一(yi)、上呼吸道病(bing)毒感染相關疾病(bing)類型(xing)有哪(na)些
1、普(pu)(pu)通(tong)(tong)感(gan)(gan)(gan)冒:上呼(hu)吸道感(gan)(gan)(gan)染簡稱(cheng)上感(gan)(gan)(gan),又(you)稱(cheng)普(pu)(pu)通(tong)(tong)感(gan)(gan)(gan)冒。是(shi)包(bao)括鼻腔(qiang)、咽(yan)或(huo)喉部急性(xing)炎癥的總稱(cheng)。廣義的上感(gan)(gan)(gan)不是(shi)一個疾(ji)病(bing)診斷,而是(shi)一組疾(ji)病(bing),包(bao)括普(pu)(pu)通(tong)(tong)感(gan)(gan)(gan)冒、病(bing)毒性(xing)咽(yan)炎、喉炎、皰疹性(xing)咽(yan)峽(xia)炎、咽(yan)結膜熱、細菌性(xing)咽(yan)-扁桃體(ti)炎。狹義的上感(gan)(gan)(gan)又(you)稱(cheng)普(pu)(pu)通(tong)(tong)感(gan)(gan)(gan)冒,是(shi)最(zui)常見的急性(xing)呼(hu)吸道感(gan)(gan)(gan)染性(xing)疾(ji)病(bing),多呈自(zi)限性(xing),但發(fa)(fa)生率較高(gao)。成人每年發(fa)(fa)生2~4次(ci),兒童發(fa)(fa)生率更高(gao),每年6~8次(ci)。全年皆可發(fa)(fa)病(bing),冬(dong)春季較多。
2、流(liu)行性感(gan)(gan)(gan)冒:流(liu)行性感(gan)(gan)(gan)冒(簡稱流(liu)感(gan)(gan)(gan))是流(liu)感(gan)(gan)(gan)病(bing)(bing)(bing)毒引起(qi)的急性呼吸道感(gan)(gan)(gan)染(ran)(ran),也(ye)是一種傳(chuan)(chuan)染(ran)(ran)性強、傳(chuan)(chuan)播(bo)速(su)度快的疾病(bing)(bing)(bing)。其(qi)主(zhu)要通過(guo)空氣中的飛沫、人(ren)與(yu)人(ren)之間的接(jie)觸(chu)(chu)或與(yu)被污(wu)染(ran)(ran)物(wu)品的接(jie)觸(chu)(chu)傳(chuan)(chuan)播(bo)。典型(xing)的臨(lin)床癥狀是:急起(qi)高熱、全身疼痛、顯著乏力和輕度呼吸道癥狀。一般秋冬季(ji)節是其(qi)高發(fa)(fa)期,所引起(qi)的并(bing)發(fa)(fa)癥和死亡(wang)(wang)現象非常(chang)嚴(yan)重(zhong)。該(gai)病(bing)(bing)(bing)是由流(liu)感(gan)(gan)(gan)病(bing)(bing)(bing)毒引起(qi),可分為(wei)甲(jia)(A)、乙(yi)(B)、丙(C)三型(xing),甲(jia)型(xing)病(bing)(bing)(bing)毒經常(chang)發(fa)(fa)生抗原變(bian)異,傳(chuan)(chuan)染(ran)(ran)性大(da),傳(chuan)(chuan)播(bo)迅速(su),極(ji)易(yi)發(fa)(fa)生大(da)范圍流(liu)行。甲(jia)型(xing)H1N1也(ye)就是甲(jia)型(xing)一種。本(ben)病(bing)(bing)(bing)具有自限性,但在嬰幼兒、老(lao)年人(ren)和存(cun)在心肺(fei)基礎疾病(bing)(bing)(bing)的患者容易(yi)并(bing)發(fa)(fa)肺(fei)炎等嚴(yan)重(zhong)并(bing)發(fa)(fa)癥而導致死亡(wang)(wang)。
3、咽(yan)(yan)(yan)(yan)炎(yan)(yan)(yan)(yan):咽(yan)(yan)(yan)(yan)部(bu)(bu)(bu)的非特異性(xing)(xing)(xing)炎(yan)(yan)(yan)(yan)癥(zheng),是各種微(wei)生(sheng)物感染咽(yan)(yan)(yan)(yan)部(bu)(bu)(bu)而產生(sheng)炎(yan)(yan)(yan)(yan)癥(zheng)的統稱,可單獨存在,也可與鼻炎(yan)(yan)(yan)(yan)、扁桃體炎(yan)(yan)(yan)(yan)和喉炎(yan)(yan)(yan)(yan)并存,或為(wei)(wei)某(mou)些疾病的前驅癥(zheng)狀。可分(fen)為(wei)(wei)急(ji)性(xing)(xing)(xing)咽(yan)(yan)(yan)(yan)炎(yan)(yan)(yan)(yan)和慢(man)性(xing)(xing)(xing)咽(yan)(yan)(yan)(yan)炎(yan)(yan)(yan)(yan)。急(ji)性(xing)(xing)(xing)咽(yan)(yan)(yan)(yan)炎(yan)(yan)(yan)(yan)為(wei)(wei)咽(yan)(yan)(yan)(yan)部(bu)(bu)(bu)黏(nian)膜(mo)及(ji)黏(nian)膜(mo)下(xia)組織(zhi)(zhi)的急(ji)性(xing)(xing)(xing)炎(yan)(yan)(yan)(yan)癥(zheng),咽(yan)(yan)(yan)(yan)淋(lin)巴組織(zhi)(zhi)常被累及(ji),炎(yan)(yan)(yan)(yan)癥(zheng)早期(qi)可局限,隨病情(qing)進展常可涉及(ji)整個咽(yan)(yan)(yan)(yan)腔,以秋冬及(ji)冬春(chun)之交較(jiao)常見(jian)(jian)。主要(yao)表(biao)現為(wei)(wei)咽(yan)(yan)(yan)(yan)部(bu)(bu)(bu)干(gan)燥,灼熱,疼(teng)痛(tong),吞咽(yan)(yan)(yan)(yan)疼(teng)痛(tong)明(ming)顯,咽(yan)(yan)(yan)(yan)部(bu)(bu)(bu)充(chong)血腫(zhong)脹等。慢(man)性(xing)(xing)(xing)咽(yan)(yan)(yan)(yan)炎(yan)(yan)(yan)(yan)又(you)可分(fen)為(wei)(wei)慢(man)性(xing)(xing)(xing)單純性(xing)(xing)(xing)咽(yan)(yan)(yan)(yan)炎(yan)(yan)(yan)(yan)、慢(man)性(xing)(xing)(xing)肥(fei)厚性(xing)(xing)(xing)咽(yan)(yan)(yan)(yan)炎(yan)(yan)(yan)(yan)和萎(wei)縮(suo)性(xing)(xing)(xing)咽(yan)(yan)(yan)(yan)炎(yan)(yan)(yan)(yan),其中慢(man)性(xing)(xing)(xing)單純性(xing)(xing)(xing)咽(yan)(yan)(yan)(yan)炎(yan)(yan)(yan)(yan)較(jiao)多見(jian)(jian),病變主要(yao)在黏(nian)膜(mo)層(ceng),表(biao)現為(wei)(wei)咽(yan)(yan)(yan)(yan)部(bu)(bu)(bu)黏(nian)膜(mo)慢(man)性(xing)(xing)(xing)充(chong)血,黏(nian)膜(mo)及(ji)黏(nian)膜(mo)下(xia)結締(di)組織(zhi)(zhi)增生(sheng),黏(nian)液(ye)(ye)腺可肥(fei)大,分(fen)泌功能亢進,黏(nian)液(ye)(ye)分(fen)泌增多。患者常咯(ge)出咽(yan)(yan)(yan)(yan)內黏(nian)痰(tan),或感覺(jue)咽(yan)(yan)(yan)(yan)部(bu)(bu)(bu)有(you)異物感,咯(ge)不(bu)出,咽(yan)(yan)(yan)(yan)不(bu)下(xia)。多見(jian)(jian)成年人,病程長,易復發,癥(zheng)狀頑(wan)固,較(jiao)難治(zhi)愈。
4、注意:肺炎(yan)型需與(yu)其他肺炎(yan)相(xiang)鑒別,中毒型需與(yu)流(liu)腦(nao)、腦(nao)炎(yan)相(xiang)鑒別,胃腸(chang)型需與(yu)胃腸(chang)炎(yan)、痢疾相(xiang)鑒別,咽(yan)炎(yan)型需與(yu)急性扁桃體炎(yan)相(xiang)鑒別。
二、上呼吸道病(bing)毒感染處理辦法是怎樣的
1、對(dui)癥(zheng)治(zhi)療(liao)(liao)(liao):用藥的(de)目的(de)在(zai)(zai)于改(gai)善癥(zheng)狀稱(cheng)為(wei)(wei)對(dui)癥(zheng)治(zhi)療(liao)(liao)(liao),或稱(cheng)治(zhi)標。對(dui)癥(zheng)治(zhi)療(liao)(liao)(liao)雖然不能根除病(bing)(bing)因(yin),但是在(zai)(zai)診(zhen)斷未明或病(bing)(bing)因(yin)暫時(shi)(shi)未明時(shi)(shi)無(wu)法根治(zhi)的(de)疾(ji)病(bing)(bing)卻是必不可少的(de)。在(zai)(zai)臨床上,某些重危急癥(zheng)如休克(ke)、驚厥、心力衰(shuai)竭、高熱、劇痛時(shi)(shi),對(dui)癥(zheng)治(zhi)療(liao)(liao)(liao)可能比對(dui)因(yin)治(zhi)療(liao)(liao)(liao)更為(wei)(wei)迫切。在(zai)(zai)可能的(de)情況下,應當對(dui)因(yin)治(zhi)療(liao)(liao)(liao)和對(dui)癥(zheng)治(zhi)療(liao)(liao)(liao)同時(shi)(shi)進(jin)行。
2、抗病(bing)(bing)毒(du)(du)(du)藥(yao)(yao):抗病(bing)(bing)毒(du)(du)(du)藥(yao)(yao)是一類(lei)用于(yu)預防和(he)治(zhi)療(liao)病(bing)(bing)毒(du)(du)(du)感(gan)染的(de)(de)藥(yao)(yao)物。在體外可抑(yi)制病(bing)(bing)毒(du)(du)(du)復制酶,在感(gan)染細胞(bao)或動物體抑(yi)制病(bing)(bing)毒(du)(du)(du)復制或繁殖,在臨床上治(zhi)療(liao)病(bing)(bing)毒(du)(du)(du)病(bing)(bing)有效的(de)(de)藥(yao)(yao)物。如病(bing)(bing)毒(du)(du)(du)靈、病(bing)(bing)毒(du)(du)(du)唑、干擾素(su)、阿糖胞(bao)苷(gan)等;板藍根、大青葉、柴胡、雙黃連等。
3、抗生(sheng)(sheng)素:抗生(sheng)(sheng)素是在低濃度下就(jiu)能選擇(ze)性(xing)地抑(yi)制某些生(sheng)(sheng)物(wu)生(sheng)(sheng)命(ming)活動(dong)的(de)微生(sheng)(sheng)物(wu)次級(ji)代(dai)謝產物(wu),及其化學半合成(cheng)或(huo)全合成(cheng)的(de)衍生(sheng)(sheng)物(wu)。抗生(sheng)(sheng)素對(dui)病原微生(sheng)(sheng)物(wu)具有抑(yi)制或(huo)殺滅(mie)作(zuo)用(yong),是防(fang)治感染性(xing)疾病的(de)重要藥物(wu)。抗生(sheng)(sheng)素不(bu)僅有抗菌作(zuo)用(yong),其作(zuo)用(yong)還包括抗腫(zhong)瘤、抗病毒、抑(yi)制免疫、殺蟲作(zuo)用(yong)、除草作(zuo)用(yong)等。如大環內酯類(lei)、青霉素、一代(dai)頭孢、氟喹諾酮類(lei)。
4、預(yu)防:如(ru)達菲和(he)扎那米韋(wei)既能預(yu)防又(you)能治(zhi)療(liao)。達菲75mg/粒(li),預(yu)防用(yong)(yong)(yong)藥每(mei)(mei)次(ci)一粒(li),每(mei)(mei)日一次(ci),連(lian)用(yong)(yong)(yong)5天(tian);治(zhi)療(liao)用(yong)(yong)(yong)藥每(mei)(mei)次(ci)一粒(li),每(mei)(mei)日2次(ci),連(lian)用(yong)(yong)(yong)5天(tian)。金剛烷胺每(mei)(mei)日口服100~200mg。中(zhong)草藥煎服。
三、上呼吸道病毒感染(ran)處方舉例
1、口服一(yi)號套餐:(1)、感冒通(2)、病毒靈(3)、VitC 片
2、口(kou)服二號套餐:(1)、備疏感冒(mao)片(2)、病毒靈(3)、VitC 片 上(shang)述用(yong)于普通
3、感冒口(kou)服三號套(tao)餐:(1)、阿莫西林膠(jiao)囊(2)、泰諾感冒片(3)、必嗽平(ping)(4)、VitC 片 適(shi)用于有發燒、咳(ke)嗽癥
4、另:(1)、5%葡(pu)萄糖(tang)注射(she)液(單(dan)軟) 250ml/瓶(ping) *1瓶(ping)(2)、0Sig. 250ml ONCE ivgtt(3)、頭孢呋辛鈉 1.5g/支(zhi)*3支(zhi)(4)、Sig. 4.5g ONCE ivgtt(5)、5%葡(pu)萄糖(tang)注射(she)液(單(dan)軟) 100ml/瓶(ping) *1瓶(ping)(6)利巴韋林注射(she)液 100ml/支(zhi) *6支(zhi)(7)、Sig. 600mg ONCE ivgtt
對(dui)于頭孢呋辛(xin)鈉,說(shuo)明(ming)書中指出成人常用量(liang)為一次0.75 g~1.5 g,每8小(xiao)時給藥一次。而對(dui)于生命受到(dao)威脅的(de)感染(ran)或罕見敏感菌(jun)引起的(de)感染(ran),應(ying)每6小(xiao)時使用1.5 g劑量(liang)。
過量使用會刺激(ji)大腦(nao)發生驚厥,血(xue)液透析(xi)法或腹(fu)膜透析(xi)法可降低本(ben)品的血(xue)清濃度(du)。
四、上呼吸道(dao)病毒感染藥(yao)物(wu)服用的詳(xiang)細(xi)案例
初診:身熱(re)不甚,但咳微(wei)渴,體溫(wen)37.8℃,舌(she)苔(tai)薄白,咽紅(hong)微(wei)痛(tong),脈(mo)(mo)象浮(fu)數。本(ben)是風溫(wen)之邪,侵于肺(fei)衛,肺(fei)失宣(xuan)降(jiang),應予桑(sang)菊飲加減為法。今(jin)誤用(yong)辛溫(wen)發(fa)(fa)汗(han)之藥治之(麻黃、杏仁、炙草),藥后發(fa)(fa)熱(re)劇增,體溫(wen)39℃,脈(mo)(mo)象滑數,咽紅(hong)腫痛(tong),舌(she)紅(hong)苔(tai)黃燥(zao)。本(ben)是風熱(re),過(guo)用(yong)辛溫(wen),既發(fa)(fa)汗(han)以(yi)傷(shang)陰(yin),又助熱(re)以(yi)化燥(zao),故高燒(shao)咽紅(hong)且腫,勢將(jiang)發(fa)(fa)熱(re)增重(zhong),姑以(yi)清(qing)潤宣(xuan)肺(fei),肅化清(qing)解(jie)。防其咳嗽暴作,飲食(shi)宜慎。處方:沙參12克(ke)(ke)(ke)(ke),浙川(chuan)貝母各6克(ke)(ke)(ke)(ke),杏仁9克(ke)(ke)(ke)(ke),炒梔皮(pi)(pi)6克(ke)(ke)(ke)(ke),淡竹葉3克(ke)(ke)(ke)(ke),連翹9克(ke)(ke)(ke)(ke),黃芩9克(ke)(ke)(ke)(ke),鮮(xian)蘆根24克(ke)(ke)(ke)(ke),鮮(xian)梨一(yi)個(連皮(pi)(pi)去核(he)切片),二付。
二(er)診(zhen):前服甘寒(han)(han)清(qing)潤(run)之(zhi)后,身熱大減,體溫37.5℃,咽(yan)紅腫略退(tui),脈象(xiang)從浮數已轉為滑數,舌(she)紅苔黃,大便略干小(xiao)便短赤(chi)。昨服甘寒(han)(han)清(qing)潤(run),陰(yin)復(fu)而熱減,再以甘寒(han)(han)養陰(yin)折熱。辛辣油黏皆忌(ji)。處方:浙(zhe)川貝母各9克(ke),沙(sha)參(can)15克(ke),杏仁9克(ke),麥冬9克(ke),炙杷葉15克(ke),黛蛤散15克(ke)(布(bu)包),瓜蔞仁24克(ke),鮮梨皮二(er)枚,洗凈切片,三付。
三診(zhen):身熱(re)退(tui)凈,體溫36.7℃,咽(yan)紅(hong)腫痛皆愈,飲(yin)食二(er)便正常。原方續服三付而康復。
[按(an)]:本案與(yu)上案均為風溫初(chu)起即誤服辛溫發汗(han)之(zhi)劑而致病情陡(dou)然(ran)加劇。然(ran)救(jiu)誤之(zhi)法卻各(ge)不相(xiang)同(tong)。本案患(huan)者因素體陰(yin)(yin)(yin)虛,加之(zhi)服麻(ma)黃劑過汗(han)傷(shang)(shang)陰(yin)(yin)(yin),故于(yu)清(qing)解之(zhi)中,參(can)以甘潤養陰(yin)(yin)(yin)。服后便得熱退。轉方甘寒養陰(yin)(yin)(yin)兼以折熱,以為善后之(zhi)計。觀此(ci)可知,溫病宜刻刻顧護(hu)陰(yin)(yin)(yin)液,豈可發汗(han)以重傷(shang)(shang)其陰(yin)(yin)(yin)耶(ye)!
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