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病情分析： 考虑你这个是蛔虫感染. 指导意见： 蛔虫病是蛔虫寄生于人体小肠所致的疾病.经口吞入感染期幼虫卵是人体感染蛔虫的主要方式. [病原学] [流行病学] [临床表现] ⒈ 幼虫移行症 见于短期内生食了含有大量受精蛔虫卵的蔬菜,瓜果者.潜伏期7—9日.出现低热,乏力,少数伴荨麻疹或皮疹.咽部异物感,阵咳,常呈哮喘样发作,痰少,偶尔痰中带血丝,胸部闻及干罗音.胸片双侧肺门阴影增深,肺纹理增多,点,片状或絮状浸润阴影,于1—2周消失.痰液检查可有嗜酸性粒细胞与夏科—莱登晶体,偶发现幼虫,病程持续7—10日,逐渐缓解. ⒉ 肠蛔虫病 绝大多数病例无任何症状.儿童常有腹痛,为脐周不定时反复腹痛,无压痛及腹肌紧张,伴食欲减退,恶心,腹泻或便秘,大便中排出蛔虫.儿童有时有惊厥,夜惊,磨牙,异食癖. 并发症 ⒈ 胆道并发症 临床上表现为胆绞痛型,急性胆囊炎,急性胆管炎,急性胰腺炎与肝脓肿五型. ⒉ 肠道并发症 表现为机械性肠梗阻,多为不完全性.阵发性脐周痛,频繁呕吐,明显腹胀,肠型及蠕动波.腹部触及条索状肿块为本病特征.X线腹平片见液平面与肠充气.梗阻时间过长可并发肠穿孔,肠扭转.蛔虫钻入阑尾可引起阑尾炎. ⒊ 蛔虫性腹膜炎 蛔虫可穿过小肠壁进入腹腔,引起腹痛,腹胀,全腹压痛等腹膜炎症状.手术时可发现蛔虫及虫卵肉芽肿. [诊断] [治疗] ⒈ 驱虫治疗 苯咪唑类 是广谱驱线虫药.阿苯达唑400mg,顿服.甲苯咪唑为C型晶体微粒剂,500mg顿服.2—4日可排除蛔虫.疗效均达90%以上,一般无副作用. 噻嘧啶 广谱驱线虫药.成人500mg,顿服.儿童每次10mg/kg,顿服.孕妇,肝,肾,心脏疾病患者暂缓给药. 哌嗪 有抗胆碱能作用,使虫体肌肉麻痹.成人3g,儿童每次80—100mg/kg,空腹或晚上1次顿服,连服2日.肝,肾疾病及癫痫患者禁服.一次治愈率70%—80%. 左旋咪唑 成人150—200mg,顿服.偶引起中毒性脑病,应慎用. ⒉ 胆道蛔虫病治疗 原则为解痉止痛,早期驱虫抗感染.阿托品0.5mg加异丙嗪25mg,肌注或静滴.蛔虫大多从胆道退出.驱虫可用阿苯咪唑或甲苯达唑口服.发热者适当应用抗感染药物.ERCP有诊断及取虫效果.并发急性化脓性胆管炎,肝脓肿,出血坏死性胰腺炎者需外科治疗. ⒊ 蛔虫性肠梗阻 应禁食,胃肠减压,解痉止痛,补液,纠正失水及酸中毒,服豆油及花生油60ml,有松解蛔虫团的作用.腹痛缓解后驱虫.并发肠坏死,穿孔,腹膜炎及完全性肠梗阻者应及时手术. [预后] [预防] 一.注意饮食卫生,不吃不洁的生冷食物,生食的蔬菜瓜果一定要洗净后才能食用. 二.养成良好的卫生习惯,不可随地大便.蛔虫病的传播途径为蛔虫排出的虫卵随大便排出体外,继而污染周围环境,又可污染蔬菜瓜果等.一旦吞食,即可感染.要做到饭前便后洗手,勤剪指甲.儿童不要吮吸指头. 参考资料： 蛔虫病是吞食蛔虫蚴卵后感染的一种最常见的肠道寄生虫病.其临床表现有发热,咳嗽,皮肤瘙痒,上腹部或脐周阵发性疼痛,时有呕吐或腹泻,睡眠时磨牙,面部有色素变浅的环状虫斑等.蛔虫又具有攻窜的特性,可到处乱窜而导致多种并发症,如胆道蛔虫症等.
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