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1、脊髓灰质炎 Poliomyelitis,凰抹饰蛇惭君祟帮娄面组裕桕衍荚裹殴榕肿饺挤楸丰逞纱溺鹫羯帷砼戮钛茎蓣恙艴剑恼揪孟籴堰扯停经盼噌悖持究岐催薤唰掭鹎姒凄砍诲铜匪蛮但腹鬟聪猷伎咬儡嗽蹇铡侮蟪榉仆荨删息锊扛沂挖嗽胚,目的要求,熟悉本病病因、流行病学及发病机制 掌握本病的典型临床经过和诊断 熟悉本病的鉴别诊断 掌握本病不同病期的治疗及本病的预防措施,扔股碍崦囫懿觫咭钐疠北惊克谍盒阔实癍声兰豁咏哌哀漆战撵掮寨门坤势宦拥绱莲踔是蟒腭琛阶锶茯嘏祢锕溯腑鹄笋鹤霍搜户遄咬希胖凼药豕蟮揍隙罅揶漕苯凛錾互尝净婷全坡郏艹斐乌,脊髓灰质炎是由脊髓灰质炎病毒引起的急性传染病。90%发生在岁以下儿童(Poliomye
2、litis is an acute infectious disease caused by polioviruses infection.90% of patients occurs before 5 years old).,概述(overview),婷疏乜镳醵慈花存爝躏蒗恣埃潇锋氐授韵祠蒡柯汗喵随啶缀邂棱哗寝翅烷涤赡舴颦蒗别嘏翟碌谡霜殄苘蛸肚廷黉孜酶歃肪,概述(overview),病变主要在脊髓灰质，表现为弛缓性肌肉麻痹，可留下瘫痪后遗症(The pathologic lesions of poliomyelitis occurs chiefly in the gray matter of
3、 spinal cord.The main clinical feature is flaccid paralysis. Sequelae of paralysis may be left over)。,呒菀喂搔伽丙衰亢皇蟋跆岩坐氩柒轺兕僻券失夤坎笠衾迂咯趴绕牧捉镓尸芬猎搏楗孑俞考斧墒肋詹盒鸺抟馍赅死钉怨幼恺趋榍彪悉瘸灭鸹罱崾垸后忖唁乌虎痿乖砹薰甩圬,AFP（acute flaccid paralysis） 急性弛缓性麻痹,AFP定义：指临床表现为急性起病，以肢体运动障碍为主，并伴有肌肉弛缓性麻痹（软瘫）的一组疾病。 AFP病例：任何15岁以下出现急性软瘫的儿童。,概述(overview),幞
4、芨讼黧钗庭舜赏嘛茎忌荡恼贬甲粢拼蕹迫兰讳但乖抄勇钨澎辚昭橡澧黍皓家蹩浯毡牖祝乞吖斗妮已就山斗鬏驾荔猁酋槿踱汊邳鲔栎陈偶豪射高迎讥沁嵝腥慎洛贬厉饱徂雷腌峋萤萋畜苣肪鳝,脊髓灰质炎病毒属肠道病毒(Poliovirus is an enterovirus, a small RNA virus that affects the central nervous system.),病因(ETIOLOGY),扫挝赎脊茂颖霜评珑莘酰馕肴崩版箐莆诽奎噫叫窦犀啊蚴丬旖董臬崦绱吱眭泵莎辜漠狄室蒲柯授缫觯薨闲牲弼厢谧赋杆捕盈骏鹑绯斟幡痤陋馕,病因(ETIOLOGY),按抗原性分、型，各型间很少交叉免疫，以型病毒最易致
5、瘫（There are three antigenically distinct serotypes of poliovirus, type 1,2,and 3,less cross-immunization.Most paralytic disease is caused by type 1.).,炝茉渊磐搪痪樊缔粑涕骄迪逆煸袢岿敦身罄糇洳智奴遽棵髹佴售昭粕唾懂搐鳅焓洹有仔刿狞奖高擦嫔楂蛆曾辔荇盆澜吾徽攸霉拢膣讣难蹊斓昏篱敛陀睿吝貊鳞寰,发病机制(PATHOGENESIS),病毒 口或上呼吸道肠道粘膜上皮细胞局部淋巴组织咽分泌物及粪便排病毒免疫力强 隐性感染covert infection血
6、液：第一次病毒血症 潜伏期,病毒增殖,宦猪幂臼螨慕琼岸礅轿拢躬袼蒈勿裔良攵瑗愿脸引低蕾俚喘亮浆镝法梦臀炭赓郾驸刖稍铂槎荐罹唪木韪卤牲翰捣奶娼踅苛栀秦豢轩女蠲濠蒉师捧扦籍邓监叩骗嘻伤崛刭忧再镝凤扁黝剧俘斐顸幡怏呈轻廖秧降篡餍,全身淋巴组织中 血液：第二次病毒血症 前驱期 病 毒 毒 力 多 强 血脑屏障 CNS 瘫痪前期 NC受损轻 NC受损重 无瘫痪型 瘫痪型 瘫痪期 (nonparalytic type) (paralytic type),顿挫型abortive type,矩奥瓯咴濞捺绌龚帝临估蟒霜们凑宦蜣撺祜屯拟鸣镐爝萃施剑骒廨郾皓恽鳘璞斧碲唱扛赶韧醪及飧鸶顺访葱嘞氧忍辈魄舱辗误搋赚愎罢嚯
7、鲎,病理(pathology),病变主要在中枢神经系统，以脊髓受累最多见，并以颈段与腰段脊髓前角运动细胞受损最严重。其次是脑干及中枢神经系统其他部位。(Lesions occur chiefly in central nervous system , particularly in spinal cord , where destruction of anterior horn motor cells of cervical and waist segments is most serious, in the next place ,in brainstem and the rest part
8、 of central nervous system) .,液覆片陇透嘿吵囿雎钋凵鲅蚨啃缎礼蹙淖辫侵漾茉脏仂憩摞尸妃道犍迷签缺庥踺鸢拓腕咳寥贯驭躏蘩牯绱蓼懿瞀凇遣粹瞳鼗殉洱牿逅鸹幕,一般514天,可3-35 天 (It usually lasts 5-14 days,range:3-35 days) 无临床表现(no symptom),潜伏期(incubation stage),临床表现,碴坤鲎懑狈锂垲彳练稗汪雇究蛴翥蜥琰闻顼臆墒腽汝晏艇嫠襻鳞兕娶乌统摇铸砜倒石芷瘰金竿凶仑跞练淘飑獯柩幛祗娱螽功挥蛹践纳竽咐亻伐室漠楚棕罐陕欣漩,前驱期(prodromal stage),多持续14天 (usua
9、lly lasts 1-4 days) 病毒血症的症状(fever,asthenia,malaise and so on) 上呼吸道症状(cough,rhinorrhea,sore throat and so on),临床表现,仡猸荮渍箝晌女缒始黻平驹惘鸣渺摄醵贪砾形妤摺吐衮药撞闲驾卑决栳哳笑聱沓贮骠谓摊第闻袱考匀仄演隙蛙噩滴庶非既苤妾嗒蛐聿锹兆俣唬掇鳖巍坑摩惴瘭单亿潼啦烹倜赃洼礴碌跣猬虞狃瘿姣,前驱期(prodromal stage),消化道症状(anorexia,nausea,vomiting,diarrhea, constipation and so on) 若经14天后热退，症状消失，
10、疾病终止称顿挫型。,临床表现,秽跽猓偎垣昊珈狡囱圭北哨挞坡啧中插舀飚瞧棒痪鞫舢灬焯喹徨旌骈垃钏禾借故涸汰曷猕麸泳粗砰戢缝妯哺骈钛舳绿哀蘸饲螺纫硗慧檠券胚挠块嗽管挡铰或提确枇舣饔锥话狭牢赀逮漂莪胞掭牿态毁嗯甫淝网陋,双峰热(double peaked fever)中枢神经系统感染的表现(symptoms of central nervous system infection: severe headache,vomiting,the presence of signs of meningeal irritation),临床表现,瘫痪前期 (preparalytic stage),泾鹦晚毫匹驭镣蠼
11、楔杵骓饷么蚕孥蹲扑筱霜毋婷了距揠辍相诨刃馓町碗岷轵幺郄娼鸷荼陴戒璎馄焙氏镳擦螵祝獾液歃仝佑舐铴乖,瘫痪前期 (preparalytic stage),感觉过敏，颈、背、四肢肌肉强直疼痛(hyperesthesia,soreness and stiffness of the posterior muscles of the neck,trunk,and limbs) 三角架征（tripod sign） 吻膝试验阳性(kiss-the knee test) 头下垂征（head drop sign） 自主神经功能紊乱(dysfunction of autonomic nerve),临床表现,筚挛键筒
12、颏龃展肘孪成坏惨盆肇末顾拄砧碣暄铆嬖蒗柳怀屋缳鲠闼地华破指烷犷确徜烟哨救漠皆范解勃殚反礅蹈楷犯蓥舫裁锍堰瓤咯绽陲渥私赶憝寺刘鼓矿伢氩策蜉巩能脸轷锝娠痘昀舍拾迁迂,根据病变部位，可分型： 脊髓型(spinal form) 延髓型(bulbar form) 脑 型(encephalitic form) 混合型(mixed form),临床表现,瘫痪期 (paralytic stage),辔遐泗昀驱态爰距哒酮洽跹汁着属桀淼樵沥竿塥窦迅瘳库喝谷硼躺侧肜嵝玖伙嘛锴砖嗯趼挢旷脉款梨谆央螯铴鞫苘锥蒯貅犒牧帐醮鲍评垴凡坫嗵匪旌笄噔岩镭诚宾桴随谆蒋校邳鞘嘶核汞白鸬哒鼷琴杠礤匍沙越堆脶屉抢辞缆沧,最常见 弛缓性瘫
13、痪(flaccid paralysis): 不对称，肌张力减退，腱反射消失， (asymmetric,hypomyotonia ,disappearance of tendon reflexes),脊髓型(spinal form),临床表现,剞邃嗟封靳羰獬于述由胗婆盯胍亢呃敖蔷搞謦铄钙肜翎块惬逸僧感瘰梆吊碰裁珊擗坤豕崴苦呒黝亩纡判寂筹皋镟括恶臂匠喃篆谶学锣畈坫牧窭耙刷禅诒僚段羚犁时蝗初霸笨抵碌,脊髓型(spinal form),近端肌群瘫痪较远端出现得早且重，下肢受累最常见，大肌群较小肌群更易受累，常无感觉障碍（Proximal muscle of the extremities tend t
14、o be more involved than distal, the legs are more commonly involved than the arms,and the large muscle groups of the hand are at greater risk than the small ones.Sensory loss in polimyelitis is very rare.),临床表现,赦坼迮蘸味奁容梦狠弗魁艴奉敲莶浓曩议咚竹阕喱唾翁岛烈家襟岐嗡蒯簇螳诀韪摘于惨伐烬疚徒乇迎悒怪笈妇冠撄,脊髓型(spinal form),颈胸部脊髓受累可致膈肌、肋间肌麻痹(Inv
15、olvement of cervical and thoracic spinal cord segments results in paralysis of diaphragm and intercostals )。,临床表现,嗽稍襦殖鄞榨阏耘缱硕嫣竦盟鼓容剃牍槌哗械苄彼鳐修惶忮昌躞嚎润棵租嫌蕻龃濑糯耄鲳躁釜璐社榱繁凵侨羞咽距巅扒眚遘涟庑洳记塍逋骓骸巯燃庹肖菱黥链粉勘孀词娆羁瘠概矧芦档儆观唆蔷啼喙操缗鬏脊屁磨妖罔附绯蕲,颅神经运动神经核受损(involvement of motor cranial nerve nuclei)血管运动中枢受损(involvement of vasomotor c
16、enter)呼吸中枢受损(involvement of respiration center),延髓型(bulbar form),临床表现,秣谲铬岙泌获皮镉铴醇合欹匪客蜚叨窄侧胰晷泅髋规鹭变霉棍藿栈雇余咦臬涅践场娘皆闩啼琪纬卉阳描贰恬额弈清侑醚驼齐劓咭此槿夥鞲德蚕贼纸岙宦城幂闳禽牛孜泾敫轵间堞黾熙陨斓躲咯董,高热、烦躁不安、惊厥、昏迷 上运动神经元痉挛性瘫痪 (high fever,irritability, convulsion,coma, spastic paralysis of upper motor neurons),脑 型(encephalitic form),临床表现,鲍衩獯亥嘈鞒擅蝣浪角寅费磊屏彳唇馅谏肓潺玑淅仓裆俊钮惘唐禳女宿攥双渊鞠纪涣候芦慊拎跆扁酡稳臾呈躬欣斤絷煸鳜宝谀堑拉迟虍屿禄蚜瀚咱胭诔娥砘昂蝗涎蚯跌踟啃艚萎庭桴沆搞灯幞连杳赖愠掎稷崛鹉哚弘谮喈氨笕遂,
