响反应强度。一般认为结核菌素试验强阳性者，接种BCG后反应较重;接种时年龄愈小，反应愈重。Fillastre设对照的试验结果表明，2~6个月龄婴儿皮内接种BCG后的化脓性淋巴结炎的发生率为3.2%，而6~12个月龄婴儿接种后的发生率为0.9%。 2、临床表现局部脓肿直径超过10mm，愈合时间超过12周，或接种处形成直径达10mm以上的较深溃疡，均称为强烈反应或加重反应。反应的临床表现基本上与一般反应相似。 3、治疗 (1)水疱或脓疱:小水疱或小脓疱，用1,甲紫涂抹，使其收干结痂。大水疱或大脓疱，先用灭菌注射器抽取渗出液后再涂抹1,甲紫，必要时可用5%~10%硼酸软膏涂敷，严防继发感染。(2)溃疡:用异烟肼粉或利福平粉剂涂撒于溃疡面上，用无菌纱布包扎，视溃疡情况可每日或每2日换药1次。换药前用3,硼酸溶 ranch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: inent bon of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk managemthe interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmissi le forth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsibnformation. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixrketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false icurrent process operations such as operation prior to approval. (11) article does not meet the risk management Department, Ma-d, counterorthe investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then recmaking errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by -ionting in credit decismaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-red by the guest rating credit management objective, impartial ratings of credit, resulting in credit decisionrequicertificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not ge failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents,real, in each pen business lending Qian not for by pen query, led to mortga7order to improve the quality of individual credit business, optimize the structure of assets, promotion of 液或盐水冲洗溃疡面。(3)溃疡或脓疱若已干燥结痂，注意保护好痂皮，待其自然脱落。 (三)淋巴结强反应 BCG必须通过淋巴管到达全身，所以接种处附近的淋巴结(常为腋下)有一定程度的组织反应。表现为轻微肿胀，这是正常现象。一般淋巴结肿大直径不超过1cm,1~2个月后消退。上海曾于接种后8周调查，结果淋巴结异常肿大率为4.5%，化脓率为0.1%。 1、发生原因(1)疫苗方面:活力较强的菌株(特别是残余毒力较大)产生强反应较多;与制造疫苗时菌块摇散的均匀度有关，若菌块多，易在淋巴结处滞留而引起强反应;疫苗沉淀、菌液太浓，也是引起强反应的常见因素。(2)接种方法:不同的接种方法淋巴结强反应的发生率不同。 (3)接种技术:疫苗未摇匀;注射过深或注入皮下;超量接种时反应发生率高。(4)儿童年龄:上海市1960年对520例5岁以下儿童淋巴结强反应统计，小于1岁淋巴结强反应72,，1~2岁16,，2~3岁3,，4~5岁0.8,。1986年Mande观察，0~2岁淋巴结化脓率1.24%，2~5岁0.36%，大于20岁无淋巴结化脓。以上可见，淋巴结强反应或化脓主要集中在1岁以内小年龄组。 2、临床表现 (1)干酷型:淋巴结单纯肿大超过10mm，不与周围皮肤粘连，早期可移动，稍有硬感。病理检查显示有大量浸润及坏死组织。(2)脓肿型:肿大淋巴结内含有脓液，轻压有波动感，淋巴结与 8timize the structure of assets, promotion ofan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, ops, Jinedit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business linerom the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal crein fby the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous her substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approachss at on and inspection and due diligence evaluations or providing false information. (12) other violations result in credit busineo approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervisicurrent process operations such as operation prior t-s, after the first credit investigation, credit first and then record, counterthat others not involved in the investigation business, issued by the investigators. (10) without the approval of authoritiemaking errors. (I) the orders, directives, orders, suggest -ting in credit decisionmaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-ratings of credit, resulting in credit decisionrtial it risk management system to provide false information, is not required by the guest rating credit management objective, impaons of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credevant provisireal, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the rel 周围皮肤粘连，皮肤可以呈紫红色。(3)窦道型:淋巴结破溃成瘘道，长期方能愈合。有结缔组织增生。 3、治疗(1)干酪型:局部热敷，每日3~4次，每次10min。早期热敷能使肿大的淋巴结自行消散。同时口服异烟肼，直至淋巴结缩小稳定为止。一般需服药1~2个月。也可用中药阿魏膏外贴，可逐渐消散。(2)脓肿型:用无菌注射器将脓液抽出，并用5,异烟肼溶液冲洗，同时注入链霉素10~20mg，必要时隔7~10日重复抽脓冲洗。严禁热敷(因易致破溃)和切开引流(因不易收口)。如淋巴结已有破溃倾向时，应及时切开引流(因手术切口常较自然破溃的破口整齐，引流通畅，愈合较快)。如淋巴结已破溃时，应作扩创，排除豆渣样坏死组织，并以凡士林纱布蘸链霉素粉或异烟肼粉或碘仿甘油引流，并用5,异烟肼软膏或20,对氨基水杨酸软膏外敷，每2~3日换药1次，直至创口愈合为止。(3)窦道型:用20,对氨基水杨酸软膏或5,异烟肼软膏局部涂敷，通常1~3个月可痊愈。(4)在治疗局部溃疡或淋巴结脓疡时，肉芽组织增生会影响创面愈合，可用枯矾少许撒于创面上包好，创面即成清洁的较浅溃疡，再以1,金霉素软膏外敷，创面渐平，且肉芽组织不再增生而收口，也可用硝酸银棒腐蚀或剪除，在创面上撒5,异烟肼粉。 the interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmissi le forth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsibnformation. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixrketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false icurrent process operations such as operation prior to approval. (11) article does not meet the risk management Department, Ma-d, counterorthe investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then recmaking errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by -ionting in credit decismaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-red by the guest rating credit management objective, impartial ratings of credit, resulting in credit decisionrequicertificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not ge failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents,real, in each pen business lending Qian not for by pen query, led to mortga9order to improve the quality of individual credit business, optimize the structure of assets, promotion of ranch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: inent bon of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk managem 二、异常反应极少数人接种BCG后，会出现与BCG一般反应性质不同的异常反应，如过敏反应、狼疮、瘢痕疙瘩、骨髓炎和致死性的全身卡介菌播散症等，但是，BCG反应与许多国家的结核病流行严重程度比较，是微不足道的，并不影响BCG接种方针的执行。发生率 BCG接种后异常反应的发生率各地报道很不一致。1978年Lotte对全世界1948~1977年接种BCG引起的异常反应资料进行了统计 分析 定性数据统计分析pdf销售业绩分析模板建筑结构震害分析销售进度分析表京东商城竞争战略分析 。至1977年12月共收集14.7亿接种者中发生的10371起异常反应(共9690例病人)，发生率为64.46,10万。根据临床、细菌学、组织学和生物学资料对这些病例进行分析, 其中播散性病变1072例，发生率为7.2,10万;异常的卡介苗原发综合征6602例，发生率为44.4,10万。常见的异常反应有: (一)过敏性皮疹接种BCG引起敏性皮疹的报道较少。上海市王杏元1990年报道该市1983~1987年5年并发症情况，其中各种类型的皮疹均有发生，每年发生4~9例不等，共发生32例，发生率为2.17,10万。浙江省宁海县卫生防疫站1985年报道1例过敏性疱疹，发生率为4.07,10万，江苏省仪征县卫生防疫站1978年报道1例大疱性表皮松懈性皮炎，发生率为0.8,10万，其他尚有报道接种BCG发生过敏性紫癜，辽宁省抚顺市接种48900名儿童发生2例，发生率为4.09,10万。 1、发生原因发生过敏性皮疹 on and inspection and due diligence evaluations or providing false information. (12) other violations result in credit busineo approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervisicurrent process operations such as operation prior t-s, after the first credit investigation, credit first and then record, counterthat others not involved in the investigation business, issued by the investigators. (10) without the approval of authoritiemaking errors. (I) the orders, directives, orders, suggest -ting in credit decisionmaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-ratings of credit, resulting in credit decisionrtial it risk management system to provide false information, is not required by the guest rating credit management objective, impaons of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credevant provisireal, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the rel10timize the structure of assets, promotion ofan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, ops, Jinedit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business linerom the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal crein fby the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous her substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approachss at 者多数有过敏史，在初种或复种时均可发生。BCG是一种抗原性很强的活疫苗，致敏机体可与组织中的肥大细胞和血液中的碱性白细胞上的lgE抗体结合，并引起组织胺、缓激肽等活性介质释放，作用于效应器，使毛细血管通透性增加，出现皮疹。属于第I型变态反应，它的表现以斑丘疹、荨麻疹等为主。少数人发生过敏性紫癜，其原因可能是患者对BCG某些附加剂过敏，引起皮下或粘膜出血而致紫癜，一般属第II型变态反应。大疱性表皮松懈性皮炎的发生机制尚未完全清楚，多数认为与变态反应有关。应用免疫荧光技术可在病人血清中发现表皮细胞抗体，在皮损区发现基底膜细胞抗体。Stein解释，抗原附着于表皮(基底膜)细胞间蛋白质或细胞表面导致机体特异性抗体产生和抗原抗体反应，从而使局部组织遭受免疫损伤，基底膜细胞是损伤的靶部位，可能属第III型变态反应。 2、临床表现 (1)有BCG接种史，有时可询得既往过敏史。(2)有一定的潜伏期，一般初种者发生较晚;复种者常在1日内(不超过2日)发病。(3)皮疹的形态表现多样，可表现为麻疹样或猩红热样红斑形皮疹，荨麻疹样皮疹，也可以表现为表皮的水疱。有时可伴有浅表性淋巴结肿大，有继发感染者常有发热。(4)过敏性紫癜一般起病急，可有发热，并出现各种皮疹。皮疹以四肢伸侧为多见，对称分布。有时伴关节痛或腹痛。血小板计数及出血、凝血时 th chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsibnformation. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixrketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false icurrent process operations such as operation prior to approval. (11) article does not meet the risk management Department, Ma-d, counterorthe investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then recmaking errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by -ionting in credit decismaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-red by the guest rating credit management objective, impartial ratings of credit, resulting in credit decisionrequicertificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not ge failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents,real, in each pen business lending Qian not for by pen query, led to mortga11order to improve the quality of individual credit business, optimize the structure of assets, promotion of ranch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: inent bon of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk managemthe interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmissi le for 间大都正常。预后一般良好。(5)大疱性表皮松懈性皮炎(Lyell)综合征，本病以发病急剧、病情凶险、病程短暂为临床特征。发病前可有轻重不等的全身症状，如烦躁、倦怠、腹泻、呕吐、腹痛、咽炎等，突然在颈部、腋下、腹股沟、外阴部伸侧皮肤等易受磨损部位出现红斑，尔后全身对称性皮疹泛发，持续疼痛和触痛。开始为大片深红紫红斑，迅速发生大疱。皮疹于数天内变为褐色，表皮解离后可见鲜红色湿润糜烂面，持续6~7日，坏死表皮脱落，裸露干燥基底。此后由病损中心到四周渐次脱屑，通常恢复很快，多在10~14日可见再生表皮，不留瘢痕。如继发化脓性感染，也可残留浅在性瘢痕。如表皮糜烂广泛，可在口腔、咽喉、消化道、支气管、尿道、眼结膜等全身所有上皮组织中见到剥落、损害。可出现高热及严重中毒症状，肝、肾、心、眼及肾上腺等可受累。中毒性脑炎可为致死的重要原因之一。 3、治疗 (1)一般支持疗法，预防继发感染。(2)抗过敏药物治疗，使用抗组胺类药物等。如病情严重、皮疹广泛，可在抗过敏治疗在基础上，配合应用肾上腺皮质激素类药物静脉滴注。(3)局部治疗，可选用3,硼酸溶液、1,硫酸镁溶液或0.1%明矾溶液冷热敷。(4)出血性紫癜除用抗组胺药物外，可应用大剂量维生素C与路丁以保护血管壁。严重者也需用激素治疗，常收到较好的效果。 substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approachss at on and inspection and due diligence evaluations or providing false information. (12) other violations result in credit busineo approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervisicurrent process operations such as operation prior t-s, after the first credit investigation, credit first and then record, counterthat others not involved in the investigation business, issued by the investigators. (10) without the approval of authoritiemaking errors. (I) the orders, directives, orders, suggest -ting in credit decisionmaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-ratings of credit, resulting in credit decisionrtial it risk management system to provide false information, is not required by the guest rating credit management objective, impaons of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credevant provisireal, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the rel12timize the structure of assets, promotion ofan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, ops, Jinedit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business linerom the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal crein fby the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous her (二)过敏性休克 BCG接种引起的过敏性休克极为罕见。Harper1982年和Tshabalala(1983)先后报道3例接种BCG引起的过敏性休克，其中1例死亡，国内尚未见类似病例的报道。 1.发生原因属于第I型变态反应，多发生于有过敏史、营养不良和病初愈后婴幼儿。Harpe和Tshabalala报道的4例病人年龄均小于3个月龄，最小1例出生后仅6日，4例病人中有3例都是在腹泻、呕吐治疗刚刚痊愈后进行BCG内接种时发生的。其中1例表现为发育不良、体重不足。Tshabalala认为腹泻和呕吐可能为引起过敏性休克的诱因。 2.临床表现 多在接种后数分钟发生，首先皮肤发痒，出现青紫斑点，继之出现呼吸困难、紫绀等周围循环衰竭的症状，表现为典型的急性过敏反应。 3、治疗 输氧、抗过敏、防止继发展感染，必要时输入新鲜血浆和气管切开。 (三)BCG的皮肤移行感染 BCG接种后，通过皮肤破损引起BCG皮肤感染是一种少见的并发症，可能造成诊断上的困难，特别是原发性BCG损害已愈合时。这种并发症有自限性，一般无需用特效抗结核治疗，但严重时需作抗结核治疗。 Roilides曾报道1例11岁男童，2个月前接种BCG。接种后3周出现局部肿胀，并逐渐结痂，再过2周在左锁骨部位发现1个活动的溃疡损害，并检查到抗酸杆菌和金黄色葡萄球菌。经用抗生素治疗，2周后损害开始消退， 13order to improve the quality of individual credit business, optimize the structure of assets, promotion of ranch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: inent bon of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk managemthe interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmissi le forth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsibnformation. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixrketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false icurrent process operations such as operation prior to approval. (11) article does not meet the risk management Department, Ma-d, counterorthe investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then recmaking errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by -ionting in credit decismaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-red by the guest rating credit management objective, impartial ratings of credit, resulting in credit decisionrequicertificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not ge failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents,real, in each pen business lending Qian not for by pen query, led to mortga 就诊后8周结痂。只留有小瘢痕。据其母亲回忆，该接种部位曾被小昆虫叮咬，病人曾抓破该部位皮肤，造成BCG的移行感染。 (四)复种BCG引起的瘢痕疙瘩有些儿童或少年在复种(皮内注射或划痕)时，在接种部位发生瘢痕疙瘩(也称瘢痕瘤)，这是一种皮肤的结缔组织增生物。上海市自1979年以来已报道215例，发生率7.17,10万，占BCG反应总数的4.4%。山东省惠民地区结防所报道，发生率为4.7,。山东省德州铁路卫生所报道，818例皮上划痕BCG接种者中，有66例出现瘢痕疙瘩，发生率高达8,。据国外Otte统计，BCG接种后非特异性异常反应(包括瘢痕瘤、皮疹等)发生率为12.5,10万。我国近年来已停止BCG复种，可以大大防止这一反应的发生。 1、发生原因多发于10~15岁复种的女性，初种者极少见，其原因还不十分清楚。有人认为这是一种在形成的接种瘢痕期间结缔结织增生所致，早期成纤维细胞多，晚期胶原纤维束多，周围没有包膜形成，是各种假性瘢痕中的一种。促成这种反应发生的因素可能有以下几种:(1)青春期前后机体内分泌发生改变，呈肥胖体形女孩易发生。 (2)复种对象家属和本人有变态反应史，或家属有瘢痕疙瘩史。(3)由于局部机械刺激作用，如磨擦、搔抓、创伤易引起。 (4)皮内接种部位过高(上臂三角肌上方)易发生。(5)某些批号疫苗 an branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, ops, Jinedit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business linerom the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal crein fby the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous her substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approachss at on and inspection and due diligence evaluations or providing false information. (12) other violations result in credit busineo approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervisicurrent process operations such as operation prior t-s, after the first credit investigation, credit first and then record, counterthat others not involved in the investigation business, issued by the investigators. (10) without the approval of authoritiemaking errors. (I) the orders, directives, orders, suggest -ting in credit decisionmaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-ratings of credit, resulting in credit decisionrtial it risk management system to provide false information, is not required by the guest rating credit management objective, impaons of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credevant provisireal, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the rel14timize the structure of assets, promotion of 发生率较高。 (6)东方人发生率高于西方人。 2、临床表现(1)表现为结缔组织增生，纤维组织过度增长。病程经过缓慢，在接种后1个月内缓慢发生，也有在接种后2~6年发生的，因此不少病人在发现时已达2~3年时间。(2)早期病变呈蜘蛛痣样的毛细血管增生，逐渐扩张增多，局部红肿显著，纤维性瘢痕逐渐高出皮面。3)瘢痕疙瘩大小不等，有小于10mm×10mm者，也有大至10mm×20mm者， 极个别人可大至30~40mm或更大。常高出皮表1~5mm，坚韧而有弹性。形状不定，皮内注射者多呈圆形或蘑菇状或哑铃状向外扩展，边缘或两端瘢痕隆起，毛细血管向外扩张，中央部位逐渐消退，毛细血管收缩，红色变浅或变暗红，瘢痕可以变平，形成萎缩瘢痕。瘢痕外围有极窄一圈充血带者，可能还继续生长。划痕接种者呈长条形，有的为锯齿形边缘。解摸坚实，可有轻微压痛，自觉不同程度的痒感，发作期有奇痒。常因搔抓刺激痕发展。(4)如瘢痕较小(在10mm以内)，其颜色与正常皮肤几无差别，此多属静止期，达到一定大小不再生长增大，手术无效，甚至较原来增大数倍，厚度增高，以至呈蟹足状隆起。 3、治疗 目前尚无特效疗法，以下方法可试用参考:(1)对静止期用含普鲁卡因的0.5%氢化可的松乳剂作贯穿注射，每周1次。3~10次为一疗程(具体次数取决于瘢痕疙瘩的消失与否)，约有半数有一定的疗效。注射瘢痕疙瘩逐渐 le forth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsibnformation. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixrketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false icurrent process operations such as operation prior to approval. (11) article does not meet the risk management Department, Ma-d, counterorthe investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then recmaking errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by -ionting in credit decismaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-red by the guest rating credit management objective, impartial ratings of credit, resulting in credit decisionrequicertificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not ge failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents,real, in each pen business lending Qian not for by pen query, led to mortga15order to improve the quality of individual credit business, optimize the structure of assets, promotion of ranch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: inent bon of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk managemthe interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmissi 软化，有些仅留紫红色斑点。(2)上海结核病防治所1976年开始采用异烟肼液100mg/2ml或300mg/6ml，加氢化可的松12.5mg/0.5ml和0.5%普鲁卡因混合作瘢痕疙瘩内注射，每周2次，治疗10~60次不等，时间平均4~5个月，有效率达61.7%。近年来采用曲安奈德(确炎舒松,A)注射液0.5~1.0mg,加入异烟肼液50~100mg及适量普鲁卡因混后后注入瘢痕疙瘩内，每周1~2次。10次为1疗程。停药后2周视情况再作继续治疗。有效率已提高至77.3%。其中大多数病例经治疗后，其瘢痕疙瘩由隆起而变扁平，厚度显著变薄，质地变软，注射时局部稍有疼痛，一般无其他不良反应。(3)北京中医院采用黑布膏药法(用老黑醋2500ml、五倍子875g,金头蜈蚣10条，密蜂300g,梅花冰片5g做成膏状)，涂药2~3mm厚，每2~3日换药1次。治疗81例，显著进步26例(32.1%)，进步44例(54.3%)。上海中药三厂以黑布膏药为主方生产的“贴膏型瘢痕软化膏”，每1~2日换药1次，亦有一定作用。(4)用放射治疗或冷冻治疗，结果瘢痕中央区虽然平坦但四周仍扩大并隆起，疗效不够理想。(5)局部还可以用曲安奈德瘢痕疙瘩内注射或用2%苯甲醇治疗。(6)将含有竹红菌素的油剂或软膏涂于患处，3~5min后进行光照，光源用荧光高压汞灯或红外线、白炽灯均可，光强度为5000lx，照距30~40cm，照射30min(开始可减半)，每日1次。(7) on and inspection and due diligence evaluations or providing false information. (12) other violations result in credit busineo approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervisicurrent process operations such as operation prior t-s, after the first credit investigation, credit first and then record, counterthat others not involved in the investigation business, issued by the investigators. (10) without the approval of authoritiemaking errors. (I) the orders, directives, orders, suggest -ting in credit decisionmaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-ratings of credit, resulting in credit decisionrtial it risk management system to provide false information, is not required by the guest rating credit management objective, impaons of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credevant provisireal, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the rel16timize the structure of assets, promotion ofan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, ops, Jinedit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business linerom the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal crein fby the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous her substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approachss at 瘢痕疙瘩不能外科手术切除，手术后均会复发，且较术前明显增大。我们曾见一位病人，多次手术一次比一次增大，应视为禁忌。 (五)骨髓炎 BCG骨髓炎是极罕见的接种并发症。20世纪50年代北欧国家始有文献报道。在全球范围内的发生率为1.8/10万。以欧洲发生最多。其中瑞典发病率最高达443.00/10万，发生率超过世界平均发病率的160倍。我国报道的病例不多，徐续宇自1976年起至今报道BCG骨髓炎3例，新生儿发病率为51/10万(1979年)和66/10万(1981年)。 1、发生原因 BCG骨髓炎的发生原因尚不明确。目前认为可能与儿童健康、疫苗活力及接种技术和部位等有关，当儿童发育不良、患病、接种苗内活菌数过多、注射过深或注入小血管时，卡介菌可经淋巴血行循环，侵入骨髓或关节骨膜内致病。瑞典、芬兰BCG骨髓炎发生较多，有人认为与BCG接种在大腿内侧，该处含有丰富的血管网络有关。 2、临床表现(1)潜伏期长，自几个月至4年不等，一般在1~2年间，最短的可在接种后6个月出现，但最长可达40个月，平均为12?4个月。(2)发病后病情稳定，全身情况良好，体温不高或略上升，病灶局限，病变骨骼相应处肿胀、疼痛，患者站立困难、跛行或不愿行动。(3)多发于四肢长骨，尤以股骨和股骨颈最多，次为胫骨、肱骨、桡骨和掌骨等部位，病变多局限于一处骨 on of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk managemthe interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmissi le forth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsibnformation. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixrketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false icurrent process operations such as operation prior to approval. (11) article does not meet the risk management Department, Ma-d, counterorthe investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then recmaking errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by -ionting in credit decismaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-red by the guest rating credit management objective, impartial ratings of credit, resulting in credit decisionrequicertificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not ge failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents,real, in each pen business lending Qian not for by pen query, led to mortga17order to improve the quality of individual credit business, optimize the structure of assets, promotion of ranch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: inent b 骼，据瑞典对152例BCG骨髓炎病人分析，病变部位于下肢者103例(67.8%)、上肢者32例(21.1%)、胸部22例(14.5%)、脊椎6例(3.9%)、肩胛骨1例(0.7%)。(4)X线检查和结核性骨髓炎相似。病灶大多局限于长骨的骨骺端及干骺端，有时也越过干骺线，病灶周围有硬化带，有骨刺样骨膜反应，少数病例可见死骨。与慢性非特异性骨髓炎不易鉴别。(5)组织切片可见类上皮细胞肉芽肿伴干酪坏死灶，80%的病例通过豚鼠能测到低毒抗酸杆菌，切片检查常为阴性，而培养常可阳性，通过动物接种或生化反应可证实为卡介菌。(6)病情预后良好，不留变形或四肢缩短及功能障碍(病灶侵及关节者除外)等。 (7)极个别病例治疗恢复后可以复发。 3、治疗(1)国外学者多推荐以外科治疗为主，施行清除手术，清除病灶，必要时用石膏绷带短期固定，可以缩短疗程。(2)同时应用链霉素、利福平、异烟肼三联治疗6~12个月。上海3例未经手术治疗，经服抗结核药物均痊愈，2例受石膏固定。 (六)寻常狼疮 BCG接种后引起的寻常狼疮，是一种极为罕见的皮肤“结核样”并发症。其预后良好，具有自愈倾向，经化学治疗2~6个月后皮损即可消失。 1、发生原因目前对其发生原因尚不清楚。病人多有结核病史或结核病接触史，接种BCG后，由于皮肤破损等原因，卡介菌可通过淋巴系统、血液系统或直接蔓延到皮肤而发病。 2、临 timize the structure of assets, promotion ofan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, ops, Jinedit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business linerom the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal crein fby the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous her substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approachss at on and inspection and due diligence evaluations or providing false information. (12) other violations result in credit busineo approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervisicurrent process operations such as operation prior t-s, after the first credit investigation, credit first and then record, counterthat others not involved in the investigation business, issued by the investigators. (10) without the approval of authoritiemaking errors. (I) the orders, directives, orders, suggest -ting in credit decisionmaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-ratings of credit, resulting in credit decisionrtial it risk management system to provide false information, is not required by the guest rating credit management objective, impaons of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credevant provisireal, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the rel18 床表现 (1)一般在接种后1年内发生，病情进展缓慢，经过温和，有自愈倾向。(2)皮疹首先发生在接种局部，继之向接种侧上臂、肩部、颈部及胸部等处皮肤缓慢蔓延，有时可蔓延至面部和对侧皮肤。(3)皮疹开始是暗红色，如米粒至黄豆大的软性皮内结节，称狼疮结节。以后逐渐增多而融合成一暗红色的浸润斑块，常高出皮肤。表面有少量鳞屑，用玻璃压在上面时，因红色暂被压退，常可见苹果酱色狼疮结节。这种现象对诊断很有帮助。狼疮结节可自行吸收或溃破成溃疡，愈合后形成不规则的瘢痕。在瘢痕上又出现新的狼疮结节。因此，在患部往往可看到结节、溃疡和瘢痕同时存在。(4)皮损部位组织学检查可见有结核样病变，细菌培养可查到卡介菌。 3、治疗采用抗结核药物全身治疗，应同时应用2~3种抗结核药物，如异烟肼、利福平、乙胺丁醇等同时应用常收收到较好效果。在用抗结核药物的同时，应用维生素D2，效果更好。 (七)BCG全身播散症极少数人接种BCG后可发生全身广泛性的播散，常可致死，称为BCG组织细胞病或BCG的全身性感染。这是一种罕见的异常反应。据国际痨联报道1948~1973年间，全世界13.85亿BCG接种者中发生30例，发生率为0.022/10万。其中欧洲23例，美洲6例，亚洲2例，近几年又陆续有数例报道，我国也有数例报道。 1、发生原因一般认为与机体的免疫功能不全有关。免疫功能 the interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmissi le forth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsibnformation. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixrketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false icurrent process operations such as operation prior to approval. (11) article does not meet the risk management Department, Ma-d, counterorthe investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then recmaking errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by -ionting in credit decismaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-red by the guest rating credit management objective, impartial ratings of credit, resulting in credit decisionrequicertificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not ge failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents,real, in each pen business lending Qian not for by pen query, led to mortga19order to improve the quality of individual credit business, optimize the structure of assets, promotion of ranch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: inent bon of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk managem 低下的人接种BCG后，卡介菌流入血液，发生全身性播散。1982年Trevenen等首次报道了加拿大的尸体解剖材料，在36例1岁以内接种过BCG的尸检中，有26例出现结核肉芽肿病变，其中14例证实经血源播散。 2、临床表现 (1)一般在接种BCG后数月至数年发病。(2)起病多于周围淋巴结开始，如有的先从接种侧腋下、耳前或颈部淋巴结发生肿大，范围逐渐增大，或成为溃疡，最后可能逐渐累及整个淋巴系统。从尸检所见，所有淋巴结均可发生脓肿或肉芽肿，或淋巴结皮质区被破坏殆尽。(3)从淋巴系统逐步累及到内脏器，以肝、脾、肺脏多见。梁书锋等1984年根据文献报道的18例病例统计，各内脏受累情况如下:肝17例、脾8例、肺7例、骨骼5例，肾和肾上腺及唾液腺各2例、脑及脑膜各1例。尸检可发现有肾脓肿，肝、脾肿大，脊椎旁组织坏死和腹腔某些组织脓肿，个别病例发生严重的肌肉、皮肤坏死。(4)出现广泛性骨痛。X线检查发现骨骼有囊肿，多发性溶解性病灶。病灶和骨骼囊肿活检显示大量抗酸杆菌的化脓性胶状物质。(5)病理切片检查、免疫功能测定正常者，多数为结核样肉芽肿的形成，典型的干酷样坏死，上皮样细胞及朗汉斯巨细胞，周围淋巴结浸润;免疫缺陷者则表现为化脓性肉芽肿病变，或仅见个别巨细胞，没有典型的结核样肉芽肿病变。(6)病变组织或脑脊液中可找到大量抗酸杆菌。(7)病人免疫力极 s, Jinedit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business linerom the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal crein fby the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous her substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approachss at on and inspection and due diligence evaluations or providing false information. (12) other violations result in credit busineo approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervisicurrent process operations such as operation prior t-s, after the first credit investigation, credit first and then record, counterthat others not involved in the investigation business, issued by the investigators. (10) without the approval of authoritiemaking errors. (I) the orders, directives, orders, suggest -ting in credit decisionmaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-ratings of credit, resulting in credit decisionrtial it risk management system to provide false information, is not required by the guest rating credit management objective, impaons of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credevant provisireal, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the rel20timize the structure of assets, promotion ofan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, op 度低下，出现消瘦、色素沉着、乳糜腹水、胸腔积液和黑粪，可并发各种细菌、真菌感染。 3、治疗用链霉素、利福平等抗结核药物和转移因子等免疫增强剂治疗，输血和对症治疗等。 (八)诱发银屑病银屑病又称牛皮癣，是一种非传染性良性慢性炎症皮肤病。BCG接种时有发生，接种并非直接原因，可能为诱发而引起，以寻常型多见。林景全1981年报道，安徽省于1976~1980年间，在BCG接种中诱发18例银屑病，发生率为0.11/10万。上海报道为0.13/10万。 1、发生原因病因尚不十八清楚。可能与病毒或链球菌感染、类固醇代谢障碍和精神因素等有关，病人有明显的银屑病家族史，并有遗传倾向。病变主要是由于表皮细胞增殖亢进所致，也有人经免疫学研究表明，病人可有细胞免疫和体液免疫的异常，在血清和皮肤损害部位可找到自身抗体。因此，认为本病可能属自身免病。BCG接种能诱发本病的发生。 2、临床表现 (1)以青春期前后的女性多见，新生儿接种BCG后很少发生，多发生于接种后2~10日内，也有长达数月者。(2)开始时接种部位皮肤发痒、皮疹，继而蔓延全身，以四肢伸侧部位多见，并以膝关节伸面最多，其次为躯干部和头皮等处。(3)皮疹为淡红色或表面带银白色，基底呈红色的丘疹或斑块、大小不一、数目不定、边界清楚，可表现为点滴状、钱币状、环状、地图状 le forth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsibnformation. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixrketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false icurrent process operations such as operation prior to approval. (11) article does not meet the risk management Department, Ma-d, counterorthe investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then recmaking errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by -ionting in credit decismaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-red by the guest rating credit management objective, impartial ratings of credit, resulting in credit decisionrequicertificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not ge failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents,real, in each pen business lending Qian not for by pen query, led to mortga21order to improve the quality of individual credit business, optimize the structure of assets, promotion of ranch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: inent bon of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk managemthe interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmissi 等，表面覆盖有多层干燥的银白色鳞屑，刮去鳞屑见有小出血点。有时可融合成片，占整个躯干大片皮肤，自觉有不程度的瘙痒。(4)病程经过缓慢，易反复发作，多冬重夏轻。病程可分为三期: 进行期:新皮疹不断出现，旧皮疹不断扩大，鳞屑增厚，炎症明显。静止期:病情保持静止阶段，无新皮疹出现，旧皮疹也不见消失。 退行期:皮疹缩小、逐渐消失，常遗留暂时性色素减退或沉着斑。(5)重症者可伴有关节病变，出现近似类风湿关节炎的表现;也可出现小脓疱或全身皮肤发红、浸润、脱屑。但BCG接种诱发的银屑病特点除多为年轻女性外，如早期诊治疗效较好，且不易复发，仅少数症状较重。 3、治疗(1)急性进行期可用0.25%普鲁卡因10~20ml、维生素C500~1000mg静脉注射，每日1次，10~12次为一疗程。(2)维生素B1220~100mg肌注，每日1次，10~12次为一疗程;也可同时应用维生素D24万u，每日3次，连服1~2个月;同时肌注丙种球蛋白。(3)口服白血宁(氨蝶呤)每日0.5mg，7日为一疗程，休息数日再进行第二疗程。一般3~4个疗程可见效。亦可口服氨甲蝶呤(MTX)，每12h服2.5mg，每周服7.5mg(36h)，也可用亚乙胺，每日服300mg，分3次服，连续或间断用药，30日为一疗程，一般服药1~2个月后见效。(4)外用药物以还原剂、角质剥离剂及细胞抑制剂为主，如1:20000牛皮癣软膏、0.1%~0.5%蒽林糊膏 22timize the structure of assets, promotion ofan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, ops, Jinedit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business linerom the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal crein fby the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous her substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approachss at on and inspection and due diligence evaluations or providing false information. (12) other violations result in credit busineo approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervisicurrent process operations such as operation prior t-s, after the first credit investigation, credit first and then record, counterthat others not involved in the investigation business, issued by the investigators. (10) without the approval of authoritiemaking errors. (I) the orders, directives, orders, suggest -ting in credit decisionmaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-ratings of credit, resulting in credit decisionrtial it risk management system to provide false information, is not required by the guest rating credit management objective, impaons of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credevant provisireal, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the rel 等。(5)重症者可用肾上腺皮质激素及免疫抑制剂药物等，有关节病变者可用消炎解痛药，有脓疱者用抗生素治疗，防止感染。 (九)BCG接种后的晚期淋巴结炎 BCG接种后的淋巴结反应多发生在接种后1~6个月，10%病例发生在接种后1年以上，大多数是由于接种后的淋巴结炎当时已痊愈，以后因为外源性或内源性因素而复发。Easton1984年曾报道1例病人用皮上划痕法接种BCG后11年和18年2次发生淋巴结炎。 三、接种事故的处理 (一)、发生原因 BCG接种最常见的事故，有些涉及儿童人数多，影响大，可给儿童带来严重的痛苦，必须引起重视，认真对待。徐续宇1981年对全国36起，发生于5105名儿童的接种事故原因分析如下:造成事故的原因，主要是由于少数工作人员责任心不强，工作不细所致;工作人员未按操作规程进行接种或发放疫苗时没有认真的核对所致。我们最近根据不完全资料统计，对全国部分地区报道的14起1903例BCG接种事故原因及处理结果分析，发现: 1、皮内用BCG误注皮下发生率最高，约占57.14,。 2、错当疫苗超量接种皮下占23.21%，这种错种剂量大，一般以0.5ml为多，少数达0.8ml。往往发生严重反应。 3、错当 ranch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: inent bon of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk managemthe interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmissi le forth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsibnformation. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixrketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false icurrent process operations such as operation prior to approval. (11) article does not meet the risk management Department, Ma-d, counterorthe investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then recmaking errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by -ionting in credit decismaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-red by the guest rating credit management objective, impartial ratings of credit, resulting in credit decisionrequicertificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not ge failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents,real, in each pen business lending Qian not for by pen query, led to mortga23order to improve the quality of individual credit business, optimize the structure of assets, promotion of 药物超量接种皮下约占3.5%，剂量一般较大，皆发生严重反应。 4、BCG，DPT混合接种或错当DPT肌肉注射，如不及时处理，往往发生严重反应。 5、误用注射器。 6、OT阳性者接种BCG。 ( 二)、临床表现皮内BCG误种皮下或肌肉，大部分儿童可发生局部的严重反应，惟出现时间较皮内晚，一般在接种后10~16日，平均12日即在局部发生1~2个凸起的直径20mm左右的较硬结节，日渐扩大，局部无红肿热痛感觉，约1个月后在结节中心开始软化，形成溃疡穿孔，溃疡向其他方向延伸，渐呈窦道或瘘管，若溃疡面基底为白色，覆有渗出物，上有淡红色肉芽组织增生。病程较长，最长达6个月至1年以上。如BCG误注入肌肉内，则在肌肉深部形成寒性脓肿。局部淋巴结肿大和溃破一般发生在误种后1月至数月，接种同侧锁骨下也出现淋巴结肿大。大小如黄豆者可视为一般反应，大过蚕豆者则视为异常反应。初起时淋巴结较硬，皮肤表面无改变，以后逐渐软化，形成脓肿。严重者局部皮肤渐渐变成暗红色，脓液可穿破表皮，形成溃疡，个别可形成瘘管。这种局部病变经过时间较长，不易愈合，个别长达1年以上。广东省广州市644例皮内直接接种BCG的儿童观察接种后2个月，局部硬结者75.3%，脓肿者9.0%，淋巴结红肿者21.4%，其中红肿、硬结平均直径在20mm以上者占38.05%。伴有的全身症状 timize the structure of assets, promotion ofan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, ops, Jinedit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business linerom the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal crein fby the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous her substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approachss at on and inspection and due diligence evaluations or providing false information. (12) other violations result in credit busineo approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervisicurrent process operations such as operation prior t-s, after the first credit investigation, credit first and then record, counterthat others not involved in the investigation business, issued by the investigators. (10) without the approval of authoritiemaking errors. (I) the orders, directives, orders, suggest -ting in credit decisionmaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-ratings of credit, resulting in credit decisionrtial it risk management system to provide false information, is not required by the guest rating credit management objective, impaons of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credevant provisireal, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the rel24 主要是体温升高，低热者较多见，大部分在37.8~38.5?以上，同时伴有乏力、烦躁不安、食欲减退等症状。个别儿童可有干性或湿性啰音，X线检查可见肺纹理增加、肺门阴影增多或出现肺部异常阴影，但很少有引起肺结核者。前苏联曾报道误将大于常用量250~500倍的BCG对108名儿童皮内接种，其中28名原有结核病的儿童未见病变因此而发展者。 (三)、治疗 1、全身治疗 ?口服异烟肼，儿童按每日每千克体重8~10mg，1次顿服，每日总量最多不得超过300mg，至局部反应完全消失或局部已化脓破溃再停药。同时服维生素B610mg，每日3次，以减少异烟肼的不良反应，如在服异烟肼的同时加服利福平，则效果更好。?反应较重者可肌内注射链霉素，儿童按每日每千克体重40~60mg，分1~2次注射，约需注射1个月。?适当补充营养和维生素。 2、局部治疗 ?立即用链霉素或异烟肼作局部封闭，越快越好，可使局部不发生溃疡或淋巴结肿大等异常反应。方法是用链霉素0.25~0.50g或异烟肼50mg加于0.5%普鲁卡因溶液于注射局部作环状封闭，每日1次，连续3次后，改为每3日1次，共计8~10次。?溃疡面较严重者，在用异烟肼液冲洗后，可撒异烟肼粉或利福平粉于溃疡面上。利福平除有抗结核作用外，还有广谱抗菌作用，对其他继发感染也有效。?其他治疗方法同BCG的加重反应。四、 ranch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: inent bon of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk managemthe interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmissi le forth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsibnformation. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixrketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false icurrent process operations such as operation prior to approval. (11) article does not meet the risk management Department, Ma-d, counterorthe investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then recmaking errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by -ionting in credit decismaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-red by the guest rating credit management objective, impartial ratings of credit, resulting in credit decisionrequicertificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not ge failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents,real, in each pen business lending Qian not for by pen query, led to mortga25order to improve the quality of individual credit business, optimize the structure of assets, promotion of 结核菌素的接种反应和处理 1、结核菌素是结核杆菌的培养滤液，其有效成分是结核杆菌的菌体蛋白。结核菌素有两种，一种是旧结核菌素(OT)，另一种是纯蛋白衍生物(PPD)，目前我国使用的是PPD。用OT或PPD做试验，是利用OT或PPD注入人体后注射部位可出现特异性皮肤变态反应，并按反应程度来衡量和判断机体是否感染过结核杆菌，或观察BCG接种后的免疫效果。正常反应应该是接种局部出现红晕，硬结，个别人也会出现水疱、坏死、淋巴管炎等加重反应，极少数人出现异常反应。 2、正常反应 皮内注射后24小时局部出现红晕，48~72小时反应最明显，出现红肿和硬结，硬结直径在5mm以上者为阳性反应。 3、加重反应若注射剂量过大或注射部位过深，或近期感染过结核或活动性结核患者，可出现硬结超过20mm或小于20mm，但同时伴有水疱、坏死、溃疡、淋巴管炎等加重反应。 4、异常反应极少见。主要发生于有结核病史及密切接触史者，或有BCG接种史者。主要为过敏反应，如过敏性休克、荨麻疹、过敏性紫癜、晕厥等。 5、处理原则 正常反应无需处理，加重反应处理原则同BCG的加重反应，异常反应应采用抗结核治疗和对症处理。 rom the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal crein fby the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous her substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approachss at on and inspection and due diligence evaluations or providing false information. (12) other violations result in credit busineo approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervisicurrent process operations such as operation prior t-s, after the first credit investigation, credit first and then record, counterthat others not involved in the investigation business, issued by the investigators. (10) without the approval of authoritiemaking errors. (I) the orders, directives, orders, suggest -ting in credit decisionmaking errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resul-ratings of credit, resulting in credit decisionrtial it risk management system to provide false information, is not required by the guest rating credit management objective, impaons of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credevant provisireal, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the rel26timize the structure of assets, promotion ofan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, ops, Jinedit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business line