兒科學(xué)緒論八年制課件

1、A Brief IntroductionPEDIATRICS XX大學(xué)兒科學(xué)系XX兒科學(xué)緒論第1頁(yè)，共43頁(yè)。緒論什么是兒科？?jī)嚎漆t(yī)師的任務(wù)是什么？?jī)和浅扇说目s影嗎？第2頁(yè)，共43頁(yè)。Pediatrics is concerned with the health of infants, children, and youths, their growth and development, and their opportunity to achieve full potential as adults. The most characteristic feature of pediatric

2、s is that it deals with the growth and development of the child, comprising all those changes in size and form and in complexity of function that constitute growing up. 第3頁(yè)，共43頁(yè)。 兒科學(xué)是研究小兒遺傳背景以及從受精開(kāi)始一直到青少年期的生長(zhǎng)發(fā)育并促使其達(dá)到成人所有潛能的一門(mén)學(xué)科。重點(diǎn)對(duì)小兒從出生至青春期的身體、精神或情感疾病進(jìn)行預(yù)防、診斷及治療。Pediatrics is the study of growth and

3、development of the child from the genetic background and moment of conception through adolescence. It is the science and art of prevention, diagnosis, and treatment of the diseases of children from birth through adolescence, whether these disturbances be physical, mental, or emotional. 第4頁(yè)，共43頁(yè)。兒科學(xué)

4、兒科學(xué)( Pediatrics )是研究小兒各年齡階段的生長(zhǎng)發(fā)育和疾病防治，提高小兒身心健康水平的醫(yī)學(xué)科學(xué)。兒科的主要治療范圍是從出生開(kāi)始到生后18歲第5頁(yè)，共43頁(yè)。Stage of children by age小兒年齡分期第6頁(yè)，共43頁(yè)。Fetal period Intrauterine life: embryonic and fetal period first trimester first 12 wk second trimester 13- 28wk third trimester 29- 40wkStage of children by age小兒從受精卵開(kāi)始到生長(zhǎng)發(fā)育停止可

5、分為7個(gè)時(shí)期受精后前8周稱為胚胎期（embryonic period），此期各系統(tǒng)的器官發(fā)育非常迅速，各重要器官的發(fā)育已見(jiàn)雛形，胎兒已基本成型第7頁(yè)，共43頁(yè)。STAGES OF HEART FORMATION1. Early blood vessel formation 1) Intraembryonic blood vessel at 13 days 2) Extraembryonic blood vessels at 17 days2. Development of heart 1) Position and cardiac tube at 22 days Heart beating a

6、t 26 days. 2) Formation of heart loop at 22-24days 3) Formation of ventricle 4) Development of sinus venosus3. Formation of cardiac septa, valves, arterial system, systemic veins 2 weeks formation start 4 weeks circulation start 8 weeks four chamber heart 第8頁(yè)，共43頁(yè)。新生兒期 ( neonatal period) 出生 28天圍生期(p

7、erinatal period) 孕期28周生后1周嬰兒期 (infancy) 生后28天 1周歲幼兒期 (toddlers age) 生后第2 3年Fetal period First week 40wkNeonatal period after birth 4wkPerinatal period 28wk of gestation 1wk after birth Infancy 4wk 1yrToddlerhood 2nd yr 3rd yrStage of children by age第9頁(yè)，共43頁(yè)。Preschool age 3 yr6(7) yrSchool age 6（7）yr

8、11(12)yrAdolescence 1112yr1718yr (female)13 15yr-1921yr (male)Stage of children by age第10頁(yè)，共43頁(yè)。Differences among these phases小兒各年齡段特點(diǎn)第11頁(yè)，共43頁(yè)。DIFFERENCES AMONG THESE PHASESFunction of various organ system;Degree of immunity to disease;Response to the effects of disease;Drug dosages and tolerance t

9、o drugs;Mental and motor ability, and Pattern of emotional response.第12頁(yè)，共43頁(yè)。Disparity in occurrence and progression of disease between children and adult1.Disparity in anatomy, physiology, and immunologic function between children and adult2.The younger, the more differentProgressionDeteriorationR

10、ecovery第13頁(yè)，共43頁(yè)。FETAL CIRCULATIONParallel circulation (combined output) Ductus Venosus shunts blood from the UV to the IVC bypassing the liver Foramen Ovale shunts blood from the RA to the LADuctus Arteriosus shunts blood from the PA to the descending aorta bypassing the lungsBlood from the LV perf

11、uses the heart & brain with well oxygenated blood50%2/3第14頁(yè)，共43頁(yè)。TRANSITIONAL CIRCULATION Dramatic changes in circulation at the moment of birth and onwards : Air breadth - lung expansion - Rp Qp - LA pressure - PFO P O2 - ductus arteriosus and venosus Obliteration of placental circulation - Rs IVC

12、pressure - PFO 第15頁(yè)，共43頁(yè)。Disparity in anatomy, physiology第16頁(yè)，共43頁(yè)。生后1小時(shí)2歲 Disparity in anatomy, physiology第17頁(yè)，共43頁(yè)。Cardiothoracic ratioDisparity in anatomy, physiology第18頁(yè)，共43頁(yè)。Heart rate Disparity in anatomy, physiology第19頁(yè)，共43頁(yè)。 Nervous system Kernig sign, Babinski sign Signs of meningeal irrita

13、tion Neonatal Kernig sign, Babinski sign(+) 3-4M Kernig sign (+) 2yr Babinski sign (+) Disparity in anatomy, physiology第20頁(yè)，共43頁(yè)。Neonatal Rooting reflex, Moro reflex Infancy Abdominal reflex () possible Tendon reflex ( ) Nervous system ReflexDisparity in anatomy, physiology第21頁(yè)，共43頁(yè)。Immunology Dispa

14、rity in anatomy, physiology第22頁(yè)，共43頁(yè)。 Hepatomegaly, Splenomegaly common in infancy ( anemia, infection)Disparity in occurrence and progression of disease between children and adult第23頁(yè)，共43頁(yè)。 Age-dependent Lab data, Physical exam 兒科學(xué)PediatricsDISPARITY IN OCCURRENCE AND PROGRESSION OF DISEASE BETWEEN

15、 CHILDREN AND ADULT 第24頁(yè)，共43頁(yè)。 Congenital anomalies Inborn errors of metabolism Newborn, infants vulnerable to infections Sinusitis rare in infancy Infants vulnerable to obstruction in respiratory tract Spectrum of disease DISPARITY IN OCCURRENCE AND PROGRESSION OF DISEASE BETWEEN CHILDREN AND ADULT

16、 第25頁(yè)，共43頁(yè)。 Pneumonia: Bronchial pneumonia, Lobar pneumonia Vitamin D deficiency Rickets(佝僂病) Malacosteon(骨軟化) Heart diseases Congenital Heart DiseaseType of diseaseDisparity in occurrence and progression of disease between children and adult Atherosclerotic heart disease 第26頁(yè)，共43頁(yè)。主要死亡原因1歲以內(nèi) 1. 圍產(chǎn)期

17、 perinatal conditions 宮內(nèi)發(fā)育不良 intrauterine growth retardation 呼吸窘迫綜合征 respiratory distress syndrome 窒息 intrauterine hypoxia/birth asphyxia 產(chǎn)傷 birth trauma 2.先天性畸形 congenital anomalies 3.嬰兒猝死綜合征 sudden infant death syndrome 4.肺炎 pneumonia 5.消化道疾病 gastrointestinal disorders 第27頁(yè)，共43頁(yè)。1 4歲 1.意外損傷 injuri

18、es 2.先天性畸形 congenital anomalies 3.惡性腫瘤 malignant neoplasms5 14歲 1.意外損傷 injuries 2.惡性腫瘤 malignant neoplasms主要死亡原因第28頁(yè)，共43頁(yè)。TASKS FOR PEDIATRICIANS18yr in total population Developed countries 22.4% Developing countries 35.7% China 30% 18yr 400 million ( china)第29頁(yè)，共43頁(yè)。1. Infective disease2. Psycho-be

19、havior problem3. Accidental injury 4. Congenital anomalies5. Prevention of adult disease in childhoodTasks in 21 centuryTASKS FOR PEDIATRICIANS第30頁(yè)，共43頁(yè)。 世界衛(wèi)生組織、聯(lián)合國(guó)健康兒童基金會(huì)在向全球發(fā)出的“新千年發(fā)展目標(biāo)”中提出的到2015年將5歲以下兒童死亡率降低2/3的要求TASKS FOR PEDIATRICIANS第31頁(yè)，共43頁(yè)。Infant mortality Developed CountriesInfant mortality

20、0.40.7%嬰兒死亡率（infant mortality）是指每1000個(gè)活產(chǎn)嬰兒中從出生到1歲之間的死亡率。是考察一個(gè)國(guó)家和地區(qū)醫(yī)療衛(wèi)生狀況的重要指標(biāo)之一。嬰兒期死亡是小兒死亡最高的時(shí)期。TASKS FOR PEDIATRICIANS5yr death0.40.8%第32頁(yè)，共43頁(yè)。5yr death 93% in rural infant accounting to 80 newborn death 65 of total infant death Leading death cause: pneumonia, asphyxia, prematurity, diarrhea, cong

21、enital anomalies, (2000) TASKS FOR PEDIATRICIANS第33頁(yè)，共43頁(yè)。Birth defect The first cause in newborn death Incidence of total birth defect 3%-5 in Shanghai 0.2-0.3 million congenital defects seen after birth each year in China 0.8-1.2 million several months or years after birthTASKS FOR PEDIATRICIANS第3

22、4頁(yè)，共43頁(yè)。出生缺陷占新生兒死亡病因首位出生缺陷發(fā)病率 3 5我國(guó)每年出生新生兒 2000萬(wàn)出生后肉眼可見(jiàn)的缺陷 20 30萬(wàn)數(shù)月到數(shù)月后出現(xiàn) 80 120萬(wàn)出生缺陷（前5位）唇裂、神經(jīng)管缺陷、多指（趾）、 心血管畸形、腦積水TASKS FOR PEDIATRICIANS第35頁(yè)，共43頁(yè)。意外傷害014歲 25萬(wàn)/年 前5位 溺水 交通事故 中毒 墜落 窒息TASKS FOR PEDIATRICIANS第36頁(yè)，共43頁(yè)。Genetics, embryology, nutriology, pshychologyPediatrics (health care)Child healthEducationSocial services第37頁(yè)，共43