小儿腹泻专题知识讲座目的要求Objective概述Summary病因Etiology病因Etiology病因Etiology肠毒素Enterotoxin糖类分解吸收障碍Carbohydratedecomposition&absorptiondisorder胃内食物积滞，胃酸少，肠道下段细菌上移繁殖Gastricstanatedfood，lessgastricacid,lowerintestinalbacteriaup-moving&propagation临床表现ClinicalMenifestations三根据病因分类Classifiedbypathogeny轮状病毒肠炎Rotavirusenteritis，大肠杆菌肠炎Escherichiacolienteritis空肠弯曲菌肠炎Campylobacterjejunienteritis,耶尔森菌小肠结炎Yersiniaenterocolitis四抗生素诱发的肠炎Antibioticprovocativeenteritis金黄色葡萄球菌肠炎Staphylocaccusaureusenterocolitis,伪膜性小肠结肠炎pseudomembranousenterocolitis,真菌性结肠炎fungalcolonitis诊断和鉴别诊断Diagnosis&DifferentialDiagnosis治疗原则PrincipleofTreatment小儿液体疗法InfantileFluidTherapy目的要求Objective概述Summary小儿体液平衡的特点CharacteristicofInfantileBodyFluidBalance小儿体液平衡的特点CharacteristicofInfantileBodyFluidBalance三水代谢的特点Watermetabolism1.水的需要量大，交换率快，不显性失水多（成人2倍）。婴儿每日水交换量为细胞外液量的1/2，成人仅为1/7。Largewaterrequirements,swiftwaterexchange,unobviouswaterloss(doubleadult’samount).Infant’swaterexchangeamountis1/2ofECF,theadult’sisjust1/7.体液调节功能不成熟，小儿肾脏的浓缩和稀释功能不成熟。Immaturebodyliquidregulatingfunction,immatureconcentrationanddilutionfunctionofinfantile.水电解质酸碱平衡紊乱DisturbancesofWater,Electrolyte&Acid-baseBalance水电解质酸碱平衡紊乱Typeofdehydration水电解质酸碱平衡紊乱DisturbancesofWater,Electrolyte&Acid-baseBalance水电解质酸碱平衡紊乱DisturbancesofWater,Electrolyte&Acid-baseBalance（二）临床表现Clinicalmenifetation1.神经——精神萎靡Nervoussystem——depressed2.肌肉骨骼肌——四肢肌乏力，肌张力↓，严重迟缓性瘫痪，呼吸肌麻痹Muscle——inertiaoflimbs，musculartensiondown，severelyretardantparalysis，respiratorymuscleparalysis3.心脏心率↑，心律失常，阿－期综合症心律↓，房室传导阻滞，心肌纤维变性，局限性坏死，心肌收缩乏力，心音低炖心电图，出现U波，U≥T，T波增宽、低平、倒置Heart——heartrateincreasing,arrhythmia,Adams－Stokessyndrome,heartratedecreasing，atrioventricularblock,heartsoundlowering,cardiogram:Uwaveappearing，U≥T，flattenedTwave4.肾脏肾小管上皮细胞空泡变性，对ADH的反应低下，浓缩功能减低，尿量增多，肾小管泌H–增加，回吸收HCO3-增加，氯的回吸收减少，可发生低钾、低氯碱中毒，伴反常性酸性尿。Kidney——concentratingfunctionlowering,urinevolumeincreasing液体疗法时常用的溶液CommonSolutionofFluidTherapy液体疗法时常用的溶液CommonSolutionofFluidTherapy小儿腹泻液体疗法InfantileDiarrheaLiqui