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デング熱とデング出血熱
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デング熱とデング出血熱の看護師向け概説。
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デング熱とデング出血熱
1.
Dengue fever and Dengue hemorrhagic fever
2.
デング熱 蚊が媒介する熱帯感染症 東南アジア、中南米を中心に 年間1億人が発症している 日本にも住んでます ヒトスジシマカ
3.
← Malaria ↓ Dengue
4.
5.
デング熱(症状) 感染3∼7日後に発症する、 突然の発熱(頭痛、筋肉痛、関節痛も) 3∼4日後より解熱とともに 発疹が出現し、 通常、後遺症なく回復する。
6.
解熱とともに発疹・・・? 経過は突発性発疹に似ている
7.
一度かかると二度とかからないが・・・ 4種類の型があるので、違う型にかかる
8.
デング出血熱 2度目以降の感染に多く、 治りかけに突然、 血漿漏出と出血傾向が出現する。 デング熱とは根本的に異なる病態。 出血自体はデング熱だけでもみられる。
9.
・血漿漏出所見(Ht上昇、胸水、腹水) ・10万/mm3以下の血小板減少 ・2-7日続く発熱 ・出血傾向(ターニケットテスト陽性か、 明らかな出血) 診断基準(以下の全てを満たす)
10.
ターニケットテスト
11.
デング出血熱の本態は 出血ではなく血漿漏出
12.
ここからデングショック症候群 そうなる前に、早めの輸液
13.
強い腹痛・腹部圧痛 持続する嘔吐 意識変容 出血 無気力・不穏 肝腫大 急な低体温・顔色不良・四肢冷感 ワーニングサイン 解熱 24Hr 24Hr 発症危険期間
14.
しかし、病態が改善すると漏れた血漿が 全部血管内に還ってくるので・・・
15.
副腎皮質ステロイドは無効 血小板輸血では 出血は止まらない 治療として
16.
重症デングを放置すると死亡率は20%。 大量補液により 死亡率は1%未満になる。
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