儿科学教学课件：RSV

Case1

Zhang**,female,3M15DAdmittedtoourhospitalOnMarch272014Chiefcomplaint:coughlasting4days,thencoughwasaggravatingwithwheezingfor1day.

HPI4daysago,thechilddevelopedcoughduetocontactingwithpeoplewithcold.Characterizedbyparoxysmalphlegmcough,nostuffynose,runnynose,barkingcough,crowechoesfever,cyanosis,difficultyinbreathing.2daysago,shewastreatedwithcefaclorinlocalhospital,butnoimprovement.1dayago,coughaggravatedwithwheezing.PersonalhistoryG1P1full-termcesareandeliveryBirthweight3100gBreast-feedingNormalgrowthanddevelopmentReceivedroutineimmunization

Past

historyNohistoryoffoodordrugallergyNohistoryofasthmaHashistoryofeczema

Familyhistorynohistoryoffamilyasthmanohistoryofallergicdisease:allergicrhinitis/atopicdermatitis/urticariaPhysicalexaminationGeneral:wellperfusionVitalsigns:T36.8℃,P160times/min,RR54times/min,shortnessofbreath,nasalalaflap,cyanosisLung:Afew

moist

ralesandalargenumberwheezingonboth

sideHeart、abdomen、nervoussystemexaminationhavenopositivesignsLaboratorytestsRoutineblood：WBC7.83*10^9/L,N28.5%,L64.2%,Hb108g/L,PLt118*10^9/LCRP:0.8mg/L(normal)Liverfunctionandkidneyfunction：NormalBloodgasanalysis：PH:7.40,PCO2:35mmHg,PO2:87mmHgLaboratorytestsRespiratoryvirusimmunefluorescencedetection(sputum)：RSVpositive

MycoplasmaPneumonia,chlamydiapneumonia,chlamydiatrachomatis-DNA(sputum)：negativeMycoplasmaPneumonia,chlamydiapneumonia,chlamydiatrachomatisIgM/IgG(serum)：negativesputumBacterialculture：negativeSerumBacterialculture：negative

RadiographyElectrocardiogram(ECG)

:SinustachycardiaChestX-rayradiograph:increasingoflungmarkingsandlungvolume

Diagnosis

BronchiolitisDifferentialdiagnosisAspirationpneumoniaTrachomachlamydiapneumoniaCongenitalmalformationoftheairwayAirwayforeignbodiesBronchopulmonarydysplasiaasthma

Treatmentneubulization：

Pulmicortrespules1mlAtrovent1mlSalbutamol0.25mlNormalSaline1mlq8hSputumsuctionMethylprednisolone(1-2mg/Kg/time（IV）intravenous

infusion.q12h)General