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1、發(fā)熱FEVERRespiratoryDepartmentofTang-DuHospital,ThefourthMilitaryMedicalUniversityFuEn-QingTopicofclass1.Understandingtherangeofdiseasesrelatedtofever.2.Graspingtheconception,degrees,sortsoffever.3.Graspingpathwaysofdiagnosisandprincipleoftreatmentoffever.4.Understandingtheepid
2、emicoffever.5.Graspingcommonprincipleoftreatmentoffever.Definitionoffever:Bodytemperatureisabovenormalrangeinanycondition(36.3—37.2degreescentigradewhichismeasuredinmouth).2.Kindsofpyrogen:（1）exogenoaspyrogen外生致熱原bacteria，virus，fungi真菌，Spirochete螺旋體，malarialparasite原蟲，Parasit
3、e寄生蟲，etal.Antigen-antibodycomplex，steroidAntigen-antibodycomplex.（2）edoogenouspyrogen內(nèi)生致熱原interleukin－1，2，6(IL-1~18）.TNF（Tumonecrosisfactor），IFN（Interferon）,endothelin,cilianyneurotrophicfactorCNTFIl-8,macrophageinflammatoryprotein-1MIP-1,3.體溫調(diào)節(jié)（調(diào)定點(diǎn)學(xué)說)thermoregulationofsetpoi
4、nttheory發(fā)熱激活物(substancestoactivatefver)exogenoaspyrogensAntigen-antibodycomplex抗原抗體復(fù)合物steroidcomplex類固醇復(fù)合物產(chǎn)EPs細(xì)胞EPs神經(jīng)介質(zhì)：PGE,Na/Ca?CRH促腎上腺激素釋放激素，aVP精氨酸加壓素，A-MSH,Liportin脂皮質(zhì)激素-1調(diào)定點(diǎn)?運(yùn)動(dòng)神經(jīng)?Motornerve交感神經(jīng)?sympatheticnerve肌緊張?muscletension寒戰(zhàn)?chilling血管收縮?bloodvesselcontract產(chǎn)熱增加散熱減少發(fā)
5、熱fever4.發(fā)熱分度：DegreesoffeverLowFever:<38.0°CMiddleFever:38.0~39.0°CHighFever:39.0~41.0°CExceedhighfever:>41.0°C5.熱型：Typesfoffever)①稽留熱：continuedfever持續(xù)高溫②馳張熱spreadfever③間隙熱intermissionfever④波浪熱:wavesfever⑤回歸熱:Recurrentfever⑥不規(guī)則熱:irregularfever6.常見病因：commonpathogeny(1)感染性發(fā)熱：inf
6、ectiousfever病毒virus支原體mycoplasm立克次體Rickettsia細(xì)菌Bacterium螺旋體Spirochete原蟲Protozoa寄生蟲Parasite真菌Fungus（2）非感染性發(fā)熱：non-infectiousfverA.無菌性壞死asepticnecrosis：腫瘤tumor血液病hematopathy血栓壞死thrombo-necrosisB.機(jī)械性物理性損傷等．MechanicalandphysicalinjureC.變態(tài)反應(yīng)性發(fā)熱allergicreactionⅠ、Ⅱ、Ⅲ、Ⅳ型變態(tài)反應(yīng)D.內(nèi)分泌及代謝障礙
7、性疾病endocrinedisorderandmetabolicobstacledisease：脫水E.體溫調(diào)節(jié)中樞功能紊亂heatregulatingcenterdisorder：中暑heatstroke發(fā)熱病因組成：青島醫(yī)學(xué)院第二附屬醫(yī)院208例186例清楚診斷：89.4%,10.6%診斷不清感染117例風(fēng)濕疾病:36例腫瘤:34例具體組成(見下表):2周呼吸道感染:26急性白血病3膽道感染14惡組1結(jié)核胸膜炎13SLE3肺結(jié)核10泌尿系感染10敗血癥6肝膿腫61-2月敗血癥10SLE10淋巴瘤4肺外結(jié)核8多發(fā)性肌炎6肝癌4肝膿腫7Still
8、病5惡組6泌尿系感染4類風(fēng)濕3腎癌3脾膿腫1急性白血病22-3月膈下膿腫1Reit綜合癥2肝癌2惡組3肺外結(jié)核4SLE4淋巴瘤2Stil
