感冒不仅仅是上呼吸道感染ppt课件.ppt

感冒-不仅仅是上呼吸道感染,2,Definition,Thecommoncold(acuteviralrhinopharyngitis,acutecoryza,viralupperrespiratorytractinfection,oracold)isacontagious,viralinfectiousdiseaseoftheupperrespiratorysystem,primarilycausedbyrhinoviruses,(picornaviruses小核糖核酸病毒)orcoronaviruses.Itisthemostcommoninfectiousdiseaseinhumans；thereisnoknowncure,butitisveryrarelyfatal.,3,Definition,Collectively,colds,influenza,andotherinfectionswithsimilarsymptomsareincludedinthediagnosisofinfluenza-likeillness.Often,influenzaandthecommoncoldaremistakenforeachother,evenbyprofessionalhealthcareworkers,butmostoftherecommendedhometreatments(drinkingplentyofwarmfluids,keepingwarm,etc.)aresimilarifnotthesame.Thesymptomsofinfluenzaoftenincludeafeverandaremoreseverethanthecold.,4,SYMPTOM,cough,sorethroat,runnynose,nasalcongestion,andsneezing;sometimesaccompaniedbypinkeye,muscleaches,fatigue,malaise,headaches,muscleweakness,uncontrollableshivering,lossofappetite,andrarelyextremeexhaustion.Feverismorecommonlyasymptomofinfluenza,anotherviralupperrespiratorytractinfection(URTI)whosesymptomsbroadlyoverlapwiththecold,butaremoresevere.Symptomsmaybemoresevereininfantsandyoungchildren(duetotheirimmunesystemnotbeingfullydeveloped)aswellastheelderly(duetotheirimmunesystemoftenbeingweakened).,5,SYMPTOM,Asensationofchillinesseventhoughthecoldisnotgenerallyaccompaniedbyfever,andalthoughchillsaregenerallyassociatedwithfever,thesensationmaynotalwaysbecausedbyactualfever.Inonestudy,60%ofthosesufferingfromasorethroatandupperrespiratorytractinfectionreportedheadaches,oftenduetonasalcongestion.Thesymptomsofacoldusuallyresolveafteraboutoneweek;however,itisnotrarethatsymptomslastuptothreeweeks.,6,WhatistheDifferenceBetweenInfluenzaandtheCommonCold?,7,complications,opportunisticcoinfectionsorsuperinfectionssuchasacutebronchitis,bronchiolitis,croup,pneumonia,sinusitis,otitismedia,orstrepthroat.（脓毒性咽喉炎）PeoplewithchroniclungdiseasessuchasasthmaandCOPDareespeciallyvulnerable.Coldsmaycauseacuteexacerbationsofasthma,emphysemaorchronicbronchitis,8,Causeandsusceptibility,oneofthe99knownserotypesofrhinovirus,atypeofpicornavirus.Around30-50%ofcoldsarecausedbyrhinoviruses.Othervirusescausingcoldsarecoronavirus(causing10-15%),humanparainfluenzaviruses,humanrespiratorysyncytialvirus,adenoviruses,enteroviruses,ormetapneumovirus.5-15%arecausedbyinfluenzaviruses.Intotalover200serologicallydifferentviraltypescausecolds.Coronavirusesareparticularlyimplicatedinadultcolds.Duetothemanydifferenttypesofvirusesandtheirtendencyforcontinuousmutation,itisimpossibletogaincompleteimmunitytothecommoncold.,9,Causeandsusceptibility,SleepLackofsleephasbeenassociatedwiththecommoncold.Thosewhosleepfewerthan7hourspernightwerethreetimesmorelikelytodevelopaninfectionwhenexposedtoarhinoviruswhencomparedtothosewhosleepmorethan8hourspernight.VitaminDA2009studyfoundthatlowbloodserumlevelsofvitaminDwereassociatedwithincreasedratesofthecommoncold.Arandomizedcontrolledtrialfoundthat104post-menopausalAfricanAmericanwomenlivinginNewYorkgivenvitaminDwerethreetimeslesslikelytoreportcoldandflusymptomsthan104placebocontrols.Alowdose(800IU/day)notonlyreducedreportedincidence,itabolishedtheseasonalityofreportedcoldsandflu.Ahigherdose(2000IU/day),givenduringthelastyearofthetrial,virtuallyeradicatedallreportsofcoldsorflu.,10,Causeandsusceptibility,ExposuretocoldweatherprolongedexposuretocoldweathersuchasrainorwinterconditionsColdNoevidencethatshort-termexposuretocoldweatherordirectchillingincreasessusceptibilitytoinfection,implyingthattheseasonalvariationisinsteadduetoachangeinbehaviorssuchasincreasedtimespentindoorsatcloseproximitytootherstestthehypothesisthatacutecoolingofthefeetcausestheonsetofcommoncoldsymptoms.ConstrictionofbloodvesselsofthenasalpassageswhichmightleadtoreducedimmunityDecreasedtemperaturemayresultinadropintissuepermeabilityand,asaresult,mayleadtoreducedplasmaleakage.-complementproteins,11,Pathophysiology,salivaornasalsecretionsofaninfectedperson;inaerosolformgeneratedbycoughingandsneezing;orfromcontaminatedsurfaces.,12,Pathophysiology,Majorentrypointforthevirusisnormallythenose,-backofthenoseandtheadenoidarea.Thevirusthenattachestoareceptor,ICAM-1,whichislocatedonthesurfaceofcellsoftheliningofthenasopharynx.Thereceptorfitsintoadockingportonthesurfaceofthevirus.Largeamountsofvirusreceptorarepresentoncellsoftheadenoid.,13,Pathophysiology,Rhinoviruscoldsdonotgenerallycausedamagetothenasalepithelium.Macrophagestriggertheproductionofcytokines,whichincombinationwithmediatorscausethesymptoms.Cytokinescausethesystemiceffects.Themediatorbradykinin(缓激肽）playsamajorroleincausingthelocalsymptomssuchassorethroatandnasalirritation,14,Pathophysiology,Thecommoncoldisself-limiting,andthehostsimmunesystemeffectivelydealswiththeinfection.Withinafewdays,thebodyshumoralimmuneresponsebeginsproducingspecificantibodiesthatcanpreventthevirusfrominfectingcells.Additionally,aspartofthecell-mediatedimmuneresponse,leukocytesdestroythevirusthroughphagocytosisanddestroyinfectedcellstopreventfurtherviralreplication.Inhealthy,immunocompetentindividuals,thecommoncoldresolvesinsevendaysonaverage,15,Incubationperiodandprogressionofdisease,Theupperrespiratoryviralreplicationcyclebegins8to12hoursafterinitialinfection.Symptomsusuallybegin2to5daysafterinitialinfectionbutoccasionallyoccurinaslittleas10hoursafter.Symptomspeak23daysaftersymptomonset,whereasinfluenzasymptomonsetisconstantandimmediate.Thesymptomsusuallyresolvespontaneouslyin7to10daysbutsomecanlastforuptothreeweeks,16,Prevention,Thebestwaytoavoidacoldistowashhandsthoroughlyandregularly;andtoavoidtouchingtheeyes,nose,mouth,andface.Anti-bacterialsoapshavenoextraordinaryeffectonthecoldvirus;itisthemechanicalactionofhandwashingwiththesoapthatremovesthevirusparticles.Rhinovirusescanliveupto3hoursoutsidethebodyontheskinorobjects.In2002,theCentersforDiseaseControlandPreventionrecommendedalcohol-basedhandgelsasaneffectivemethodforreducinginfectiousvirusesonthehandsofhealthcareworkers.Thecommoncoldiscausedbyalargevarietyofviruses,whichmutatequitefrequentlyduringreproduction,resultinginconstantlychangingvirusstrains.Thus,successfulimmunizationishighlyimprobable.,17,LungdiseaseandInfluenza,GetvaccinatedforbothseasonalfluandH1N1flu接种疫苗，包括季节性流感和H1N1流感Coveryournoseandmouthwithyourarmwhenyoucoughorsneeze打喷嚏时用胳膊挡住口鼻Washyourhandsfrequentlywithsoapandwater勤洗手Alcohol-basedhandcleanersarealsoeffectivewhenwashingisntpossible酒精消毒Avoidtouchingyoureyes,noseormouth避免接触眼睛及口鼻Trytoavoidclosecontactwithsickpeople避免与患病者近距离接触Avoidlargecrowds不去人群密集处Askfamilyandfriendstobemindfulofyourhigherriskandnotexposeyoutotheirsicknessiftheyareill避免和高危人群接触Stayhomeifyouaresick:患病后勿外出For7daysaftersymptomsbegin;or症状出现后7天或症状消失后24消失内Untilclearofsymptomsfor24hoursWatchforpublichealthadvisories,astheserecommendationsmaychange健康咨询Forthosewithasthma,pleaseremembertorefertoandmaintainyourAsthmaActionPlanasnecessary.哮喘患者必要时仍需行哮喘治疗,18,Treatment,ConservativemanagementTheNationalInstituteofAllergyandInfectiousDiseasessuggestsgettingplentyofrest,drinkingfluidstomaintainhydration,garglingwithwarmsaltwater,usingcoughdrops,throatsprays,orover-the-counterpainorcoldmedicines.Salinenasaldropsmayhelpalleviatecongestion.Treatmentsthatmayhelpalleviatesymptomsincludeanalgesics,decongestants,andcoughsuppressants,first-generationantihistaminessuchasbrompheniramine,chlorpheniramine,diphenhydramineandclemastine(whichreducemucusglandsecretionandthuscombatblocked/runnynosesbutalsomaymaketheuserdrowsy).Second-generationantihistaminesdonothaveausefuleffectoncolds.,19,Treatment,ConservativemanagementVitaminCinnormalormegadoseshasnotbeenshowntobebeneficialinanormalpopulationforthepreventionortreatmentofthecommoncold.Ithowevermightbebeneficialinpeopleexposedtoperiodsofseverephysicalexerciseorcoldenvironments.Variouscoldmedicinesexisthoweverlittleevidencesuggesttheyareanymoreeffectivethansimpleanalgesics.Theyincludeantitussives,antihistaminesanddecongestantsusuallyincombinationwithananalgesic.Theyarenotrecommendedforuseinchildrenbecauseevidencedoesnotsupporttheireffectivenessandthereareconcernsofharm.,20,Treatment,AntibioticsAntibioticsonlytargetbacteriaandthusdonothaveanybeneficialeffectagainstthecommoncold.AntiviralsTherearenoapprovedantiviraldrugsforthecommoncold.NasalsteroidstillintrialAlternativetreatmentsalternativetreatmentswhichsimilarlylacksolidscientificevidenceincludecalendula,ginger,garlicandvitaminCsupplements.,21,惠菲宁的主要成分及药理作用,马来酸氯苯那敏（扑尔敏）（A）：抑制腺体分泌，减少鼻液后流对咽喉部的刺激以及抗胆碱能活性盐酸伪麻黄碱（D）：选择性地收缩血管，减轻水肿、充血对呼吸道的影响氢溴酸右美沙芬：通过抑制咳嗽中枢，有效控制咳嗽,22,右美沙芬无成瘾性和呼吸抑制，临床应用更放心,中华医学会呼吸病学分会哮喘学组.中华结核与呼吸杂志,2005,28(11):738-44.周敏,等.中国新药与临床杂志,2005,24(9):693-6.,抑制呼吸中枢、成瘾性,无呼吸中枢抑制作用、无成瘾性,中枢性非依赖性镇咳药,中枢性依赖性镇咳药,右美沙芬,可待因,作用于N-甲基-D-天冬氨酸受体和Sigma受体，具有中枢和外周镇咳作用,作用于阿片受体，中枢镇咳作用,镇咳作用强,相当或略强,分类,作用机理,疗效,安全性,23,美敏伪麻溶液：不良反应少，临床应用更放心,长期使用甘草可出现水肿、高血压、低血钾等副作用,24,中医中药,感冒的发生主要由于体虚，抗病能力减弱，当气候剧变时，人体内外功能不能适应，邪气乘虚由皮毛、口鼻而入，引起一系列肺卫症状。中医将感冒分为风寒型感冒、风热型感冒、暑湿型感冒和时行感冒（流行性感冒）四种类型。根据辨证施治的原则，不同类型的感冒应选用不同的中成药治疗。中成药含有西药成分,25,感冒-不仅仅是上呼吸道感染,CommonColdInfluenza,Complications,ColdlikesymptomsFatalDiseases,26,ComplicationsdealingENT,AcuteOtitisMediaAcuteRhinosinusitisAcuteTonsillitisAcuteLaryngitisAcuteEpiglottitis,27,感冒治疗的几个误区,乱吃抗生素硬扛着不看医生随便乱输液,28,慎用抗生素,英国的著名的健康和临床医疗研究所(NationalInstituteforHealthndClinicalExcellence)就向大众指出：消炎药在很多情况下都是没有必要的，有时它们不但不能有效控制感染，反而容易导致带有超强抗药性的金黄色葡萄球菌等超级病菌的蔓延。英国还出台了相关的行医规定：英国医生不得向患有耳部感染、咽喉肿痛、扁桃腺炎、支气管炎、感冒、咳嗽等轻微病症患者开抗生素。因此，医生不得不打发他们回家休息，最多给他们服用一些止痛片。,29,与几种疾病的鉴别,感冒与过敏性鼻炎感冒与百日咳(百日咳杆菌）感冒与猩红热（乙型溶血性链球菌）感冒与脊髓灰质炎（脊髓灰质炎病毒）,30,H1N1甲型流感,31,ThanksforyourConcern,