课件：儿童发热处理原则PPT课件.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * OB has a low prevalence, so even though WBC is a sensitive and specific screening test, it has a low PPV. So the test does not discriminate between children who have FWS who are bacteremic and those who are not. Therefore, blood culture is the gold standard?still has a high number of false positives, take 24-48hrs, and most cases of occult pneumococcal bacteremia clear without treatment. * * * * * * * * Those 6 months retain protective maternal antibodies against common organisms, while those 18-24 months old are more immune competent, and are at a lower risk of developing bacteremia * * * * * Occurs when IL-1, IL-6, TNF-? or other cytokines are released from monocytes and macrophages in response to infection, tissue injury, drugs, and other inflammatory processes, increasing the body’s set point. The anterior hypothalamus maintains an inherent set point near 36oC(98.6oF). * * 5 to 20% of febrile children have no localizing signs on PE and nothing in the history to explain the fever. By definition, less than 7 days. FWS(like fever) is most common in children younger than age 5, with a peak prevalence between 6 and 24 months of age. * * * * * * * * * * * * * Acyclovir(primary maternal infxn, esp if delivered vaginally, PROM, fetal scalp electrodes, skin eye or mouth lesions, seizures, CSF pleocytosis) * * * * * * * * * * * 对症治疗的选择 应用能恢复下丘脑体温调节中枢调定点的药物 布洛芬：退热更有效和疗效时间更长；对全身有抗炎效果;对乙酰氨基酚没有全身的抗炎效果 阿司匹林：因为易致Reye综合症，禁止用于婴儿或儿童，赖氨匹林体内代谢产物为阿司匹林 2月龄，肛温 39℃（口温38.5℃，腋温38.2℃），或因发热出现了不舒适和情绪低落的发热儿童，推荐口服对乙酰氨基酚，剂量为每次15mg/kg，2次用药的最短间隔时间为6h。 6月龄儿童，推荐使用对乙酰氨基酚或布洛芬，布洛芬的剂量为每次10mg/kg，2次用药的最短间隔6～8h，布洛芬与对乙酰氨基酚的退热效果和安全性相似 对症治疗的选择 物理降温：宽衣松裹\温水擦浴\不用酒精\不用冰敷 虽然在对乙酰氨基酚退热基础上，联合温水擦浴，并没有更好的退热效果，却会明显增加患儿不适感，不推荐使用温水擦浴退热，更不推荐冰水或乙醇擦浴方法退热 只有在对退热药过敏、不耐受、呕吐无法服药的情况下才进进行温水擦浴 退热剂的毒性和剂量 布洛芬 易致胃炎和胃肠道出血？过量时，比对乙酰氨基酚和阿司匹林容易处理 每6小时用10mg/kg，可用于6月以上患儿 对乙酰氨基酚 除非过量，几乎无毒性 4－6小时用10-15mg/kg，可用于2月以上患儿 不推荐对乙酰氨基酚联合布洛芬用于儿童退热，也不推荐对乙酰氨基酚与布洛芬交替用于儿童退热 解热镇痛药不能有效地