過(guò)敏性鼻炎的診斷和治療學(xué)習(xí)資料課件

NasalmucosalhyperreactiverhinopathyAllergicRhinitis(AR)Perennial~(PAR),Seasonal~(SAR)（Pollinosis）Morbidity:10%~20%Inhalantallergens——dustmite,housedust,pollen,fungi,animaldanders,cockroach；Foodallergens——milk,eggs,fishandshrimp,meat,vegetables,fruits.

MiteMoldPollenCatAntigensforallergicrhinitis變應(yīng)性鼻炎的病因?qū)W

內(nèi)在因素──遺傳因素：有家族史者較無(wú)家族史者發(fā)病危險(xiǎn)高２～６倍母系第１１對(duì)染色體長(zhǎng)臂ｑ段外在因素（環(huán)境因素）：基因表達(dá)受非遺傳因素影響。７０００對(duì)孿生兒，同時(shí)有AR癥狀者為２１％易感個(gè)體在一定環(huán)境條件作用下才發(fā)病變應(yīng)原與致敏靶細(xì)胞表面IgE結(jié)合致敏靶細(xì)胞脫粒、釋放、合成生物活性介質(zhì)肥大細(xì)胞儲(chǔ)備的介質(zhì)新合成的介質(zhì)組胺緩激肽白三烯血小板活化因子前列腺素D2毛細(xì)血管擴(kuò)張、通透性增加，腺體分泌增多

嗜酸/堿性粒細(xì)胞哮喘鼻炎發(fā)病機(jī)制Pathology：Typeallergy

Allergicinflammation:PredominantTcells&eosinophiliccellsinfiltrate.Symptoms&Signs：Nasalirritationandichingrecurrentattacksofparoxysmalsneezingcopiouswateryrhinorrheanasalobstruction鼻后滴漏Diagnosis：1、History（allergenexposure,hypersensitivity,familyhistory）2、Examination3、Skintest:skinpricktest4、IgEantibody，SerumtotalIgE、specialIgE5、NasalprovocationornasalchanllengetestsDifferentialDiagnosis：1、Vastomotorrhinitis2、Nonallergicrhinitiswitheosinophiliasyndrome,NARES3、Hyperreflectoryrhinitis4、AcuterhinitisComplications：1、Allergicsinusitis2、Asthma3、Secretoryotitismedia4、AllergicpharyngolaryngitisTreatment：1、Avoidance2、Drugs1）Antihistamines2）Corticosteroids3）Sodiumcromoglycate(SCG)Cromolynsodium4）Anticholinergicagents5）Vasoconstrictorsympasthomimetics3、Hyposensitization4、Others：TraditionalChinesemedicine,laser,operationNasalPolyp&NasalPolyposisEtiology：mutilfactors1.allergic；2.chronicinflammationPathology：highlyswelledconnectivetissue.Predominanteosinophiliccellsinfiltrate.Lymphaticcells,neutrophils,basophils,mastcells.Polypinmaxillarysinus（L），polypinmiddlemeatus（R）Symptoms&Sign：persistentnasalobstruction，closenasalsound，hyposmia,rhinorrhea,snore,“frognose”AntrochoanalpolypAntrochoanalpolypDiagnosis：Anteriorrhinoscopy：translucent,soft,smoothmasses.Endoscopy,X-rayandCTscanner.DifferentialDiagnosis：Papillomainverted，angiofibromaofnasopharynx，malignanttumorofnasalcavity，meningoencephaloceleTreatment：1、conservativetreatment——corticosteroids2、surgicaltreatmentPolyps（above），papilloma（below）papilloma（L），MTofnasalcavity（R）SinusitisAcutesuppurativesinusitisFeaturesofsinusanatomy：1、smallostiaofthesinuses；2、continuativemucosabetweennasalcavityandsinuses；3、contiguousoftheostia；4、locationoftheastiaandfeaturesofthesinuses.FrontalSinus

EthmoidSinusMaxillarySinusEtiology：1、Generalfactors:Poorgeneralhealth(influenza,measles,whoopingcough…)2、Localfactors：Sinusdiseases；Infectivefocusoferipheralorgans，Directinfection；Nasaltampon(packing)；Rapidchangeofatmosphericpressure

ABS主要病原體：肺炎鏈球菌和嗜血流感桿菌SAHP.OtolaryngolHeadNeckSurg.2004;130:1-45.20-43%22-35%Anaerobes0-9%Staphylococcusaureus

0-8%Otherbacteria4%MoraxellacatarrhalisOtherstreptococci3-9%2-10%S.pneumoniae成人Acutebacterialrhinosinusitis(ABS)病因H.influenzae兒童Acutebacterialrhinosinusitis(ABS)病因ABS主要病原體：肺炎鏈球菌、嗜血流感桿菌和卡他莫拉菌OtolaryngolHeadNeckSurg.2004;130:1-45.Symptoms&Signs：Generalsymptoms：Malaise,fever.Localsymptoms:1）Nasalobstructionsustained,withhyposmia2）Suppurativerhinorrhea,streakywithblood,foulsmell(odontogentic~)3）headachorlocalacheAntralpain——frominnercanthusdownwardsacrossthecheek,upperalveolusontheaffectedside.Ethmoidalpain——overbridgeofthenose&innercanthusbehindtheeye.Frontalpain——forehead,periodicity,persistforanhourortowaftergettingupinthemorning,andclearduringtheafternoon.Sphenoidalpain——occipitalorverticalheadache.Diagnosis：History，Signs,Anteriorrhinoscopy,Nasalendoscopy,Radiologicalexamination,PunctureandirrigationofmaxillarysinusTreatment：Eradicatecauses，keepdrainage；controlinfectionandpreventcomplications1、Generaltreatment：takerest，antibiotics，antihistamine(ifnecessary)2、Localtreatment3、Bodydrainage4、Physicaltherapy5、

PunctureandirrigationofmaxillarysinusMaxillarysinuspunctureandirragationChronicsuppurativesinusitisEtiology：Acute——ChronicSymptoms&Signs：General~:Local~：rhinorrhea,nasalobstruction,headache,hyposmia,visiondisorderDiagnosis：1、History；2、Examination：anteriorrhinoscopy,nasalendoscopy3、Radiologicalexamination：CTorMRI4、PunctureandirrigationofsinusNormalimageofnasalendoscopyMaxillarysinusitis——pusinthemiddlemeatusMaxillarysinusitis(R)Sphenoidsinusitis——pusinthesphenoethmoidalrecessSphenoidsinusitisPansinusitisPansinusitisTreatment：1、Intranasalmedications：Corticosteroid，Vasoconstrictorsympasthomimetics2、Punctureandirrigationofmaxillarysinus3、Displacementmethod——frontalsinusitis,ethmoidalsinusitis,sph