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Jingdong book

实用儿科危重症鉴别诊断学

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Books Medical Science Pediatrics
Jingdong book

实用儿科危重症鉴别诊断学

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儿科急救医学是儿科学领域近年来发展迅速的一门重要学科，如果危重症在很短时间内不能确诊就会影响治疗，可导致患儿致残或死亡。而不少危重症的临床表现、病理生理变化有类似处，但也有各自的特征，故在临床工作中及时对危重症进行充分地鉴别诊断十分重要。目前国内尚未见到相关专著。为了使临床医生能更详细透彻地了解危重症的诊断，我们把危重症相关的、病程相似的临床表现、实验室检查、影像检查以及它们之间的主要区别进行分析讨论，编写了这本《实用儿科危重症鉴别诊断学》，供临床医师参考。
危重症的临床表现复杂多变，每种危重症的发病率不同、诊断难易不一，故在讨论中繁简不一。
本书主要由河北省儿童医院发起，并邀请湖南省儿童医院、北京市儿童医院、首都儿科研究所及深圳市儿童医院从事儿科急症多年并深有造诣的有关专家进行撰写，本书各章均有相对的独立性，但为保持其完整性，有些内容略有重复。由于作者较多，本书涉及内容广泛，疏漏错误难免，敬请专家、读者批评指正。
Catalogue

第一章 儿科常见危重急症
第一节 发热
第二节 休克
第三节 发绀
第四节 昏迷
第五节 急性中毒
第六节 腹痛
第七节 皮疹
第八节 剧烈啼哭

第二章 呼吸系统急症
第一节 呼吸困难
第二节 咯血
第三节 胸腔积液
第四节 气胸
第五节 气管异物
第六节 喉梗阻
第七节 喘息持续状态

第三章 心血管系统急症
第一节 急性心力衰竭
第二节 心律失常
一、室上性快速性心律失常
二、室性快速性心律失常
三、严重缓慢性心律失常
第三节 高血压

第四章 消化系统急症
第一节 重型感染性腹泻病
第二节 呕吐
第三节 脱水
第四节 急性腹胀
第五节 呕血与黑便
第六节 急性肝功能衰竭
第七节 出血坏死性肠炎

第五章 代谢紊乱
第一节 代谢性酸中毒
第二节 低钠血症
第三节 高钠血症
第四节 低钾血症
第五节 高钾血症
第六节 低钙血症
第七节 高钙血症

第六章 神经系统急症
第七章 内分泌系统急症
第八章 血液系统急症
第九章 泌尿系统急症
第十章 新生儿急症
附录 常用医学名词的英文缩写及英文、中文对照
Book Abstract

第二章 呼吸系统急症
第一节 呼吸困难
呼吸困难是指患儿主观感觉空气不足，呼吸费力；客观上表现为辅助呼吸肌参与呼吸运动，呼吸频率、节律、深度、呼吸比等不同程度的异常。呼吸困难是临床极常见的病理过程，是很多疾病引起死亡的最重要的原因。呼吸困难不仅见于病理状态，正常儿童在剧烈活动后也可出现。
[发病机制]
氧的获得和利用包括外呼吸、气体运输和内呼吸。其过程为外界氧被吸入，弥散人血液，再与血红蛋白结合，由血液循环输送到全身，最后被组织细胞摄人利用。其中任一环节发生障碍都能引起组织缺氧，导致血氧分压降低，使动脉氧含量（CaO2）减少，组织供氧不足，机体可出现一系列代偿反应，表现为呼吸困难。按疾病系统和特点，将呼吸困难分为以下几种：
（一）肺源性呼吸困难
是指由于呼吸系统疾病引起的通气或换气功能障碍，导致缺氧和（或）二氧化碳潴留。是临床上最常见的一大类，按发病机制分为三种类型：
1.吸气性呼吸困难主要是由于喉、气管、支气管等大气道不畅所致进入肺内气体减少，引起动脉血氧分压（PaO2）降低。当PaO2低于60mmHg（8kPa）以下可刺激颈动脉体和主动脉体外周化学感受器，反射性地增强呼吸运动，引起呼吸加深加快，辅助呼吸肌参与呼吸运动，吸气时可出现“三凹征”。但当PaO2低于30mmHg（4kPa）时，缺氧对呼吸中枢的抑制作用大于反射性兴奋作用，则表现为呼吸浅慢、节律改变，甚至呼吸暂停。
2.呼气性呼吸困难 主要由于小支气管狭窄阻塞或肺组织弹性减弱所致二氧化碳潴留。动脉血二氧化碳分压（PaCO2）升高作用于中枢化学感受器，使呼吸中枢兴奋，引起呼吸加深、加快。但当PaCO2超过80mmHg（10.7kPa）时，反面抑制呼吸中枢，此时呼吸运动主要造动脉血低氧分压对血管化学感受器的刺激得以维持。
Introduction

儿科急救医学是儿科学领域近年来发展迅速的一门重要学科，如果危重症在很短时间内不能确诊就会影响治疗，可导致患儿致残或死亡。而不少危重症的临床表现、病理生理变化有类似处，但也有各自的特征，故在临床工作中及时对危重症进行充分地鉴别诊断十分重要。目前国内尚未见到相关专著。为了使临床医生能更详细透彻地了解危重症的诊断，我们把危重症相关的、病程相似的临床表现、实验室检查、影像检查以及它们之间的主要区别进行分析讨论，编写了这本《实用儿科危重症鉴别诊断学》，供临床医师参考。
危重症的临床表现复杂多变，每种危重症的发病率不同、诊断难易不一，故在讨论中繁简不一。
本书主要由河北省儿童医院发起，并邀请湖南省儿童医院、北京市儿童医院、首都儿科研究所及深圳市儿童医院从事儿科急症多年并深有造诣的有关专家进行撰写，本书各章均有相对的独立性，但为保持其完整性，有些内容略有重复。由于作者较多，本书涉及内容广泛，疏漏错误难免，敬请专家、读者批评指正。

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