症状是指患者观感受到不适或痛苦异常感觉

发 热fever体温调节Thermoregulationl Basal metabolism l Muscular activity (shivering) l Thyroxine and epinephrine l Specific dynamic effectl Radiation l Conduction l Convection l Evaporation secrete perspiration sweatingHomeostasis (36 37）Activates heat-loss center in hypothalamusSkin blood vessels constrictSkeletal muscles activated, shivering beginsSkin blood vessels dilateSweat glands activatedImbalanceImbalanceBody temperature decreasesActivates heat-promoting center in hypothalamusHot stimulus Blood warmer than set pointCold stimulus Blood cooler than set pointBody temperature increases正常人体温 normal body temperaturenoral temperature naxillary temperature nrectal temperature Circadian rhythm：Lowest between 2 and 6 AM; Highest around 6 PM Fever is an elevated body temperature that is medicated by an increase in the hypothalamic heat-regulating set point. It is characterized by a body temperature 0.5 above the normal range or daily temperature variations greater than 1. 定义定义 Definition of feverBODY 感染性发热感染性发热 infective fever：最常见，占发热病因的最常见，占发热病因的5060%。 （其中细菌性占约（其中细菌性占约43%，病毒性占约，病毒性占约6%），各种病原体引起的急性、），各种病原体引起的急性、 亚急性、慢性，全身或局部感染均可引起发热。亚急性、慢性，全身或局部感染均可引起发热。Diseases Bacteria Viruses Mycoplasma Rickettsia Fungi Spirochete Parasite 非感染性发热非感染性发热 non-infective fever 无菌性坏死物质的吸收无菌性坏死物质的吸收 Absorption of aseptic necrosis substance 抗原抗原抗体反应抗体反应 Antigen and antibody reaction 内分泌代谢障碍内分泌代谢障碍 Endocrine and metabolic disease 皮肤散热减少皮肤散热减少 Decrease of heat loss through skin 体温调节中枢功能失常体温调节中枢功能失常 Abnormity of heat regulating center 自主神经功能紊乱自主神经功能紊乱 Abnormal automatic nerve function 发热机制发热机制 下丘脑下丘脑 动态平衡动态平衡致热源性发热的机制致热源性发热的机制外源性致热外源性致热原原内源性致热内源性致热原原下丘脑体温调节中枢的体温调定点下丘脑体温调节中枢的体温调定点上上升升垂体内分泌垂体内分泌运动神经运动神经交感神经交感神经产热产热散散热热发热发热Blood vessels constrictionMonoluclear phagocyteLeucocyteEndogenous pyrogen IL-1 TNF IFNShiveringReceptors in skinThermoregulation center in hypothalamusBloodBloodSympathetic Sympathetic nervenervemotor nervemotor nerveFeverHeat Heat losslossHeat productionHeat productionExogenous pyrogenAntigen antibody complexFungibacterial productsEndotoxinLymphokinesBacteriaVirusesPolynucieotideCrystal(urate) etc.临床表现Classificationn低热低热 low fever： 37.338oCn中度热中度热 middle fever： 38.139oCn高热高热 high fever： 39.141oCn超高热超高热 hyperpyrexia： 41oC Temperature increase stageHigh fever stageDefervescence stageSet-point returns to normalBody reaches new set-pointTemperature increases to new set-pointinitiation of heat losing mechanismsSweating wet skinheat lossheat production body temperature decreasesHeat-production center shuts offno longer shivering cutaneous vasodilation heart beat respiratory frequency sweatingflushed skin dehydrationThermoregulation centerThermoregulation centerSympathetic NMotor Ncutaneous vasoconstrictionwarm receptors in skinskeletal muscles constrictshivering Piloerection Muscular sorenesschillypale skinheat loss heat production heat loss heat productionbody temperature increases 体温升高期体温升高期高热期高热期体温下降期体温下降期设定值回到正常设定值回到正常上调最高值后停止上调最高值后停止温度升至新设定值温度升至新设定值同左同左产热产热 散热散热 （汗）（汗）关闭产热关闭产热产热产热 散热散热启动产热、关闭散热启动产热、关闭散热启动散热启动散热通过神经通过神经体液调节体液调节（热）（热） 产热产热 散热散热（冷）（冷）同左同左 Increase Decrease abruptly gradually abruptly gradually hours days hours days malaria septemia lobar pneumonia typhoid tuberculosis malaria lober pneumonia typhoid rheumatic fever 临床表现临床表现 热型热型 Fever type稽留热稽留热 continued fever n体温恒定地维持体温恒定地维持在在39403940以上以上的高水平，达数的高水平，达数天或数周。天或数周。2424小小时内体温波动范时内体温波动范围不超过围不超过1 1 。n常见于大叶性肺常见于大叶性肺炎、斑疹伤寒及炎、斑疹伤寒及伤寒高热期伤寒高热期. .弛张热弛张热 remittent fever n常见于败血症、常见于败血症、风湿热、重症风湿热、重症肺结核、化脓肺结核、化脓性炎症、恶性性炎症、恶性组织细组织细 胞病胞病等等间歇热间歇热 intermittent fever n体温骤升达高峰体温骤升达高峰后持续数小时，后持续数小时，又迅速降至正常又迅速降至正常水平，无热期水平，无热期（间歇期）可持（间歇期）可持续续1 1天至数天，天至数天，如此高热期与无如此高热期与无热期反复交替出热期反复交替出现。现。n见于疟疾、急性见于疟疾、急性肾盂肾炎、化脓肾盂肾炎、化脓性局灶性感染等。性局灶性感染等。波状热波状热(波浪热波浪热) undulant fever n体温逐渐上升体温逐渐上升达达3939或以上，或以上，数天后又逐渐数天后又逐渐下降至正常水下降至正常水平，持续数天平，持续数天后又逐渐升高，后又逐渐升高，如此反复多次，如此反复多次，呈波浪状起伏。呈波浪状起伏。n常见于布氏杆常见于布氏杆菌病、恶性淋菌病、恶性淋巴瘤、腹膜炎巴瘤、腹膜炎回归热（再发热）回归热（再发热）recurrent fevern 体温急骤上升至体温急骤上升至3939或以上，持或以上，持续数天后又骤然续数天后又骤然下降至正常水平。下降至正常水平。高热期与无热期高热期与无热期各持续若干天后各持续若干天后规律性交替一次。规律性交替一次。n可见于回归热、可见于回归热、霍奇金病、周期霍奇金病、周期热等热等不规则热不规则热 irregular fever n发热高低不发热高低不等，无一定等，无一定规律及热型规律及热型n见于流感、见于流感、支气管肺炎、支气管肺炎、渗出性胸膜渗出性胸膜炎炎热型热型体温体温温差温差其他特点其他特点临床意义临床意义稽留热稽留热高达高达394024h2Tmin正常正常败血症、风湿败血症、风湿热热间歇热间歇热高热与无热相高热与无热相交替交替24h数度数度反复发作反复发作疟疾、疟疾、急性肾急性肾盂肾炎、盂肾炎、不规则热不规则热高低不等高低不等不定不定发热无一定规律发热无一定规律支气管肺炎、支气管肺炎、渗出性胸膜炎渗出性胸膜炎波状热波状热缓升达缓升达39以以上上缓升缓降缓升缓降数天后又渐降至正数天后又渐降至正常水平，如此反复常水平，如此反复多次多次布氏杆菌病、布氏杆菌病、恶性淋巴瘤恶性淋巴瘤回归热回归热骤升达骤升达39以以上上骤升骤降骤升骤降数天后又骤降至正数天后又骤降至正常水平，若干天后常水平，若干天后规律性交替一次规律性交替一次回归热、霍奇回归热、霍奇金病、周期热金病、周期热等等伴随症状与体征（有定位或重要意义）伴随症状与体征（有定位或重要意义）问诊要点问诊要点口唇单纯疱疹口唇单纯疱疹结膜充血结膜充血( (回归热回归热) )麻疹皮疹及麻疹口腔粘膜斑麻疹皮疹及麻疹口腔粘膜斑(Koplik(Koplik斑斑) )猩红热皮疹猩红热皮疹风疹皮疹风疹皮疹水痘皮疹水痘皮疹皮肤黄染皮肤黄染巩膜黄染巩膜黄染伤寒面容伤寒面容 病因1.2.3.