感冒不僅僅是上呼吸道感染

1、感冒-不僅僅是上呼吸道感染,2,Definition,The common cold (acute viral rhinopharyngitis, , acute coryza, viral upper respiratory tract infection, or a cold) is a contagious, viral infectious disease of the upper respiratory system, pri

2、marily caused by rhinoviruses, (picornaviruses小核糖核酸病毒 ) or coronaviruses. It is the most common infectious disease in humans；there is no known cure, but it is very rarely fatal.,3,Definition,Collectively, colds, influenz

3、a, and other infections with similar symptoms are included in the diagnosis of influenza-like illness.Often, influenza and the common cold are mistaken for each other, even by professional healthcare workers, but most o

4、f the recommended home treatments (drinking plenty of warm fluids, keeping warm, etc.) are similar if not the same.The symptoms of influenza often include a fever and are more severe than the cold.,4,SYMPTOM,cough, sore

5、 throat, runny nose, nasal congestion, and sneezing; sometimes accompanied by ‘pink eye’, muscle aches, fatigue, malaise, headaches, muscle weakness, uncontrollable shivering, loss of appetite, and rarely extreme exhaust

6、ion. Fever is more commonly a symptom of influenza, another viral upper respiratory tract infection (URTI) whose symptoms broadly overlap with the cold, but are more severe. Symptoms may be more severe in infants and y

7、oung children (due to their immune system not being fully developed) as well as the elderly (due to their immune system often being weakened).,5,SYMPTOM,A sensation of chilliness even though the cold is not generally acc

8、ompanied by fever, and although chills are generally associated with fever, the sensation may not always be caused by actual fever. In one study, 60% of those suffering from a sore throat and upper respiratory tract in

9、fection reported headaches, often due to nasal congestion. The symptoms of a cold usually resolve after about one week; however, it is not rare that symptoms last up to three weeks.,6,What is the Difference Between In

10、fluenza and the Common Cold?,7,complications,opportunistic coinfections or superinfections such as acute bronchitis, bronchiolitis, croup, pneumonia, sinusitis, otitis media, or strep throat.（膿毒性咽喉炎） People with chronic

11、 lung diseases such as asthma and COPD are especially vulnerable. Colds may cause acute exacerbations of asthma, emphysema or chronic bronchitis,8,Cause and susceptibility,one of the 99 known serotypes of rhinovirus, a t

12、ype of picornavirus. Around 30-50% of colds are caused by rhinoviruses. Other viruses causing colds are coronavirus (causing 10-15%), human parainfluenza viruses, human respiratory syncytial virus, adenoviruses, enterovi

13、ruses, or metapneumovirus. 5-15% are caused by influenza viruses. In total over 200 serologically different viral types cause colds. Coronaviruses are particularly implicated in adult colds. Due to the many different t

14、ypes of viruses and their tendency for continuous mutation, it is impossible to gain complete immunity to the common cold.,9,Cause and susceptibility,Sleep Lack of sleep has been associated with the common cold. Those wh

15、o sleep fewer than 7 hours per night were three times more likely to develop an infection when exposed to a rhinovirus when compared to those who sleep more than 8 hours per night.Vitamin D A 2009 study found that low b

16、lood serum levels of vitamin D were associated with increased rates of the common cold. A randomized controlled trial found that 104 post-menopausal African American women living in New York given vitamin D were three ti

17、mes less likely to report cold and flu symptoms than 104 placebo controls. A low dose (800 IU/day) not only reduced reported incidence, it abolished the seasonality of reported colds and flu. A higher dose (2000 IU/day),

18、 given during the last year of the trial, virtually eradicated all reports of colds or flu.,10,Cause and susceptibility,Exposure to cold weather prolonged exposure to cold weather such as rain or winter conditions –C

19、old No evidence that short-term exposure to cold weather or direct chilling increases susceptibility to infection, implying that the seasonal variation is instead due to a change in behaviors such as increased time

20、 spent indoors at close proximity to others "test the hypothesis that acute cooling of the feet causes the onset of common cold symptoms." Constriction of blood vessels of the nasal passages which

21、 might lead to reduced immunity Decreased temperature may result in a drop in tissue permeability and, as a result, may lead to reduced plasma leakage. -complement proteins,11,Pathophysiology,saliva or nasal secre

22、tions of an infected person; in aerosol form generated by coughing and sneezing; or from contaminated surfaces.,12,Pathophysiology,Major entry point for the virus is normally the nose, - back of the nose and the aden

23、oid area. The virus then attaches to a receptor, ICAM-1, which is located on the surface of cells of the lining of the nasopharynx. The receptor fits into a docking port on the surface of the virus. Large amounts of vi

24、rus receptor are present on cells of the adenoid.,13,Pathophysiology,Rhinovirus colds do not generally cause damage to the nasal epithelium.Macrophages trigger the production of cytokines, which in combination with med

25、iators cause the symptoms.Cytokines cause the systemic effects. The mediator bradykinin(緩激肽） plays a major role in causing the local symptoms such as sore throat and nasal irritation,14,Pathophysiology,The common cold

26、is self-limiting, and the host's immune system effectively deals with the infection. Within a few days, the body's humoral immune response begins producing specific antibodies that can prevent the virus from infe

27、cting cells. Additionally, as part of the cell-mediated immune response, leukocytes destroy the virus through phagocytosis and destroy infected cells to prevent further viral replication. In healthy, immunocompetent

28、individuals, the common cold resolves in seven days on average,15,Incubation period and progression of disease,The upper respiratory viral replication cycle begins 8 to 12 hours after initial infection. Symptoms usuall

29、y begin 2 to 5 days after initial infection but occasionally occur in as little as 10 hours after. Symptoms peak 2–3 days after symptom onset, whereas influenza symptom onset is constant and immediate.The symptoms us

30、ually resolve spontaneously in 7 to 10 days but some can last for up to three weeks,16,Prevention,The best way to avoid a cold is to wash hands thoroughly and regularly; and to avoid touching the eyes, nose, mouth, and f

31、ace. Anti-bacterial soaps have no extraordinary effect on the cold virus; it is the mechanical action of hand washing with the soap that removes the virus particles. Rhinoviruses can live up to 3 hours outside the bod

32、y on the skin or objects.In 2002, the Centers for Disease Control and Prevention recommended alcohol-based hand gels as an effective method for reducing infectious viruses on the hands of health care workers. The comm

33、on cold is caused by a large variety of viruses, which mutate quite frequently during reproduction, resulting in constantly changing virus strains. Thus, successful immunization is highly improbable.,17,Lung disease and

34、Influenza,Get vaccinated for both seasonal flu and H1N1 flu 接種疫苗，包括季節(jié)性流感和H1N1流感Cover your nose and mouth with your arm when you cough or sneeze 打噴嚏時用胳膊擋住口鼻Wash your hands frequently with soap and water 勤洗手 Alcoho

35、l-based hand cleaners are also effective when washing isn’t possible酒精消毒 Avoid touching your eyes, nose or mouth避免接觸眼睛及口鼻 Try to avoid close contact with sick people避免與患病者近距離接觸 Avoid large crowds不去人群密集處Ask family and

36、 friends to be mindful of your higher risk and not expose you to their sickness if they are ill 避免和高危人群接觸Stay home if you are sick: 患病后勿外出For 7 days after symptoms begin; or 癥狀出現(xiàn)后7天或癥狀消失后24消失內(nèi)Until clear of symptoms f

37、or 24 hours Watch for public health advisories, as these recommendations may change健康咨詢 For those with asthma, please remember to refer to and maintain your Asthma Action Plan as necessary.哮喘患者必要時仍需行哮喘治療,18,Treatment,C

38、onservative managementThe National Institute of Allergy and Infectious Diseases suggests getting plenty of rest, drinking fluids to maintain hydration, gargling with warm salt water, using cough drops, throat sprays, o

39、r over-the-counter pain or cold medicines. Saline nasal drops may help alleviate congestion.Treatments that may help alleviate symptoms include analgesics, decongestants, and cough suppressants, first-generation antihis

40、tamines such as brompheniramine, chlorpheniramine, diphenhydramine and clemastine (which reduce mucus gland secretion and thus combat blocked/runny noses but also may make the user drowsy). Second-generation antihistami

41、nes do not have a useful effect on colds.],19,Treatment,Conservative managementVitamin C in normal or mega doses has not been shown to be beneficial in a normal population for the prevention or treatment of the common

42、cold. It however might be beneficial in people exposed to periods of severe physical exercise or cold environments.Various cold medicines exist however little evidence suggest they are any more effective than simple a

43、nalgesics. They include antitussives, antihistamines and decongestants usually in combination with an analgesic. They are not recommended for use in children because evidence does not support their effectiveness and th

44、ere are concerns of harm.,20,Treatment,Antibiotics Antibiotics only target bacteria and thus do not have any beneficial effect against the common cold.Antivirals There are no approved antiviral drugs for the comm

45、on cold.Nasal steroid still in trialAlternative treatments alternative treatments which similarly lack solid scientific evidence include calendula, ginger, garlic and vitamin C supplements.,21,惠菲寧的主要成分及藥理作用,馬來酸

46、氯苯那敏（撲爾敏）（A）：抑制腺體分泌，減少鼻液后流對咽喉部的刺激以及抗膽堿能活性鹽酸偽麻黃堿（D）：選擇性地收縮血管，減輕水腫、充血對呼吸道的影響氫溴酸右美沙芬：通過抑制咳嗽中樞，有效控制咳嗽,22,右美沙芬無成癮性和呼吸抑制，臨床應(yīng)用更放心,中華醫(yī)學(xué)會呼吸病學(xué)分會哮喘學(xué)組. 中華結(jié)核與呼吸雜志, 2005,28(11):738-44.周敏, 等. 中國新藥與臨床雜志, 2005,24(9):693-6.,,,,,抑制呼吸中

47、樞、成癮性,無呼吸中樞抑制作用、無成癮性,中樞性非依賴性鎮(zhèn)咳藥,中樞性依賴性鎮(zhèn)咳藥,右美沙芬,可待因,作用于N-甲基-D-天冬氨酸受體和Sigma受體，具有中樞和外周鎮(zhèn)咳作用,作用于阿片受體，中樞鎮(zhèn)咳作用,鎮(zhèn)咳作用強(qiáng),相當(dāng)或略強(qiáng),分類,作用機(jī)理,療效,安全性,,23,美敏偽麻溶液：不良反應(yīng)少，臨床應(yīng)用更放心,長期使用甘草可出現(xiàn)水腫、高血壓、低血鉀等副作用,24,中醫(yī)中藥,感冒的發(fā)生主要由于體虛，抗病能力減弱，當(dāng)氣候劇變時，人體內(nèi)外功能

48、不能適應(yīng)，邪氣乘虛由皮毛、口鼻而入，引起一系列肺衛(wèi)癥狀。 中醫(yī)將感冒分為風(fēng)寒型感冒、風(fēng)熱型感冒、暑濕型感冒和時行感冒（流行性感冒）四種類型。根據(jù)辨證施治的原則，不同類型的感冒應(yīng)選用不同的中成藥治療。中成藥含有西藥成分,25,感冒-不僅僅是上呼吸道感染,Common ColdInfluenza,↓,,Complications,↓,Cold like symptomsFatal Diseases,26,Complications

49、dealing ENT,Acute Otitis MediaAcute RhinosinusitisAcute TonsillitisAcute LaryngitisAcute Epiglottitis,,27,感冒治療的幾個誤區(qū),亂吃抗生素硬扛著不看醫(yī)生隨便亂輸液,28,慎用抗生素,英國的著名的健康和臨床醫(yī)療研究所(National Institute for Health ａnd Clinical Excellence)

50、就向大眾指出：消炎藥在很多情況下都是沒有必要的，有時它們不但不能有效控制感染，反而容易導(dǎo)致帶有超強(qiáng)抗藥性的金黃色葡萄球菌等超級病菌的蔓延。 英國還出臺了相關(guān)的行醫(yī)規(guī)定：英國醫(yī)生不得向患有耳部感染、咽喉腫痛、扁桃腺炎、支氣管炎、感冒、咳嗽等輕微病癥患者開抗生素。因此，醫(yī)生不得不打發(fā)他們回家休息，最多給他們服用一些止痛片。,29,與幾種疾病的鑒別,感冒與過敏性鼻炎感冒與百日咳 (百日咳桿菌）感冒與猩紅熱（乙型溶血性鏈球菌）