医学咽喉带状疱疹PPT培训课件

按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,*,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,*,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,*,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,*,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,*,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,*,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,*,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,*,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,*,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,*,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,*,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,*,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,*,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,咽喉带状疱疹,Pharyngolaryngeal Involvement byVaricella-Zoster Virus,Journal of Voice Volume 27,Issue 5,September 2013,Pages 636641,咽喉带状疱疹,水痘,-,带状疮疹病毒,初次感染后，病毒在神经节内潜伏；常在部位：三叉神经节和背根神经节或自主神经节,病毒重新被激活，在神经分布区产生疱疹，为带状疱疹，老年人或免疫力降低时易得病,颅神经中，最多见的是三叉神经眼支,(herpes zoster ophthalmicus),和面神经,(herpes zoster oticus).,耳鼻喉科最常见的为耳带状疱疹,其他颅神经受累较少，咽喉带状疱疹很少,瑞士,Nisa,从,MEDLINE,中收集,2012,年,1,月以前的文献，得,54,例咽喉带状疱疹，其中,83%,并有其它颅神经受累，,VII(48%),VIII(44%),V(18%),XI(15%),XII(10%),VI(5%),III(4%),and IV(2%).,咽反射,72%,病例有治疗记录，其中,77%,抗病毒,(acyclovir,valacyclovir,or famciclovir).57%Prednisone,治疗,(2/3,病例联合抗病毒,18%,未治,63%,病例有随访，随访期,5.6 5.5,月,(2,周,28,月,).,(1),多与,VII,、,VIII,颅神经病伴随发生,;,(2),最早的表现为吞咽痛和发音困难,;,(3),症状偏侧，软颚及咽喉轻偏瘫及偏侧感觉缺失，为恒定特征症状，不一定有疱疹,;,(4),血清学是可靠的诊断工具，大多数病例放射学检查正常,;,(5),完全恢复率低,(26%),，很多病人长期留有神经功能障碍,有的病例只有单侧咽部疱疹，有的病例伴,IIIXII,颅神经病损。,1/3,病例有前驱耳痛症状，但未发展为耳带状疱疹。耳痛可以是反射性的，也可以是外耳神经,(CN V,、,VII),受累,CN VII,膝状神经节是,VZV,最常潜伏的部位，亲神经性病毒 有沿,CN VII and CN V,CN VIII,CN IX,and CN X,神经间吻合扩展的潜能。,34%,病例没有疱疹,，,肯定诊断需靠血清或脑脊液证明,VZV,感染。,VZV,感染的,IgG,绝对值缺乏特异性，发病后,3,周最高，在可疑病例，比较,2-to 3,周间隔的两次检查值，如有升高就有意义,公认疱疹出现,72,小时内用抗病毒剂可减轻疼痛。,本文收集的病例，用与不用抗病毒剂的效果，无统计学差异，激素治疗,VZV,感染是个争议的问题,Case 1,55,岁，女，喉痛伴左耳痛、声嘶、吞咽困难,5,天，耳部及口腔无疱疹，喉镜见左下咽、杓会厌襞、杓状软骨、会厌黏膜肿胀、红色糜烂,.,左软腭运动力弱，发,“Ah”,声偏右，伸舌偏左，左声带固定在旁中央位，提示,9,、,10,、,12,颅神经麻痹,实验室检查：白细胞,4520/mm3,、,72.4%,中性,、,13.5%,淋巴、,12.8%,单核，,C-,反应蛋白明显升高,5.9 0.3 mg/dL,，血沉,25 20 mm/h.,最初,VZV,血清免疫球蛋白,IgM,（,-,）、,IgG10.80 negative 0.80 index.,随访,VZV IgM 3.46 negative 0.80 index,VZV IgG,升至,11.29