几种常见传染病的诊疗规范

几种常见传染病的诊疗规范 甲类传染病(2种):鼠疫、霍乱。 乙类传染病(25种):传染性非典型肺炎、艾滋病、病毒性肝炎、脊髓灰质炎、人感染高致病性禽流感、麻疹、流行性出血热、狂犬病、流行性乙型脑炎、登革热、炭疽、细菌性和阿米巴性痢疾、肺结核、伤寒和副伤寒、流行性脑脊髓膜炎、百日咳、白喉、新生儿破伤风、猩红热、布鲁氏菌病、淋病、梅毒、钩端螺旋体病、血吸虫病、疟疾。 丙类传染病(12种):流行性感冒、流行性腮腺炎、风疹、急性出血性结膜炎、麻风病、流行性和地方性斑疹伤寒、黑热病、包虫病、丝虫病，除霍乱、细菌性和阿米巴性痢疾、伤寒和副伤寒以外的感染性腹泻病，手足口病 水 痘 流行性乙型脑炎 定 义 流行性乙型脑炎，简称乙脑，也称日本脑炎。是由乙脑病毒(日本脑炎病毒)经蚊虫叮咬而传播的以脑实质炎症为主要病变的急性传染病，发生于夏秋季，儿童多见。 临床上以高热、意识障碍、抽搐、呼吸衰竭、脑膜刺激征及病理反射征为主要特征。 重症病人病死率高。部分患者留有严重后遗症，重症患者病死率较高。 provisions of paragraph 6.5 submission of complete information. Monitoring inspection and safety assessment of the implementation of the outcome of the owners of the relevant regulations. 10.11 the completion at the end of the contract period, we will transfer to the owners of all monitoring facilities, engineering data, documents, reports and other project-related content. For monitoring facilities, replaceable equipment availability monitoring instruments should be 100%, not replacing equipment availability monitoring instruments should be 95% or more. Curtain Grouting in the 11th Chapter 11.1 project overview the on curtain Grouting works primarily for River yongxing secondary hydropower station dam Foundation curtain grouting, quantities of 200m. Dam Foundation curtain Grouting in dam concrete pouring is complete, reaches a certain intensity, agreed by the supervising engineer and began construction. 11.2 11.2.1 General requirements we are responsible for the procurement of materials, transport, storage, keeping drilling and apart from the employer's manpower required to grout materials for all materials. Admixture, admixture of each procurement shall meet the relevant quality 乙脑病毒属黄病毒科黄病毒属 ，有包膜，呈球型，直径20,30nm，核心为含单股RNA的核衣壳。乙脑病毒有三种蛋白: 培 抵抗力 本病毒在外界环境中抵抗力不强，对酸、乙醚和氯仿等脂溶剂敏感，56?30分钟或100?2分钟即可灭活。但对低温和干燥的抵抗力很强，用冰冻干燥法在4?冰箱中可保存数年。 临床分型 并发症 发生率10% 支气管肺炎:最常见 肺不张 败血症 尿路感染 褥疮 诊断标准 疑似病例 流行病学资料:流行地区、流行季节 临床特征:发热、神志意识障碍 临床诊断病例 符合疑似病例条件，且CSF常规检查:压力增高，非化脓样改变 确诊病例 provisions of paragraph 6.5 submission of complete information. Monitoring inspection and safety assessment of the implementation of the outcome of the owners of the relevant regulations. 10.11 the completion at the end of the contract period, we will transfer to the owners of all monitoring facilities, engineering data, documents, reports and other project-related content. For monitoring facilities, replaceable equipment availability monitoring instruments should be 100%, not replacing equipment availability monitoring instruments should be 95% or more. Curtain Grouting in the 11th Chapter 11.1 project overview the on curtain Grouting works primarily for River yongxing secondary hydropower station dam Foundation curtain grouting, quantities of 200m. Dam Foundation curtain Grouting in dam concrete pouring is complete, reaches a certain intensity, agreed by the supervising engineer and began construction. 11.2 11.2.1 General requirements we are responsible for the procurement of materials, transport, storage, keeping drilling and apart from the employer's manpower required to grout materials for all materials. Admixture, admixture of each procurement shall meet the relevant quality 符合临床诊断病例条件，且下述3点中任一项阳性者: ?一个月内未接种乙脑苗，CSF抗乙脑IgM抗体阳性 ?恢复期血清中抗乙脑IgG抗体滴度较急性期有4倍以上增 加者，或抗乙脑IgG抗体急性期阴性，恢复期转阳性者 ?CSF、脑组织、或血清分离出乙脑病毒者。 鉴别诊断 化脓性脑膜炎 结核性脑膜炎 霉菌性脑膜炎 中毒性菌痢 • 其它病毒: CMV, HSV,EBV 治 疗 • 一般治疗 • 对症治疗 • 恢复期及后遗症处理 • 一般治疗 ? 病人住院隔离，防蚊 ? 严密监护，密切观察病情变化 ? 昏迷护理:保护角膜;昏迷抽搐防护舌咬伤;预防褥疮 ? 水电解质平衡与能量供给: ? 静脉给予足够量的液体，维持水、电解质的平衡;给 予高热量的液体 provisions of paragraph 6.5 submission of complete information. Monitoring inspection and safety assessment of the implementation of the outcome of the owners of the relevant regulations. 10.11 the completion at the end of the contract period, we will transfer to the owners of all monitoring facilities, engineering data, documents, reports and other project-related content. For monitoring facilities, replaceable equipment availability monitoring instruments should be 100%, not replacing equipment availability monitoring instruments should be 95% or more. Curtain Grouting in the 11th Chapter 11.1 project overview the on curtain Grouting works primarily for River yongxing secondary hydropower station dam Foundation curtain grouting, quantities of 200m. Dam Foundation curtain Grouting in dam concrete pouring is complete, reaches a certain intensity, agreed by the supervising engineer and began construction. 11.2 11.2.1 General requirements we are responsible for the procurement of materials, transport, storage, keeping drilling and apart from the employer's manpower required to grout materials for all materials. Admixture, admixture of each procurement shall meet the relevant quality ? 鼻饲给予营养和液体 治 疗 • 高热的处理:设法尽快将体温控制在38?左右 ? 物理降温:可用30%酒精擦浴，在腹股沟、腋下、 颈部放置冰袋;也可用降温床或冷褥。 ? 药物降温: ? 解热镇痛药，可口服，或肛门给药 ? 亚冬眠疗法，氯丙嗪及异丙嗪各0.5,1mg/kg/ 次， im,每4,6小时一次，同时物理降温 ?控制室温:将室温控制在30?以下，可采用室内放冰 块、电风扇、空调等。 • 抗惊厥或抽搐 ? 降温 ? 保持呼吸道通畅:呼吸道分泌物阻塞所致缺氧者，应 及时吸痰、必要时气管切开 ? 治疗脑水肿:20%甘露醇1, 1.5g/kg静脉注射或快速 静滴 ? 脑实质炎: ? 予镇静剂(安定、水合氯醛、副醛、苯巴比妥钠、 苯妥英钠、异戊巴比妥钠) ? 亚冬眠疗法。 provisions of paragraph 6.5 submission of complete information. Monitoring inspection and safety assessment of the implementation of the outcome of the owners of the relevant regulations. 10.11 the completion at the end of the contract period, we will transfer to the owners of all monitoring facilities, engineering data, documents, reports and other project-related content. For monitoring facilities, replaceable equipment availability monitoring instruments should be 100%, not replacing equipment availability monitoring instruments should be 95% or more. Curtain Grouting in the 11th Chapter 11.1 project overview the on curtain Grouting works primarily for River yongxing secondary hydropower station dam Foundation curtain grouting, quantities of 200m. Dam Foundation curtain Grouting in dam concrete pouring is complete, reaches a certain intensity, agreed by the supervising engineer and began construction. 11.2 11.2.1 General requirements we are responsible for the procurement of materials, transport, storage, keeping drilling and apart from the employer's manpower required to grout materials for all materials. Admixture, admixture of each procurement shall meet the relevant quality ? 肾上腺糖皮质激素的应用 • 呼吸衰竭的治疗 ? 保持呼吸道畅通、给氧、反复吸痰无效者，应及早气 管切开 ? 呼吸兴奋剂 在自主呼吸未完全停止时使用效较佳。可 用洛贝林、可拉明、利他林等 ? 血管扩张剂东莨菪碱、山莨菪碱有一定效果 ? 积极治疗脑水肿 ? 必要时使用呼吸机辅助呼吸 • 抗病毒治疗:利巴韦林、干扰素(疗效尚不确定， 需早期使用 • 预防细菌感染:精心护理、抗生素预防用药 • 激素的使用:尚有争议，一般认为使用不当弊多利 少，仅用于有频繁抽搐，脑水肿征象 明显者 • 恢复期及后遗症的处理 ? 高压氧 ? 功能锻炼 ? 理疗、按摩、针灸 ?药物治疗 ?谷氨酸钠注射液、谷氨酸片、烟酸等促进血管神经功 能恢复 provisions of paragraph 6.5 submission of complete information. Monitoring inspection and safety assessment of the implementation of the outcome of the owners of the relevant regulations. 10.11 the completion at the end of the contract period, we will transfer to the owners of all monitoring facilities, engineering data, documents, reports and other project-related content. For monitoring facilities, replaceable equipment availability monitoring instruments should be 100%, not replacing equipment availability monitoring instruments should be 95% or more. Curtain Grouting in the 11th Chapter 11.1 project overview the on curtain Grouting works primarily for River yongxing secondary hydropower station dam Foundation curtain grouting, quantities of 200m. Dam Foundation curtain Grouting in dam concrete pouring is complete, reaches a certain intensity, agreed by the supervising engineer and began construction. 11.2 11.2.1 General requirements we are responsible for the procurement of materials, transport, storage, keeping drilling and apart from the employer's manpower required to grout materials for all materials. Admixture, admixture of each procurement shall meet the relevant quality ?兴奋不安者可用安定、利眠宁或氯丙嗪 ?有震颤或肌张力高者，可用安坦，东莨菪碱或左旋多 巴，亦可使用盐酸金刚烷胺 ?肌张力低者，可用新斯的明 保护易感人群: - 预防接种 6月,12月婴幼儿为主要接种对象 接种地鼠肾细胞灭活疫苗或地鼠 肾细胞减毒活疫苗，初种2次， 0.5 ml/次,隔1 , 2周。 provisions of paragraph 6.5 submission of complete information. Monitoring inspection and safety assessment of the implementation of the outcome of the owners of the relevant regulations. 10.11 the completion at the end of the contract period, we will transfer to the owners of all monitoring facilities, engineering data, documents, reports and other project-related content. For monitoring facilities, replaceable equipment availability monitoring instruments should be 100%, not replacing equipment availability monitoring instruments should be 95% or more. Curtain Grouting in the 11th Chapter 11.1 project overview the on curtain Grouting works primarily for River yongxing secondary hydropower station dam Foundation curtain grouting, quantities of 200m. Dam Foundation curtain Grouting in dam concrete pouring is complete, reaches a certain intensity, agreed by the supervising engineer and began construction. 11.2 11.2.1 General requirements we are responsible for the procurement of materials, transport, storage, keeping drilling and apart from the employer's manpower required to grout materials for all materials. Admixture, admixture of each procurement shall meet the relevant quality 流行性腮腺炎 概 述 • 流行性腮腺炎是由腮腺炎病毒引起的急性呼吸道传染病，主要 发生在儿童和青少年。临床表现为腮腺非化脓性肿胀、疼痛， 伴发热和轻度不适，可引起脑膜炎、睾丸炎、卵巢炎、胰腺炎 等并发症。一般预后良好。 病 原 学 • 病原体:腮腺炎病毒，属于副粘病毒，为有包膜的单链RNA 病毒，仅一个血清型。 • 理化特性 对物理、化学因素很敏感。 • 存在部位 病人的唾液、尿液、血液、脑脊液中。 流行病学 , 传染源 早期患者及隐性感染者? , 传播途径 呼吸道(通过空气、飞沫传播) , 易感者 人类普遍易感,感染后获得持久免疫 , 流行特征 冬春多见 流行性腮腺炎感染者的传染性 流腮病例构成比的季节分布 provisions of paragraph 6.5 submission of complete information. Monitoring inspection and safety assessment of the implementation of the outcome of the owners of the relevant regulations. 10.11 the completion at the end of the contract period, we will transfer to the owners of all monitoring facilities, engineering data, documents, reports and other project-related content. For monitoring facilities, replaceable equipment availability monitoring instruments should be 100%, not replacing equipment availability monitoring instruments should be 95% or more. Curtain Grouting in the 11th Chapter 11.1 project overview the on curtain Grouting works primarily for River yongxing secondary hydropower station dam Foundation curtain grouting, quantities of 200m. Dam Foundation curtain Grouting in dam concrete pouring is complete, reaches a certain intensity, agreed by the supervising engineer and began construction. 11.2 11.2.1 General requirements we are responsible for the procurement of materials, transport, storage, keeping drilling and apart from the employer's manpower required to grout materials for all materials. Admixture, admixture of each procurement shall meet the relevant quality 临床表现 • 潜伏期:14,25天，平均18天 • 全身症状:发热、头痛、无力、肌肉酸痛、食欲不振、 咽痛等 • 局部症状:发病1,2天后出现腮腺(颌下腺、舌下腺)肿痛， 起病时先从一侧开始，多呈 双侧性腮腺肿大。以耳垂为中心， 向前后下发展，如梨形，边缘不 清，坚韧感;轻度触痛。并有腮 腺管的红肿 • 病程一般1周左右，有自限倾向 腮腺管口红肿 临床表现 • 主要并发症 ? 神经系统 – 脑膜脑炎、脑炎(多见于儿童患者以脑膜受累为主，65% 脑脊液有异常) – 耳聋 – 多发性神经炎 ? 腺体组织 – 胰腺炎(恶心、呕吐、腹痛;<10%) – 睾丸炎(14~35%、单侧) provisions of paragraph 6.5 submission of complete information. Monitoring inspection and safety assessment of the implementation of the outcome of the owners of the relevant regulations. 10.11 the completion at the end of the contract period, we will transfer to the owners of all monitoring facilities, engineering data, documents, reports and other project-related content. For monitoring facilities, replaceable equipment availability monitoring instruments should be 100%, not replacing equipment availability monitoring instruments should be 95% or more. Curtain Grouting in the 11th Chapter 11.1 project overview the on curtain Grouting works primarily for River yongxing secondary hydropower station dam Foundation curtain grouting, quantities of 200m. Dam Foundation curtain Grouting in dam concrete pouring is complete, reaches a certain intensity, agreed by the supervising engineer and began construction. 11.2 11.2.1 General requirements we are responsible for the procurement of materials, transport, storage, keeping drilling and apart from the employer's manpower required to grout materials for all materials. Admixture, admixture of each procurement shall meet the relevant quality – 卵巢炎(5%) ? 其它: 肾炎、心肌炎、乳腺炎、甲状腺炎等 水 痘 概 述 水痘是由带状疱疹病毒(Varicella-herpes Zoster virus, VZV)引 起的经呼吸道和直接接触传播的急性病毒性传染病。 • 水痘90%或以上为显性感染。 • 传染源 :水痘患者为主要传染源，自水痘出疹前1,2天至结 痂后7天时，均有传染性 • 传播途径: 主要通过飞沫和直接接触传播 • 易感人群: 普遍易感。但学龄前儿童发病最多。6个月以内的 婴儿由于获得母体抗体，发病较少，妊娠期间患水痘可感染胎 儿。病后获得持久免疫，但可发生带状疱疹。 • 流行特征: 全年均可发生，冬春季多见。本病传染性很 强，易感者接触患者后约90%发病，故幼儿园、小学等幼儿集体机构易引起流行。 临 床 表 现 • 典型水痘 潜伏期:2周 主要表现:突起发热、全身不适，食欲 不振等，同时出现皮疹 皮疹特征: provisions of paragraph 6.5 submission of complete information. Monitoring inspection and safety assessment of the implementation of the outcome of the owners of the relevant regulations. 10.11 the completion at the end of the contract period, we will transfer to the owners of all monitoring facilities, engineering data, documents, reports and other project-related content. For monitoring facilities, replaceable equipment availability monitoring instruments should be 100%, not replacing equipment availability monitoring instruments should be 95% or more. Curtain Grouting in the 11th Chapter 11.1 project overview the on curtain Grouting works primarily for River yongxing secondary hydropower station dam Foundation curtain grouting, quantities of 200m. Dam Foundation curtain Grouting in dam concrete pouring is complete, reaches a certain intensity, agreed by the supervising engineer and began construction. 11.2 11.2.1 General requirements we are responsible for the procurement of materials, transport, storage, keeping drilling and apart from the employer's manpower required to grout materials for all materials. Admixture, admixture of each procurement shall meet the relevant quality ? 红色斑丘疹 ? 椭圆型水滴样小水泡， 周围红晕 ?水疱 内容物变浑浊，水 疱易破溃?结痂，皮疹脱痂后，一般不留瘢痕 ? 皮疹分布部位:躯干部?面部?四肢，呈向心性分布。 ? 皮疹陆续分批出现，快慢不一，故同一时间内可见上 述形态皮疹同时存在。 病程:自限性，1-2周 • 重症水痘 发生条件:白血病、淋巴瘤等恶性病;免疫功能受损病儿。 表现:高热，出疹1周后体温40,410c， 全身中毒症状 皮疹融合，形成大疱型疱疹，或出血性皮疹，呈离 心性分布 常伴有血小板减少而发生爆发性紫癜。 • 先天性水痘: • 母亲妊娠期患水痘可累及胎儿。与母亲妊娠时间有关。 ? 若在妊娠的头4个月，则可能发生先天性水痘综合 征 表现:出生体重低、瘢痕性皮肤病变、肢体萎缩、 视神经萎缩、白内障、智力低下等。 ? 在产前4天以内，新生儿常于出生后4,5天发病，易 形成播散性水痘，病死率25%,30%。 provisions of paragraph 6.5 submission of complete information. Monitoring inspection and safety assessment of the implementation of the outcome of the owners of the relevant regulations. 10.11 the completion at the end of the contract period, we will transfer to the owners of all monitoring facilities, engineering data, documents, reports and other project-related content. For monitoring facilities, replaceable equipment availability monitoring instruments should be 100%, not replacing equipment availability monitoring instruments should be 95% or more. Curtain Grouting in the 11th Chapter 11.1 project overview the on curtain Grouting works primarily for River yongxing secondary hydropower station dam Foundation curtain grouting, quantities of 200m. Dam Foundation curtain Grouting in dam concrete pouring is complete, reaches a certain intensity, agreed by the supervising engineer and began construction. 11.2 11.2.1 General requirements we are responsible for the procurement of materials, transport, storage, keeping drilling and apart from the employer's manpower required to grout materials for all materials. Admixture, admixture of each procurement shall meet the relevant quality ? 新生儿水痘的皮疹有时酷似带状疱疹的皮疹 • 并发症 ? 皮肤继发细菌感染 ? 继发性血小板减少 ? 水痘肺炎 ? 神经系统:水痘后脑炎、格林-巴利综合征、 横贯性脊髓炎、面神经瘫痪、 Reye综合征等 ? 其它:心肌炎、肝炎、肾炎、关节炎、睾丸炎 预 后 • 水痘一般呈自限性，10天左右自愈，成人、免疫缺陷小儿和新 生儿患水痘症状严重，常形成播散性和持续性水痘。 provisions of paragraph 6.5 submission of complete information. Monitoring inspection and safety assessment of the implementation of the outcome of the owners of the relevant regulations. 10.11 the completion at the end of the contract period, we will transfer to the owners of all monitoring facilities, engineering data, documents, reports and other project-related content. For monitoring facilities, replaceable equipment availability monitoring instruments should be 100%, not replacing equipment availability monitoring instruments should be 95% or more. Curtain Grouting in the 11th Chapter 11.1 project overview the on curtain Grouting works primarily for River yongxing secondary hydropower station dam Foundation curtain grouting, quantities of 200m. Dam Foundation curtain Grouting in dam concrete pouring is complete, reaches a certain intensity, agreed by the supervising engineer and began construction. 11.2 11.2.1 General requirements we are responsible for the procurement of materials, transport, storage, keeping drilling and apart from the employer's manpower required to grout materials for all materials. Admixture, admixture of each procurement shall meet the relevant quality