全在这里!带状疱疹诊断与用药

2017-09-03 高丽丽 基层医师公社

大家看完下面这些图表,应该会在带状疱疹的治疗方法上有进一步的认识。

大家看完下面这些图表,应该会在带状疱疹的治疗方法上有进一步的认识。

一.疱疹分类

疱疹病毒是一群中等大小的双股DNA病毒,据理化性质主要分为α、β、γ三个亚群。



二.带状疱疹诊断

水痘-带状疱疹病毒(VZV)初次感染引起水痘,临床表现为发热、萎靡不振、斑丘状痒疹并逐渐形成小疱。恢复后病毒潜伏在感觉神经节,外伤、发热等因素能激活潜伏在神经节内的病毒,复活的病毒经感觉神经纤维轴突下行至所支配的皮肤区,再次感染引起带状疱疹(HZ)。



三.带状疱疹用药

1、抗病毒治疗

⑴指征

①>50岁患者任一部位的带状疱疹。

②所有年龄患者的头/颈部带状疱疹。

③躯干/四肢严重的带状疱疹。

免疫功能低下或缺陷患者的带状疱疹。

⑤有恶性原发性疾病的带状疱疹。

⑥有颅神经受累(特别是眼带状疱疹和耳带状疱疹)的带状疱疹。

⑦伴有严重特应性皮炎或严重湿疹患者的带状疱疹。

⑧<50岁患者躯干、四肢的带状疱疹。

⑨皮疹发生超过一个皮区、有出血性皮损和(或)粘膜受累的带状疱疹。

⑵时机

系统性抗病毒治疗尽可能在皮肤症状出现后的48-72小时内开始。有内脏器官受累的播散性带状疱疹、持续性眼带状疱疹和耳带状疱疹以及免疫功能缺陷患者,在症状出现后的72小时后抗病毒药仍然获益。

⑶药物

主要有3种药物,包括阿昔洛韦、伐昔洛韦和泛昔洛韦。都是鸟嘌呤腺苷类似物,对病毒有特殊的亲和力,毒性低。


注:PHN指带状疱疹后神经痛

2、局部治疗

①局部可以用3%硼酸溶液或冷水湿敷进行干燥和消毒,每日数次,每次15-20分钟。

②水疱少时可涂炉甘石洗剂。

③无明显渗出可外用3%阿昔洛韦乳膏、1%喷昔洛韦乳膏等。

④后期可以外用聚维酮碘、呋喃西林、苯扎氯铵溶液湿敷,去除结痂,预防继发感染。

3、物理治疗

半导体激光、氦氖激光照射等均可作为带状疱疹的辅助治疗方法。



四.特殊人群带状疱疹药物选择



五.带状疱疹并发症治疗



原始出处:

1.钱之玉.药理学[M].北京:中国医药科技出版社.2009:139-140

2.中国带状疱疹治疗指南(草稿)[J].2013

3.蔡俊龙.2015 RCOG 妊娠期水痘管理指南(推荐意见翻译)[J].2015

4.肖长纪等.《妊娠期微小病毒B19、水痘带状疱疹病毒及弓形虫感染的临床实践指南》解读[J].中华围产医学杂,2015,18(12):886-887

5.王谢桐.美国妇产科医师协会“妊娠期水痘- 带状疱疹病毒感染的临床实践指南”解读[J].中国实用妇科与产科杂志,2016,32(6):508-510

6.带状疱疹后神经痛诊疗中国专家共识[J].中国疼痛医学杂志,2016,22(3):161-165

7.中国特发性面神经麻痹诊治指南[J].中华神经科杂志,2016,49(2):85

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    2017-09-09 laoli

    归纳全面.值得收藏!

    0

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    2017-09-09 laoli

    谢谢分享!

    0

  3. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b5b2139948, createdName=1591feaa30m, createdTime=Mon Sep 04 10:06:14 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240329, encodeId=cf702403290b, content=已学习并已分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Mon Sep 04 10:05:34 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240303, encodeId=4795240303c4, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Mon Sep 04 08:29:56 CST 2017, time=2017-09-04, status=1, ipAttribution=)]
    2017-09-08 yayale

    总结的太全面.太好了.谢谢

    0

  4. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b5b2139948, createdName=1591feaa30m, createdTime=Mon Sep 04 10:06:14 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240329, encodeId=cf702403290b, content=已学习并已分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Mon Sep 04 10:05:34 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240303, encodeId=4795240303c4, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Mon Sep 04 08:29:56 CST 2017, time=2017-09-04, status=1, ipAttribution=)]
    2017-09-05 1391fee957m

    谢谢分享

    0

  5. 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level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Mon Sep 04 08:29:56 CST 2017, time=2017-09-04, status=1, ipAttribution=)]
    2017-09-05 戒馋,懒,贪

    谢谢分享

    0

  6. 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  7. 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createdBy=272a110164, createdName=laoli, createdTime=Sat Sep 09 23:09:51 CST 2017, time=2017-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=241676, encodeId=0ba92416e67a, content=总结的太全面.太好了.谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/UibwsCIqUomb0XFG5wxowcjvLxRyYuO0l5q2IGxx4icISWVVmiaUeavbRetqvAjdWPYMfHM2GMSV5wnMMWRz8VNLw/132, createdBy=42aa106928, createdName=yayale, createdTime=Fri Sep 08 08:29:44 CST 2017, time=2017-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240745, encodeId=e6b1240e45d8, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/X2NCXWNhaVX6zwVp0m01UibwbaTA9PDJQVLabf3setiaKKhTibGqE2ugPz59niaXvm1ulSV0kiaapNXncFz0Yw6oWjQ/0, createdBy=53392141148, createdName=1391fee957m, createdTime=Tue Sep 05 13:20:11 CST 2017, time=2017-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240676, encodeId=6fce2406e653, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Tue Sep 05 09:41:54 CST 2017, time=2017-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1580396, encodeId=07ae158039665, content=<a href='/topic/show?id=c026e05485f' target=_blank style='color:#2F92EE;'>#疱疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70548, encryptionId=c026e05485f, topicName=疱疹)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Tue Sep 05 05:39:00 CST 2017, time=2017-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240493, encodeId=31882404938d, content=学习了.谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Mon Sep 04 22:06:18 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240331, encodeId=fa20240331e0, content=己学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b5b2139948, createdName=1591feaa30m, createdTime=Mon Sep 04 10:06:14 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240329, encodeId=cf702403290b, content=已学习并已分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Mon Sep 04 10:05:34 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240303, encodeId=4795240303c4, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Mon Sep 04 08:29:56 CST 2017, time=2017-09-04, status=1, ipAttribution=)]
    2017-09-04 changjiu

    学习了.谢谢

    0

  8. 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objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70548, encryptionId=c026e05485f, topicName=疱疹)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Tue Sep 05 05:39:00 CST 2017, time=2017-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240493, encodeId=31882404938d, content=学习了.谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Mon Sep 04 22:06:18 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240331, encodeId=fa20240331e0, content=己学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b5b2139948, createdName=1591feaa30m, createdTime=Mon Sep 04 10:06:14 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240329, encodeId=cf702403290b, content=已学习并已分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Mon Sep 04 10:05:34 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240303, encodeId=4795240303c4, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Mon Sep 04 08:29:56 CST 2017, time=2017-09-04, status=1, ipAttribution=)]
    2017-09-04 1591feaa30m

    己学习

    0

  9. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b5b2139948, createdName=1591feaa30m, createdTime=Mon Sep 04 10:06:14 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240329, encodeId=cf702403290b, content=已学习并已分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Mon Sep 04 10:05:34 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240303, encodeId=4795240303c4, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Mon Sep 04 08:29:56 CST 2017, time=2017-09-04, status=1, ipAttribution=)]
    2017-09-04 15938038573红旗飘飘

    已学习并已分享

    0

  10. 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level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Mon Sep 04 08:29:56 CST 2017, time=2017-09-04, status=1, ipAttribution=)]
    2017-09-04 戒馋,懒,贪

    谢谢分享.学习了

    0

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