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小宝见PED归来说说CROUP(格鲁布/哮吼/义膜性喉炎)
作者:home99
发表时间:2009-10-08
更新时间:2009-10-12
浏览:11725次
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::: 栏目 :::
写给准妈妈1
宝宝护理与成长3
写给准妈妈3
为人父母3
英语学习
为人处世
休闲娱乐
理财话题
为人父母2
写给准妈妈2
实用资料
宝宝护理与成长2
为人父母1
其它
医药健康话题
写给新妈妈
宝宝护理与成长1
异国他乡

先感慨一下啊,当妈妈真是有操不完的心,将宝宝养大真不容易啊!所谓养儿方知父母恩。宝宝健康、平安、快乐真是比什么都重要!

还是言归正传吧,下面是我上周五开始写的。

这几天妈妈的日子真不好过啊,周三周四两天请假在家,几乎整天是抱着小宝过来的,小宝肯下地自己玩的时间几乎没有,周四去看了PED,今天一早妈妈醒来,发现高烧两天三夜之后的小宝终于可以安静地睡着了,妈妈算是松了口气。可怜的是这两天小宝连哭都哭不出来,睡不好、吃得少,妈妈陪着眼泪汪汪。什么国庆啊、中秋啊,妈妈哪有心思去想,电话、EMAIL什么的哪里顾得上,只是希望怀里的小宝能早点儿好起来啊!

来说说具体情形啊,希望对JMs有些参考。

周二(9/29)晚上小宝吃得还算不错,妈妈还暗自高兴呢,睡觉前妈妈觉得小宝有点热,当时也没特别引起重视,还以为是她调皮蹦了半天弄热的。没想到凌晨可能快到3点的样子小宝哭闹着醒来,妈妈抱到怀里发现她烫得厉害,于是赶紧给她吃Tylenol,之后她仍睡不踏实,大宝因此也没睡好,早上喊半天仍不想起床。

周三(9/30)妈妈实在不忍扔下发烧的小宝去上班,于是趁爸爸送大宝去学校的工夫赶紧打电话请假。中午她又烫得不行,只好再给她吃Tylenol,然后下午可能4点多吧小宝又开始高烧,时间越来越短了,而且妈妈发觉小宝的嗓子有些嘶哑,整天很累的样子,几乎没有说什么话,包括发烧时想哭的时候。

因为小宝以前有过发烧多天才退,所以才开始也没想到要带她去医院。到晚上8点左右爸爸开始着急起来,因为小宝出现了呼吸困难,可以听到她每次呼吸都很费力,而且很难发声,即便想哭都哭不出来,要不是顾及到大宝第二天要去上学,爸爸妈妈差点儿就带她去看急诊了。

爸爸决定先给她洗个热水澡,然后房间里用了Humidifier,希望能使她舒服点儿,晚上等大宝入睡之后将小宝抱回到大床上,爸爸妈妈实在放心不下啊。夜里小宝睡得极不踏实,因为高烧醒来吃药之外仍多次醒来,可能是呼吸困难,她想哭却哭不出来,只是迷糊中嘶哑地哭着找妈妈。因为怕吃多了Tylenol不好,所以吃了3次之后就让她改吃了2次Motrin。小宝喜欢Tylenol (grape)的味道,所以每次吃Tylenol她都会很乐意张开小嘴巴,但换了Motrin (original berry),通常勉强半天爸爸妈妈一起才能喂下去,所以若是半夜里醒来要吃药,妈妈只好给她吃Tylenol。

[周五妈妈起来打字的当儿,小宝醒来没见妈妈在身边,于是起床来找妈妈,喝了点水,妈妈抱着睡了会儿,还是决定陪她躺下,看着身边终于不再是“烫山芋”的小宝,妈妈轻轻地舒了口气,希望乖乖的fever这次是真正退了啊,从昨晚吃药到现在应该有8个小时以上了。妈妈见小宝又睡了,起来接着写啊。]

小宝这几天平均4~6小时就要吃一次退烧药,因为以前发烧时喝牛奶总是吐得稀里哗啦,所以妈妈只敢在她烧退的间隙让她喝牛奶或吃点东西,平常8Oz小宝很快就能喝完,如今能喝到4Oz就算是很不错的了。

周四(10/1)妈妈本来是该去上班了,可是看小宝如此情形,高烧没退不说,还出现呼吸困难,不仅可以看出她的费劲,而且可以听到沉重急促带着杂音的呼吸声,妈妈只好再次打电话请假,然后让刚送大宝回来的爸爸给PED打电话,可能是情况比较紧急很快就约上了,我们不一会就从家里出发。小宝通常会在车子里睡觉,但可能太不舒服,她只是时不时望着窗外。

到了医院,check in之后没有等很久护士就来叫了,小宝此时烧退了,精神似乎不错就自个撒开小腿跟着护士跑在前面,先是给小宝称体重,好象是第一次试图让小宝站秤上称体重,小宝不肯,于是合衣抱到婴儿秤上,护士拿出Dora Sticker,让小宝选自己喜欢的,在这分神的当儿,得到了她的体重,呵呵,妈妈没看仔细,后来听爸爸说是26磅。之后便到房间,护士简单问了几个问题以及谁是小宝的PED,然后就出去了。在等医生的当儿,小宝还极力想恢复原来的小调皮本色,眼睛里还出现了平常的神采,这可能是这几天唯有的几分钟。不久进来一个不认识的男PED,看来是谁available就来给生病的宝宝看病,而不必是宝宝自己的PED。

PED没怎么问,可能进来时就听到了小宝的呼吸声,上来就拿出听诊器在胸前靠颈部听了听,然后跟爸爸说了情况,妈妈只听懂了asthma等几个词,听到PED几次提到croup这个词,就有些迷惑了,心想小宝怎么可能有asthma呢,等PED出去后便问爸爸什么是croup,爸爸虽然明白却也没解释清楚。PED的意思小宝多半是asthma,还问我们有无家族史,但也不排除是croup,说是先让护士给小宝试吸服一种药看有无效果再说。

于是PED就出去了,不一会护士拿了一个仪器带了不少连接的管子以及一个面罩,原来想让爸爸抱着小宝的,可是小宝挣扎得厉害,说什么也不肯戴上那个面罩,妈妈只好过来抱她,护士在爸爸的帮助下差不多是强制性地给她戴上了。吸药整个过程可能至少有那么5~10分钟吧,但感觉时间很长。那个装置好象就是个Pump,药物通过蒸汽进入小宝的鼻中,开始蒸汽很足,妈妈有些担心会不会热或烫着,因为从头到尾小宝是哭着进行的,眼睛都哭红了,后来PED进来还冲着小宝问,刚才是你在哭吗?估计楼道都能听到,而能听到她的哭声本身就是一个好迹象,因为原来小宝根本哭不出来,这说明此药物对小宝起作用了!

之前见steam很少了不见护士回来,妈妈见小宝哭得可怜便一再让爸爸去找护士,护士进来取下看了看,说还点药,于是又让小宝戴上,过了一会才取下,小宝这才止住哭声,开始还有点生妈妈的气,伸出小手让爸爸抱,妈妈真是有些伤心。不过没两分钟,小宝似乎原谅了妈妈,还是钻回妈妈的怀抱。吸服完药物,小宝哭闹之后,鼻子里不仅弄出点鼻屎,而且还象感冒似的出了清鼻涕,用tissue擦了几次才好,这说明小宝的鼻子通了,呼吸声也明显改善,这也是PED为什么说药物对小宝有效。

于是开了单子给我们,说是必要时给小宝出现呼吸困难时给她吸服(PED的字太难认了,还是爸爸拿了药回来才知道的),药物名称是Ventolin HFA (Albuterol sulfate),上面有个NOTE是“INHALE 2 PUFFS EVERY 4 HOURS IF NEEDED”;此外还买了一个简易装置,感觉是个手动的PUMP,连着个mask,按PED的意见是必要时每4小时给小宝吸服一次,每次PUMP两下。具体的名称是“AEROCHAMBER PLUS With ComfortSeal Mask-Small”,感觉是设计给宝宝用的。回来的路上小宝很快就睡着了,上了高速可能还没开到下一个出口,看她睡得香甜的样子,妈妈真是好欣慰啊,虽说小宝呼吸声还有些沉重,不过至少不是那么费劲了,这几天乖乖真是累坏了。

[妈妈后来在网上查词典,算是明白PED开的药是舒喘灵(喘乐宁) 气雾剂,是一种平喘药(β2受体激动药/支气管扩张药),有效成分是硫酸沙丁胺醇。对Croup也作了一番研究,才发现Croup居然是小儿常见病,后面再详细写啊。]

因为要到daycare付这个月的费用,妈妈通常都是每个月底写支票给他们,但因为小宝病了,妈妈一直守着她,没顾上,而今天已经是这个月的第一天,说什么也要付了,于是决定在小宝的daycare停一下,然后在附近的Kroger去买小宝喜欢吃的一种酸奶。小宝开始一直坐在shopping cart里,后来快check out时爸爸情不自禁说了句“What a pitiful thing!”,妈妈忍不住伸手将小宝抱起来。爸爸在将东西一个个SCAN check out的时候,小宝突然大吐起来,早上吃喝进去的一点东西都出来了,吐了自己和妈妈一身不算,还吐了一地,里面的一个工作人员赶紧拿了纸过来,爸爸赶紧向人家道谢和道歉。

回到家第一件事便是给小宝洗澡,妈妈也不得不冲个澡,然后是将衣服放到洗衣机里加了bleach,否则那味儿实在冲啊。之后小宝似乎舒服点了,虽说后来烧没有立即退,又吃了两三次退烧药。晚上睡觉前为了保险还是让小宝吸服了一次买回来的药(听爸爸说两样东西一起就要100刀),因为只有两下,小宝虽然不情愿,不过很快就过去了,不象在医院里那样折腾(后来我们没再给小宝用)。等大宝入睡之后,还是将小宝转移到大床上和爸爸妈妈一起睡,这样小宝万一有什么异常情况好立即知道。

周五早上起来小宝的烧算是彻底退了,周末妈妈的小调皮基本上回来了,这周明显好转,只是这几天小宝还有些咳嗽,昨夜还醒来多次哭闹。每次喝了牛奶之后妈妈便担心她咳嗽时会吐,周日夜里还接连咳嗽了好一会。因为医生说小宝可能是病毒感染(这也是Croup常见病因),虽说妈妈这些天一直和小宝在一起也没事,不过为了保险,爸爸妈妈还是决定让宝周五仍呆在家里,这样也不至于传染给别的宝宝,而且希望能够帮助她恢复。妈妈上班忙完了之后就请假回来陪她。

下面就将妈妈对Croup的学习所得贴出来,仅供宝爸宝妈们参考啊。

一、什么是Croup?

结合网上查字典及SEARCH,大致有3种译法,一是音译的“格鲁布”或“格鲁布喉炎”,二是“哮吼”,还有一个就是“义膜性喉炎”,其中第二种可以查到的资料似乎相对比较多,先引用一个解释:

“哮吼:病名。呼吸急促,喉中有哮吼之声,即哮证。见《万病回春•哮吼》。《医宗金鉴》卷四十一:“呼吸气出急促者,谓之喘急;若更喉中有声响者,谓之哮吼。”《古今医鉴》卷四十一:“呼吸气出急促者,谓之喘急;若更喉中有声响者,谓之哮吼。”《古今医鉴》卷四:“夫哮吼专主于痰,宜用吐法。亦有虚而不可吐者,此寒包热也。治法必用薄滋味,不可纯用寒凉,须常带表散。”方用定喘汤。参见哮证、齁喘条。”

可见很早就有这个词了。所以结合中英文的资料,似乎可以将Croup理解为是一种上呼吸道(气管支气管)病毒性疾病,又称为“急性喉气管支气管炎”、“狮子吼”或“急性咽气管支气管炎”等,与哮喘症不同。哮喘的特色是吸气时喘鸣像笛声;Croup的症状则包括咳嗽像小狗吠、吸气费力且有怪声和呼吸困难。Croup最常见于6个月到3岁的幼儿,有的说可以影响到5岁或6岁的孩子,如果这样,我有些怀疑大宝去年Thanksgiving前(不到4岁半)的咳嗽是否也属于这个范畴,这是因为:

一是当时大宝的呼吸也是十分费劲,只是因为咳嗽很厉害,我们认为他可能嗓子疼,听声音挺恐怖,担心影响到肺,去看了PED,结果PED相当保守,居然连止咳药也不让吃。后来实在看不下去他那么受罪,听了daycare老师的意见,去药店买了给小孩吃的止咳药之后大宝才好起来的。二是关于宝宝咳嗽的资料里不少也提到“义膜性喉炎”,有文还将它作为引起孩子咳嗽的元凶之一。关于小儿咳嗽,我在网上也看到不少资料,另外再写啊。

顺便提一下,Croup旧称为“false croup (假性格鲁布,痉挛性哮吼)”,或bronchitis convulsive(痉挛性支气管炎)、catarrhal croup(卡他性格鲁布)。在以前白喉尚多的年代,Croup作为白喉的别名而通用,而把白喉以外引起哮吼的疾病命名为假性格鲁布。由于预防接种的关系,白喉已绝迹,如今大都只称格鲁布(Croup)。我的同事也告诉我,Croup是个很古老的词,也就是我们现在所说的Croup与以前的含义其实已经不同了。

那么究竟什么是Croup呢?

简单地说,Croup是一种多发于半岁至三岁婴幼儿的喉部病毒感染疾病,通常伴有呼吸系统感染症状,如流涕、咳嗽等,对幼儿是一种严重的呼吸疾病,会在夜里突然发作或加重,可持续数个小时,此时宝宝会出现较剧烈的咳嗽以及呼吸困难。

临床表现为声音嘶哑,吸气时费力且有犬吠样/海豹样吼哮声,这是由于喉周组织炎症反应、气道痉挛、粘膜肿胀而造成患儿呼吸困难,每次吸气时气流强行通过狭窄的气道而发出刺耳的吼声。当时PED也特别提到小宝是吸气时有异样的声音,平常我们呼吸胸部会起伏,但当时随着每一次呼吸,小宝的腹部也跟着动,可见她呼吸是很费力的。

Croup的病程为5~6天,多由病毒感染引起,细菌感染较罕见,具有高度传染性。好发年龄为3个月到6岁(平均年龄2岁),在这个年龄段的儿童,小气道易被梗阻,较大的孩子患本病则称为喉炎。多数病例为轻型,家庭治疗即可。少数严重病例或会厌炎(一种与哮吼无关的会厌细菌感染性疾病,其症状与哮吼相似)的患儿,需住院治疗。

二、Croup的症状

Croup常见于3个月到5岁幼儿,可能出现的症状有:

1、剧烈、嘶哑、沉重的犬吠样咳嗽(barking cough),类似于海豹的吼叫声,这种声音不同于你以前听到过的咳嗽声。

2、通常发生在午夜,病情白天缓解,晚上严重,伴有吸气性呼吸困难,吸气时会发出刺耳的喘鸣,这种声音类似于孩子长时间大哭之后的抽泣。

3、由于呼吸困难,每次呼吸时颈部肌肉、肋骨、胸骨都有明显的起伏。

4、发炎期间,若发烧且伴有暂时性乾咳、呼吸急促。

常发生于上呼吸道感染之后。痉挛性犬吠样咳嗽和声音嘶哑标志着吸气性喘鸣的急性发作,一般多在夜间发生。在夜间睡眠中小儿常因呼吸困难而醒来,呼吸增快以及锁骨上窝,胸骨上下窝和肋间隙吸气性凹陷。

在严重病例,随着小儿疲劳,可能出现发绀和呼吸浅表。最具有特征性的体征是呼吸窘迫和刺耳的吸气性喘鸣。听诊可发现吸气延长和喘鸣,常伴有呼气性干啰音和哮鸣音,可能有湿音。呼吸音可因肺不张而减低。半数病儿有发热,病儿状况常于早晨好转,但到晚上又加剧。开始可能白细胞升高伴有多形核细胞增加,以后变为白细胞减少和淋巴细胞增多。由于肺实质受侵犯,动脉血气分析显示低氧血症,伴或不伴高碳酸血症。住院病儿中80%有低氧血症。颈部前后位X线片显示声门下狭窄。本病一般持续3~4天。

反复发作的喉气管支气管炎常被称为“痉挛性喉气管支气管炎”,变态反应和呼吸道反应性在此病中起一定作用,但痉挛性发作的临床表现与一般的病毒性喉气管支气管炎病例不容易鉴别,而且痉挛性喉气管支气管炎也往往是以病毒感染开始起病的。

三、Croup的病因

由喉咙、气管或支气管(肺内的通气管道)的黏膜发炎及肿胀引起的。多数病例由副流感病毒感染所致,又称急性喉气管支气管炎,是上呼吸道和下呼吸道的急性病毒性炎症,临床特征为吸入性哮吼,声门下肿胀和呼吸窘迫,呼吸窘迫在吸气时最突出。通过患儿咳出的悬浮在空气中的微粒传播。

其他病毒可能包括:呼吸合胞体病毒(RSV)、流感病毒、腺病毒、肠道病毒、艾柯病毒、克沙奇病毒及麻疹病毒等。

流感引起的喉气管支气管炎特别严重,可发生于各年龄组的儿童。喉气管支气管炎常呈季节性暴发,副流感病毒引起者主要发生于秋季,而呼吸道合胞病毒和流感病毒可能引起冬春季的流行。大多通过空气传播或接触具有感染性的分泌物而传染。

四、Croup的治疗与护理

Croup一般发生在6 岁以下的小儿。经由飞沫传染病菌引起,Croup的初期症状如同感冒,先有1至3天咳嗽、鼻塞、流鼻水和高烧;接着发作典型的哮吼症状,如声音沙哑、咳嗽时有怪声音,听起来像狗吠声、吸气时有哮吼音(吸气时喉头有杂音,表示上呼吸道阻塞),在白天或晚上均可以发作,晚上更厉害。严重时会出现呼吸急速、呼吸困难、肋骨间或锁骨上皮肤随呼吸而凹陷,甚至发展为呼吸衰竭,需要插管给予呼吸支持。

常在夜间起病,起病时患儿声音嘶哑,发出破竹样咳嗽,吸气有吼声,呼吸用力,有时胸廓的胁间内陷。为减轻宝宝的症状,可以先尝试以下家庭治疗方法,如果症状不见缓解,要及时就医。

1、家庭治疗

● 让儿童坐起,令其呼吸较为畅顺。
● 冷湿加湿器可改善患儿呼吸,注意不要让雾喷到患儿脸上,同时不要加药,以免刺激咽部。或用湿毛巾放在暖气片、暖气炉上,让小孩呼吸10~20分钟水蒸汽。
● 蒸汽可稀化粘痰,缓解咽部痉挛。打开淋浴器,使浴室中充满蒸汽,将患儿抱到浴室中(不要放在淋浴器下),直到患儿呼吸得到改善。
● 冷空气有时可缓解哮吼。当晚上很冷时,可带患儿乘车兜风,并将车窗摇下。
● Tylenol或Motrin退热,降低患儿呼吸频率。
● 让患儿饮用足够的液体,以保持体内水分并稀化粘痰。
● 远离吸烟者。
● 指压辅助治疗:至少需按压四个穴位才能奏效,合谷穴、外关穴、肺俞穴、翳风穴、神庭穴。

2、自我护理

Croup自然病程约3~7 天。在此期间,您可以采取下列措施使您的孩子感到舒适并加快其恢复:

● 尽量使您的孩子保持镇静: 哭闹只会使呼吸更困难。
● 湿润空气:经常保持房间温暖和适当的湿度,湿润的空气有助于孩子呼吸轻松,对轻度格鲁布喉炎患儿帮助更大。可以使用空气增湿器,或者让孩子在蒸汽浴室里呆上几分钟,给他呼吸暖和湿润的空气。
● 凉爽一会: 有时候,呼吸清新凉爽的空气对病情有帮助。若室外凉爽,可用毛毯包裹孩子到外面走上几分钟。
● 孩子竖着抱,使呼吸更容易。
●咳嗽可能引起呕吐,因此病儿不宜喂固体食物。可多次给少量饮料,如水、米汤、果汁、姜汤等。
● 鼓励孩子多休息: 睡眠有助于机体抗感染。
● 如果孩子有发烧,可考虑用扑热息痛等退烧药。
● 不需要给孩子服用止咳糖浆: 因为它不是因喉头气管受累引起的,因此止咳糖浆起不到缓解作用。
● Croup多在夜间加重,建议家长与小儿同居一室或使用baby monitor,以便及时了解婴儿的情况。

3、药物治疗

除极其严重的Croup外,大多患儿在家庭护理即可。当症状严重到一定程度时,可拍X线片以了解是否存在会厌炎。如果患会厌炎,可短期住院给予抗生素治疗。严重的哮吼患儿亦需住院,吸人异丙肾上腺素或口服皮质激素可减轻水肿。

轻型病例可在家中进行照料,给予适当的支持性措施。应使小儿舒适并保持充分饮水。休息非常重要,因为疲劳和哭闹会使病情加重。家中湿化设备(例如“冷蒸气”喷雾器或湿化器)可改善上呼吸道的干燥。

呼吸窘迫加重或持续不改善,心动过速,疲劳,发绀或脱水说明需要住院。由于中度低氧血症可无发绀,对呼吸窘迫的病儿开始就应该进行动脉血气分析。如果开始动脉血氧分压(PaO2 )低于8KPa(60mmHg)应该给湿化的氧。吸入氧浓度保持在30%~40%一般已足够。动脉血二氧化碳分压(PaCO2 )>6KPa(45mmHg)说明有二氧化碳潴留,此时病人一般表现疲劳,需密切监视。气管插管应提前进行,器械和工作人员应事先做好准备。下列情况需要立即进行插管:(1)尽管给予足够的氧,雾化治疗和补液,CO2 潴留仍加重;(2)吸氧后低氧血症无改善;(3)分泌物难以咳出。

雾化治疗可降低气管支气管分泌物的粘稠度从而易于被清除。标准的喷射型雾化器能改善喉部的湿度,但毛细支气管的湿化需要使用固定在面罩或氧帐上的超声雾化器。

消旋肾上腺素(沙丁胺醇)雾化吸入能成功地改善症状,解除疲劳。但是必须了解,其作用短暂并且不能改变病程,治疗病毒感染,提高动脉血氧分压,而且可能发生心动过速及其他副作用。

经肠道外应用大剂量地塞米松(>0.3mg/kg),口服地塞米松(0.5~0.6mg/kg)及皮质类固醇雾化吸入对住院的中,重度病人有利。皮质类固醇对门诊病人的价值尚不明了。

最常引起喉气管支气管炎的病毒一般并不促发继发性的细菌感染,因而很少需要用抗生素。

五、中药方

也将看到的这个中药的治疗方法贴下面,感觉好些似乎是治哮喘的。

《寿世保元》 [明] 龚廷贤(公元1368年—1644年) [卷三] 哮吼
脉大抵浮而滑。易治。脉微而涩。难治。夫哮吼以声响名。喉中如水鸡声者是也。专主于痰。宜用吐法。亦有虚而不可吐者。治之有以紫金丹导痰。小胃丹劫之而愈者。有以六味地黄丸、补中益气汤。兼进而愈者。必须量虚实而治之也。

千金定喘汤
治哮吼如神。麻黄(二钱)桑白皮(蜜制三钱)杏仁(一钱五分)苏子(二钱)白果(二十一个炒)款冬花(三钱)黄芩(一钱五分炒)半夏(甘草水泡)甘草(各一钱)上锉。白水煎。食远服。诸病原来有药方。唯愁喘最难当。麻黄桑杏寻苏子。白果冬花更又良。甘草黄芩同半夏。水煎百沸不须姜。病患遇此仙方药。服后方知定喘汤。一论人素有喘急。遇寒暄不常。发则哮吼不已。夜不能睡者。用此方。

苏沈九宝汤
紫苏薄荷麻黄杏仁(去皮尖)桑白皮大腹皮官桂甘草上锉。用生姜三片。乌梅一个。水一碗。煎至八分。食后服。即效且住服。惟慎劳碌。戒浓味。节欲。日间常服些顺气化痰丸。夜卧时服抑火润下丸。如除根。须合六味地黄丸加黄柏、知母、人参、紫菀、五味子、百合各二两。浮小麦粉、熟蜜四两。糊为丸。每服百丸。空心。柿饼汤送下。饼随食之。

二母丸
治哮喘。知母(去皮毛二两)贝母(去心二两)百药煎(一两)上为细末。将乌梅肉蒸熟捣烂为丸。如梧子大。每服三十丸。临卧或食后。连皮姜汤送下。一论喘气哮吼。上喘不休。或者盐戗水戗肺窍。俗谓之喘气病。用此秘方。小蓟草一把。用精猪肉四两。入水同煮令熟。食肉并汤立已。其草三月生。七八月有四棱。茎叶尖。杪有花子。一论凡遇天气欲作雨者。便发喘。甚至坐卧不得。饮食不进。此乃肺窍中积有冷痰。乘天阴寒气从背自鼻而入。则肺胀作声。此病有苦至终身者。亦有子母相作者。每发时即服。不过七八次。觉痰腥臭。吐出白色。是绝其根也。用此方。

紫金丹
白砒(一钱生用)枯白矾(三钱另研)淡豆豉(出江西者一两水浸去皮蒸研如泥旋加二味末合匀)上捻作丸。如绿豆大。但觉举发。用冷茶送下七丸。甚者九丸。以不喘为愈。再发。勿多增丸数。慎之。小儿服一二丸。

导痰小胃丹
(方见痰气)治哮吼经年不愈。宜久久服之。断根。一论哮喘气急而不息者。宜用

均气八仙汤
麻黄(二钱)杏仁(二钱)石膏(三钱)桔梗(一钱)片芩(二钱)贝母(一钱用北细辛三分煎汤拌炒三次为末)生甘草(一钱)知母(二钱)上锉一剂。水煎。温服。一治上气喘急。经年咳嗽。久不愈。遇发即服三五次。永不再发。

夺命丹
人言(一钱)白矾(二钱)白附子(二钱)南星(四钱)半夏(泡五钱)上先用人言与白矾一处。于石器内火红。出火。黄色为度。切不可犯铁器。却和半夏、南星、白附末。生姜汁煮面糊为丸。黍米大。朱砂为衣。每服七丸。小儿三丸。井水化下。忌食热物。

哮吼灵秘丹
海上异人传。胆南星(二两)大半夏(二两用白矾五钱牙皂五钱同一夜不见白星)赤茯苓(去皮二两)苦葶苈(二两)大贝母(二两)沉香(一两)青礞石(硝五钱)天竺黄(二钱)珍珠(三钱豆腐煮)羚羊角(一支锉末)乌犀角(三钱)白矾(一两)硼砂(一两)风化硝(五钱)花蕊石(火五钱)孩儿茶(五钱)款冬花(一两)铅白霜(五钱)上为细末。炼蜜为丸如梧子大。每服二三十丸。临卧。姜汤送下。外制六味地黄丸。空心服。百发百中。真仙方也。一治素患哮吼之病。发则喘急。痰涎上壅。不时举发。令慎劳役。戒浓味。节欲。早服六味丸。加黄柏、知母、人参、紫菀、五味、百合各二两。浮小麦粉、熟蜜四两。打糊为丸。每服百丸。空心。柿饼汤下。饼随食之。夜卧时服后方。各一料而愈。

千金定吼丸
南星半夏(各四两用生姜牙皂各三两煎汤浸星半一宿切片再加白矾二两入汤内同星半煮至汤干去姜皂只用星半)贝母枳实(麸炒)黄连(姜炒)黄芩(酒炒)连翘(去心)白附子天麻僵蚕(炒)桔梗栝蒌(各一两)锦纹大黄(酒拌九蒸九晒一两)青礞石(用硝如金色者五钱)沉香(五钱)上为细末。竹沥、姜汁和为丸。如弹子大。每服一丸。临卧。口噙化下。或丸如黍米大姜汤送下亦可。一人哮吼十数年。发则上气喘促。咳嗽吐痰。自汗。四肢发冷。六脉沉细。此气虚脾弱。用黄(二钱蜜水炒)人参(二钱)白术(二钱去芦)白茯苓(二钱去皮)半夏(二钱)杏仁(三钱)五味子(三分)麦门冬(二钱去心)陈皮(一钱五分)甘草(八分)上锉。姜、枣煎服。一人自幼患哮吼之病。每逢寒即发。发则上气喘急。咳嗽。痰涎上壅。年久不愈。已成痼疾。百药罔效。予制此方。一料全愈。

清上补下丸
怀生地黄(炒锅内酒拌蒸黑四两)南枣(酒蒸去核二两)怀山药(一两五钱)白茯苓(去皮一两五钱)牡丹皮(一两五钱)泽泻(一两五钱)辽五味子(一两五钱)天门冬(去心一两五钱)枳实(麸炒一两五钱)贝母(一两五钱)麦门冬(去心一两五钱)桔梗(去芦一两五钱)黄连(姜炒一两五钱)杏仁(去皮一两五钱)半夏(姜炒一两五钱)栝蒌仁(去油一两五钱)枯芩(酒炒一两五钱)甘草(五钱)上为细末。炼蜜为丸。如梧桐子大。每服三钱。空心。淡姜汤送下。

六、出现以下情况必须立即就诊

● 吞咽困难、不能吞口水
● 看上去很烦躁,非常易激惹
● 呼吸困难、挣扎着呼吸
● 口鼻、指甲周围皮肤发绀或发灰
● 宝宝Croup伴高热(体温超过39.5℃)。
● 家庭常备药无效,Croup症状加重,需住院治疗。
● 宝宝出现Croup,呼吸频率超过50次/分,伴有严重的呼吸困难,不能讲话。若出现皮肤苍白、紫绀,这些都是严重呼吸窘迫的症状,立即拨打急救中心电话,进行急救。
● 小于5岁的儿童呼吸时出现鸣音、频率增快,为误吸异物所致。
● 突然出现流涎、吞咽不能,伴高热,无咳嗽,患儿身体前倾,不能低头、讲话,提示其患有一种非常危险的细菌感染——会厌炎,可导致呼吸道梗阻。
切记此时不要让患儿张口检查口腔,因为这个动作可能导致咽部完全梗阻,使呼吸中断。立即拨打急救中心电话,进行抢救。
● 宝宝最近没有咳嗽,但却有呼吸困难的现象。
● 儿童在咳嗽后常出现面色苍白或发蓝的情况。
● 你认为情况不寻常。

七、Croup问答

Q:什么是哮吼?
A:哮吼就是喉部和气管发生肿胀。可能由过敏、细菌或吸入刺激物引起,但更常见的是由于病毒感染,比如副流感病毒、呼吸道合胞病毒(RSV)、腺病毒、流感病毒或麻疹病毒。现在大部分哮吼的症状都比较轻,但如果发病严重可能会很危险。哮吼最常发生在秋、冬两季,3个月至5岁之间的儿童最容易得病。

Q:哮吼的症状是怎么样的?
A:因为哮吼使咽喉肿胀,所以当宝宝咳嗽时气流通过狭窄的气管,咳嗽声音会发生改变。如果你的宝宝咳起来声音非常沙哑、低沉,就像是海豹的叫声,那么很可能就是哮吼。事实上,哮吼的咳嗽声很有特点,医生可能仅仅听到宝宝咳嗽就能诊断。哮吼最初几天的症状类似感冒,一般到夜里会发作更厉害。随着病情发展,宝宝可能会出现呼吸费力或有喘鸣(吸气时发出鸟叫或鸡打鸣一样的高调音)。同时,宝宝还可能出现低烧症状。

Q:哮吼会有危险吗?
A:不像以前那么危险了。现在针对麻疹、流感嗜血杆菌(Hib)和白喉的疫苗可以保护宝宝避免得一些更危险类型的哮吼。你宝宝的哮吼很可能在3~7天内自愈。但如果宝宝的哮吼症状比较重,也可能会导致严重的呼吸困难。

Q:什么时候应该去医院?
A:如果你怀疑宝宝得了哮吼,请立刻带宝宝去医院。医生可能会问你一些关于宝宝咳嗽和呼吸的具体问题。

如果你的宝宝在没咳嗽时出现呼吸费力或喘鸣,要带他去医院。咳嗽发作时这些症状也许是不可避免的,但如果宝宝在安静时也表现出这些症状,这可能意味着他的喉部肿胀非常严重,可能危及生命。当然,如果你的宝宝看起来呼吸困难、止不住流口水、嘴唇或皮肤变紫,请立刻拨打急救电话120。

Q:怎么治疗哮吼?
A:如果你的宝宝是初次发作哮吼,并且医生认为他的病情较轻,那么可以在家治疗。湿润的空气或冷空气似乎有助于减轻气管肿胀,因此,一般的方法是将宝宝带到充满蒸气的浴室里待15~20分钟,或夜里带他到室外呼吸冷空气。但是,不要期望咳嗽能彻底根除。当宝宝夜里咳嗽醒来时,你可能需要反复带他去浴室。

你也可以尝试在宝宝的房间里使用加湿器来保持湿润的环境。但是要确保每天用消毒(漂白)水清洗加湿器,避免真菌或细菌生长。也要给宝宝多补充液体,同时问问医生是否可以给宝宝吃对乙酰氨基酚(也叫扑热息痛)缓解发烧。

由于引起哮吼的病原物可能是病毒,所以抗生素也许不管用(抗生素只对细菌有效)。也不要给宝宝吃止咳药,这不会减轻喉部的肿胀,而且还可能使宝宝更难把痰咳出来。

不过,这也不是说医生就不用开药了。如果浴室蒸气和冷空气的方法都没有使宝宝病情缓解,那么可能需要给你的宝宝开口服类固醇减轻肿胀,帮助改善呼吸。虽然以前口服类固醇往往只用于中度或重度哮吼宝宝,但近来的研究表明在轻症患者中也可能有帮助。你可以就这个问题和宝宝的医生讨论一下。

如果你的宝宝得了严重哮吼需要住院,他可能需要吸氧、吸入药物或类固醇来帮助减轻气管的肿胀,还可能需要输液以防止脱水。

Q:我的宝宝还会再得哮吼吗?
A:是的,事实上,有些宝宝似乎比其他孩子更容易得哮吼,直到他们的气管发育得较大才会好转。如果你的宝宝再次得哮吼,你要马上采取在家治疗的方法,并且及时带宝宝去医院。每一次哮吼发作可能表现得并不一样,有些时候发作会更严重,或者需要更积极的治疗。

Q:哮吼有传染性吗?
A:是的,除了由过敏原或刺激物引起的哮吼,其他类型的哮吼是有传染性的。因此,宝宝生病期间要让他待在家里,直到症状完全消失。哮吼通常只持续4~6天,在第二或第三天时症状最严重。

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★ Croup一览:

简单小结一下,放这里供JMs需要时快速参考:

● 定义:一种急性上呼吸道阻塞疾病,副流行性感冒病毒(parainfluenza virus)感染是最常见的病因,这种病毒通常侵袭半岁至三岁的孩子,可造成通往肺部的主要气管通道发炎和狭窄,引起的不同程度喉部阻塞,对幼儿有时会引起严重的呼吸困难,需要紧急治疗(成人及年长一些的孩子由于气管较宽,因此膨胀时不大会影响呼吸);

一种喉头(声带)及周围组织感染、发炎及肿大的现象,此现象会造成呼吸困难及在每次“吸气”或咳嗽时产生所谓的“哮吼”声。天气转冷的季节发生率较高。

起病时症状可能并不典型,先有一至三天咳嗽、鼻塞、流鼻水、高烧的普通感冒症状,声音沙哑,之后,随着呼吸道分泌粘液的增加,以及会厌软骨下面(声门下方或声带处)软组织水肿,造成呼吸道狭窄,发出狗吠样声音,在白天或晚上均可以发作,晚上更厉害。有时候会往下蔓延成气管炎或支气管炎。严重时出现呼吸窘迫及呼吸系统衰竭现象,脸色转青,要立即就医紧急处理。

一、主要症状:

1、通常先有鼻咽炎或轻微的喉炎,发烧的现象。
2、发现刺耳如如狗吠般的咳嗽声。
3、声音嘶哑、嘶吼咳嗽声。
4、吸气时有喘鸣声,听诊吸气时的蝉鸣声。
5、宝宝看起来焦虑不安,很倦怠。
6、严重时可能因喉部水肿,阻塞呼吸道而引起呼吸困难,且肤色发紫等现象。

三、居家护理:

1、天气转寒时,应特别保护宝宝,避免让其受寒而感冒。
2、尽量避免让宝宝与上呼吸道感染或其他传染病之患者接触。
3、当症状出现时,应提供宝宝一安静且具有高湿度空气之环境,并让他多卧床休息。
4、若有呼吸困难的现象,可协助宝宝采取较舒服的姿势,如半坐卧式。
5、急性发作时,可以让宝宝在密闭的浴室内呼吸热水龙头所散发出来的蒸气,有缓解呼吸困难的效果,但需注意安全,避免烫伤。
6、冷空气有利于缓解症状,发作时抱宝宝到外面吸点冷空气会有所帮助,但要注意不要太久,也不要天冷时将窗户大开,以免宝宝着凉。
7、尽可能地陪伴宝宝,并提供他感觉舒适的东西,如熟悉的玩具或毯子,以减少焦虑与惧怕。
8、缓和宝宝的情绪,去除环境之刺激物,尽量让他保持安静。
9、情况许可时应鼓励宝宝进食高热量液体及食物。

四、注意观察其病情变化,若出现下列症状时,应尽速就医以免危及生命:

1、呼吸困难无法吞口水或水时,应立即就医
2、呼吸异常急促 (喘):每分钟呼吸率增加到80
3、指甲或嘴唇变黑、变蓝或发紫
4、胸骨上凹陷、或肋缘凹陷
5、精神活动力差
6、冷湿空气之治疗三十到六十分钟无法改善轻微哮吼症状时。
7、舌头发青,偶尔也可见皮肤发青。

五、几点须知:

★ 若小儿不能呼吸、咳嗽、言语,身体前倾,不能屈颈时,切记不可让患儿张嘴、仰头检查咽部。因为这个动作可造成咽喉完全梗阻、窒息。立即拨打急救电话。若患儿呼吸停止,立即进行心肺复苏术。

● 如何预防:
* 勤洗手,和病人保持距离
* 为了预防再度感染,第一次发作后注意在宝宝床边设置保湿机(Humidifier/Vaporizer)。
* 若您家族有Croup的问题,请考虑在家中空调系统中加入维持湿度的装置。

●治疗与预后:Croup是很可怕的,因为它通常在夜间发作,宝宝醒来发觉呼吸吃力会很紧张导致症状加重;多数情况并不严重,症状可以减缓,若疾病在白天发作,伴随发烧的话症状会较严重。

呼吸湿润的空气,饮水等家庭自我护理能加快病情的恢复,除此之外几乎不需要进一步治疗。除非您孩子的症状持续或加重,医生可能会开一些皮质激素、肾上腺素或者其它能开放气道的药物。

Croup病程进展有快有慢,一旦严重极易迅速引起呼吸道阻塞导致呼吸困难,往往抢救不及而致命,所以不可不加以注意。当宝宝有以上主要症状出现时,应谨慎观察,若症状仍无减轻且继续加重时,请立即就医。

● 用药:若Croup是由于细菌感染所造成,您的医师可能会开立抗生素;然而大部分的病例为病毒感染,故抗生素通常无效。

● 饮食建议:Croup通常会减低食欲,故应常提供小量液体如:水、姜汁汽水、茶、果汁或可乐不要牛奶。Croup亦可能造成呕吐,故切勿在疾病发作时给孩子固体食物。

● 建议的活动:一旦Croup发作,降低宝宝之活动并鼓励其休息,切勿让孩子在冷空气的户外游玩,因为冷空气会促使Croup发作(虽然发作时,冷空气有助于减轻症状)。

●父母须知:
A、咳嗽抑制剂:如果宝宝咳得无法入睡,抑制剂也许能帮上忙。询问医生该选用什么样的抑制剂。然而,我们应该知道,抑制咳嗽有时会使病情加剧,或是延长患病时间。

B、祛痰剂:这些药剂的作用是化痰,但是研究表明它们并不十分有效。长期实践证明,水是良好的祛痰剂。

C、广谱感冒药:由于这类药物的配方中含有一种以上的成分,因此在给宝宝服用之前一定要认真阅读说明。这类药物有可能产生一些副作用,例如失眠(常见于抗组胺类药物)或是过敏(常见于减充血剂)。

D、润喉糖:服用止咳糖浆能够增加唾液的分泌,从而润滑喉咙,缓解咳嗽。但是医生叮嘱,千万不要给4岁以下的宝宝吃润喉糖。因为润喉糖会像硬糖果一样,有导致窒息的危险。

F、喂药:在给宝宝喂药时一定要使用量勺或量杯之类的容器,以确保正确的给药量。

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最后附上Croup英文资料,供JMs参考。

一、对Croup比较系统的解释与说明

1、About Croup

Croup is a condition that causes an inflammation of the upper airways — the voice box (larynx喉) and windpipe (trachea气管). It often leads to a barking cough or hoarseness嘶哑, especially when a child cries.

Most cases of croup are caused by viruses. Those involved are usually parainfluenza (副流感, 类流感) virus (which accounts for most cases), adenovirus (腺病毒), and respiratory syncytial virus (呼吸道合胞体病毒,RSV). Croup is most common — and symptoms are most severe — in children 6 months to 3 years old, but can affect older kids, too.

Most cases of viral croup are mild and can be treated at home, though rarely it can be severe and even life-threatening. Some children are more prone to developing croup when they get a viral upper respiratory infection.

The term spasmodic croup (痉挛性格鲁布) refers to a type of croup that develops quickly and may happen in a child with a mild cold. The barking cough usually begins at night and is not accompanied by fever. Spasmodic croup has a tendency to come back again (recur).

Symptoms are treated the same for either form of croup.

2、Signs and Symptoms

At first, a child may have cold symptoms, like a stuffy or runny nose and a fever. As the upper airway (the lining of the windpipe and the voice box) becomes progressively inflamed and swollen, the child may become hoarse, with a harsh, barking cough. This loud cough, which is characteristic of croup, often sounds like the barking of a seal.

If the upper airway becomes increasingly swollen, it becomes even more difficult for a child to breathe, and you may hear a high-pitched or squeaking noise when a child inhales (this is called stridor喘鸣). A child also may tend to breathe very fast and might have retractions (when the skin between the ribs pulls in during breathing). In the most serious cases, a child may appear pale or have a bluish tinge around the mouth due to a lack of oxygen.

Symptoms of croup are often worse at night and when children are upset or crying. Besides the effects on the upper airway, the viruses that cause croup can cause inflammation farther down the airway and affect the bronchi支气管 (large breathing tubes that connect to the windpipe).

3、Contagiousness

Outbreaks of croup tend to occur in the fall and early winter when the viruses that cause it peak. Many children who come in contact with the viruses that cause croup will not get croup, but will instead have symptoms of a common cold.

4、Diagnosis

Doctors can usually diagnose croup by listening for the telltale barking cough and stridor. They will also ask if your child has had any recent illnesses with a fever, runny nose, and congestion, and if your child has a history of croup or upper airway problems.

If a child's croup is severe and slow to respond to treatment, a neck X-ray may be taken to rule out any other reasons for the breathing difficulty, such as a foreign object lodged in the throat, an abscess behind the throat, or epiglottitis会厌炎(a inflammation of the epiglottis, the flap of tissue that covers the windpipe). Typical findings on an X-ray if a child has croup includes the top of the airway narrowing to a point, which doctors call a 'steeple sign'

5、Treatment

Most, though not all, cases of viral croup are mild. Breathing in moist air seems to make kids feel better. And ibuprofen or acetaminophen can make a child feel more comfortable. Doctors will also sometimes treat with steroids, which help with the airway swelling.

The best way to expose your child to moist air is to use a cool mist humidifier, or run a hot shower to create a steam-filled bathroom where you can sit with your child for 10 minutes. Breathing in the mist will sometimes stop a child from severe coughing. In the cooler months, try taking your child outside for a few minutes to breath in the cool air — this may also alleviate symptoms. You can also try driving your child around in the car with the windows down.

When your child is sick, you might also want to consider sleeping overnight in the same room to provide close observation. If you are not able to break your child's fast breathing and croupy (格鲁布性的, 哮吼性的) cough, call your child's doctor or seek medical attention as soon as possible.

Medical professionals will need to evaluate your child if the croup appears serious or if there's any suspicion of airway blockage. If the croup becomes severe, doctors will give a breathing treatment that contains epinephrine (肾上腺素adrenalin). This reduces swelling in the airway quickly. Oxygen may also be given, and sometimes a child with croup will remain in the hospital overnight for observation. As with most illnesses, rest and plenty of fluids are recommended.

6、Duration

The symptoms of croup generally peak 2 to 3 days after the symptoms of infection with a virus start. Viral croup usually lasts 3 to 7 days.

7、Complications

The vast majority of children recover from croup with no complications. Rarely, children will develop a bacterial infection of the upper airway, or pneumonia. Dehydration may occur due to inadequate fluid intake.

Children who were born prematurely or who have a history of lung disease (such as asthma), or neuromuscular disease like cerebral palsy are more likely to develop severe symptoms of croup and often require hospitalization. Croup rarely causes any long-term complications.

8、Prevention

Frequent hand washing and avoiding contact with people who have respiratory infections are the best ways to reduce the chance of spreading the viruses that cause croup.

9、When to Call the Doctor

Immediately call your doctor or seek medical attention if your child has:

● difficulty breathing, including rapid or labored breathing
● retractions: when the skin between the ribs pulls in with each breath
● stridor: high-pitched or squeaking noise when inhaling
● a pale or bluish color around the mouth
● drooling or difficulty swallowing
● a fatigued appearance
● signs of dehydration
● a very sick appearance

【Croup At A Glance】

● Croup is an infection of the larynx, trachea, and the bronchial tubes usually caused by viruses, less often caused by bacteria.
● Croup is contagious, especially during the first few days of illness.
● A cough that sounds like a barking seal and a harsh crowing sound during inhaling can be symptoms of croup.
● Treatment of croup can include moist air, saltwater nose drops, decongestants and cough suppressants, pain medication, fluids, and occasionally antibiotics.
● The major concern in croup is the accompanying breathing difficulties as the air passages narrow.
● Close monitoring of the breathing of a child with croup is important, especially at night.

二、一些相关术语
Croup Glossary of Terms

Acetaminophen: A pain reliever and fever reducer. Brand name: Tylenol. The exact mechanism of action of acetaminophen is not known. Acetaminophen relieves pain by elevating the pain threshold (that is, by requiring a greater amount of pain to develop before it is felt by a person). Acetaminophen reduces fever through its action on the heat-regulating center (the "thermostat") of the brain. Generic is available.

Aspirin: A good example of a tradename that entered into the language, Aspirin was once the Bayer trademark for acetylsalicylic acid.

Bacteria: Single-celled microorganisms which can exist either as independent (free-living) organisms or as parasites (dependent upon another organism for life).

Bacterial: Of or pertaining to bacteria. For example, a bacterial lung infection.

Brain: That part of the central nervous system that is located within the cranium ( skull ). The brain functions as the primary receiver, organizer and distributor of information for the body. It has two (right and left) halves called "hemispheres."

Breathing: The process of respiration, during which air is inhaled into the lungs through the mouth or nose due to muscle contraction, and then exhaled due to muscle relaxation.

Chest: The area of the body located between the neck and the abdomen . The chest contains the lungs , the heart and part of the aorta . The walls of the chest are supported by the dorsal vertebrae , the ribs , and the sternum .

Coma: A state of deep unarousable unconsciousness.

Common cold: A viral upper respiratory tract infection. This contagious illness can be caused by many different types of viruses , and the body can never build up resistance to all of them. For this reason, colds are a frequent and recurring problem. In fact kindergarten children average 12 colds per year, while adolescents and adults have around seven colds per year.

Cortisone: An adrenocorticoid hormone , a naturally occurring hormone made by and secreted by the adrenal cortex , the outer part (the cortex ) of the adrenal gland .

Cough: A rapid expulsion of air from the lungs typically in order to clear the lung airways of fluids, mucus, or material. Also called tussis.

Croup : A respiratory problem that occurs mainly in children, particularly from 2 to 4 years of age, due to an infection of the respiratory tree -- the larynx (voice box), the trachea (windpipe), and the bronchial tubes.

Dehydration : Excessive loss of body water. Diseases of the gastrointestinal tract that cause vomiting or diarrhea may, for example, lead to dehydration. There are a number of other causes of dehydration including heat exposure, prolonged vigorous exercise (e.g., in a marathon), kidney disease, and medications (diuretics).

Ear: The hearing organ. There are three sections of the ear, according to the anatomy textbooks. They are the outer ear (the part we see along the sides of our head behind the temples), the middle ear, and the inner ear. But in terms of function, the ear has four parts: those three and the brain. Hearing thus involves all parts of the ear as well as the auditory cortex of the brain. The external ear helps concentrate the vibrations of air on the ear drum and make it vibrate. These vibrations are transmitted by a chain of little bones in the middle ear to the inner ear. There they stimulate the fibers of the auditory nerve to transmit impulses to the brain.

Family: 1. A group of individuals related by blood or marriage or by a feeling of closeness. 2. A biological classification of related plants or animals that is a division below the order and above the genus. 3. A group of genes related in structure and in function that descended from an ancestral gene. 4. A group of gene products similarly related in structure and function and of shared genetic descent. 5. Parents and their children. The most fundamental social group in humans.

Fever : Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.).

Humidifier: Anything, usually a machine today, that adds moisture to the air.

Ibuprofen: A non-steroidal anti-inflammatory drug (NSAID) commonly used to treat pain, swelling, and fever. Common brand names for Ibuprofen include Advil, Motrin, and Nuprin.

Infection: The growth of a parasitic organism within the body. (A parasitic organism is one that lives on or in another organism and draws its nourishment therefrom.) A person with an infection has another organism (a "germ") growing within him, drawing its nourishment from the person.

Influenza: The flu is caused by viruses that infect the respiratory tract which are divided into three types, designated A, B, and C. Most people who get the flu recover completely in 1 to 2 weeks, but some people develop serious and potentially life-threatening medical complications, such as pneumonia. Much of the illness and death caused by influenza can be prevented by annual influenza vaccination.

Kidney: One of a pair of organs located in the right and left side of the abdomen which clear "poisons" from the blood, regulate acid concentration and maintain water balance in the body by excreting urine. The kidneys are part of the urinary tract. The urine then passes through connecting tubes called "ureters" into the bladder. The bladder stores the urine until it is released during urination.

Larynx: The larynx is the portion of the breathing, or respiratory, tract containing the vocal cords which produce vocal sound. It is located between the pharynx and the trachea. The larynx, also called the voice box, is a 2-inch-long, tube-shaped organ in the neck.

Lips: Aside from the lips of the mouth, there are two pairs of lips at the entrance to the vagina. They are the labia majora (the larger outside pair) and the labia minora (the smaller inside pair). Together they form part of the vulva (the female external genitalia).

Liver: An organ in the upper abdomen that aids in digestion and removes waste products and worn-out cells from the blood. The liver is the largest solid organ in the body. The liver weighs about three and a half pounds (1.6 kilograms). It measures about 8 inches (20 cm) horizontally (across) and 6.5 inches (17 cm) vertically (down) and is 4.5 inches (12 cm) thick.

Lungs: The lungs are a pair of breathing organs located with the chest which remove carbon dioxide from and bring oxygen to the blood. There is a right and left lung.

Medication: 1. A drug or medicine. 2. The administration of a drug or medicine. (Note that "medication" does not have the dangerous double meaning of "drug.")

Mouth: 1. The upper opening of the digestive tract, beginning with the lips and containing the teeth, gums, and tongue. Foodstuffs are broken down mechanically in the mouth by chewing and saliva is added as a lubricant. Saliva contains amylase, an enzyme that digests starch. 2. Any opening or aperture in the body. The mouth in both senses of the word is also called the os, the Latin word for an opening, or mouth. The o in os is pronounced as in hope. The genitive form of os is oris from which comes the word oral.

Mucus: A thick slippery fluid produced by the membranes lining certain organs such as the nose, mouth, throat, and vagina. Mucus is the Latin word for "a semifluid, slimy discharge from the nose." Note that mucus is a noun while the adjective is mucous.

Nasal: Having to do with the nose. Nasal drops are intended for the nose, not (for example) the eyes. The word "nasal" came from the Latin "nasus" meaning the nose or snout.

Nose: The external midline projection from the face.

Onset: In medicine, the first appearance of the signs or symptoms of an illness as, for example, the onset of rheumatoid arthritis . There is always an onset to a disease but never to the return to good health. The default setting is good health.
Pain: An unpleasant sensation that can range from mild, localized discomfort to agony. Pain has both physical and emotional components. The physical part of pain results from nerve stimulation. Pain may be contained to a discrete area, as in an injury, or it can be more diffuse, as in disorders like fibromyalgia . Pain is mediated by specific nerve fibers that carry the pain impulses to the brain where their conscious appreciation may be modified by many factors.

Respiratory: Having to do with respiration, the exchange of oxygen and carbon dioxide. From the Latin re- (again) + spirare (to breathe) = to breathe again.

Respiratory system: The organs that are involved in breathing. These include the nose, throat, larynx, trachea, bronchi, and lungs.

Salt: In medicine, salt usually refers to sodium chloride, table salt, used for seasoning food, for the preservation of meat, etc. Salt is found in the earth and in sea water and is isolated by evaporation and crystallization from sea water and other water impregnated with particles of salt.

Skin: The skin is the body's outer covering. It protects us against heat and light, injury, and infection. It regulates body temperature and stores water, fat, and vitamin D. Weighing about 6 pounds, the skin is the body's largest organ. It is made up of two main layers; the outer epidermis and the inner dermis.

Sore: 1. (adjective) A popular term for painful. I have sore fingers from typing dictionary terms. She has a sore throat . 2. (noun) A nondescript term for nearly any lesion of the skin or mucous membranes. He has a number of sores in his mouth.

Sore throat : Pain in the throat. Sore throat may be caused by many different causes, including inflammation of the larynx, pharynx, or tonsils.

Syndrome: A set of signs and symptoms that tend to occur together and which reflect the presence of a particular disease or an increased chance of developing a particular disease.

Syringe: A device used in medicine to inject fluid into or withdraw fluid from the body. Medical syringes consist of a needle attached to a hollow cylinder that is fitted with a sliding plunger. The downward movement of the plunger injects fluid; upward movement withdraws fluid.

Teaspoon: An old-fashioned but convenient household measure. A teaspoon holds about 5 cc of liquid.

Temperature: The temperature is the specific degree of hotness or coldness of the body. It is usually measured with a thermometer.

Throat: The throat is the anterior (front) portion of the neck beginning at the back of the mouth , consisting anatomically of the pharynx and larynx . The throat contains the trachea and a portion of the esophagus .

Tired: A feeling of a lessened capacity for work and reduced efficiency of accomplishment, usually accompanied by a sense of weariness and fatigue.

Trachea: A tube-like portion of the breathing or "respiratory" tract that connects the "voice box" (larynx) with the bronchial parts of the lungs.

Tubes: The "tubes" are medically known as the Fallopian tubes. There are two Fallopian tubes, one on each side, which transport the egg from the ovary to the uterus (the womb). The Fallopian tubes have small hair-like projections called cilia on the cells of the lining.
See the entire definition of Tubes

Tylenol: See: Acetaminophen.

Viral: Of or pertaining to a virus. For example, "My daughter has a viral rash ."

Viral infection: Infection caused by the presence of a virus in the body. Depending on the virus and the person's state of health, various viruses can infect almost any type of body tissue, from the brain to the skin. Viral infections cannot be treated with antibiotics; in fact, in some cases the use of antibiotics makes the infection worse. The vast majority of human viral infections can be effectively fought by the body's own immune system, with a little help in the form of proper diet, hydration, and rest. As for the rest, treatment depends on the type and location of the virus, and may include anti-viral or other drugs.

Virus: A microorganism smaller than a bacteria, which cannot grow or reproduce apart from a living cell. A virus invades living cells and uses their chemical machinery to keep itself alive and to replicate itself. It may reproduce with fidelity or with errors (mutations)-this ability to mutate is responsible for the ability of some viruses to change slightly in each infected person, making treatment more difficult.

Viruses: Small living particles that can infect cells and change how the cells function. Infection with a virus can cause a person to develop symptoms. The disease and symptoms that are caused depend on the type of virus and the type of cells that are infected.

Voice box: The voice box, or larynx, is the portion of the respiratory (breathing) tract containing the vocal cords which produce sound. It is located between the pharynx and the trachea. The larynx, also called the voice box, is a 2-inch-long, tube-shaped organ in the neck.

Windpipe: The trachea, a tube-like portion of the respiratory (breathing) tract that connects the larynx (the voicebox) with the bronchial parts of the lungs.

三、常见问题FAQs

Q:What is croup? What causes it?
A:Croup is an infectious illness of the respiratory system involving the voice box and vocal cords (larynx), windpipe (trachea), and the airways leading to the lungs (bronchial tubes). It is usually caused by many different viruses, including those responsible for the common cold and influenza. Occasionally, it is caused by a bacterial infection. Croup can result in serious breathing difficulties in children. It is more common in babies over 6 months of age and young children, and it occurs more often in boys than girls. It tends to occur more often in the winter months when the weather is colder.

Q:Is croup contagious?
A:Croup is contagious, and it is usually spread by airborne infectious droplets sneezed or coughed into the air by infected children. When infectious droplets are inhaled by a healthy child, symptoms can develop in two to three days. The infection can also be spread by infected mucus deposited on doors, furniture, toys, and other objects. A healthy child can become infected by accidentally touching the infectious mucus and transferring the infection into his/her mouth.

Q:What are the symptoms of croup?
A:Approximately two or three days after being infected, the child notices increasing hoarseness and sore throat. A hacking "croupy" cough develops which sounds like a barking seal and becomes worse at night. Gagging and vomiting can occur with coughing. The cough is usually accompanied by a fever (100.4 to 104 degrees F; 38 to 40 degrees C). The infection causes swelling of the larynx and impairs air passage. A harsh crowing sound ("stridor") during inhaling can be heard when the child's air passage becomes abnormally narrowed. If this should occur, immediate evaluation by a physician is recommended. Even though most children with croup are cared for at home, those with breathing difficulties, high fever, or dehydration may need to be hospitalized. Infants with croup are grumpy, tired, and have poor appetites. The major part of the illness lasts for three days. A wet cough can continue for another two weeks. It is also possible to acquire the infection more than once.

Q:What is the treatment for croup?
A:Croup can be frightening for both children and parents. Therefore, comforting and reassuring the child is the first step. Breathing difficulties can develop and worsen rapidly. Close monitoring of the child is, therefore, important during the early phases of the illness.

To help the child breathe more comfortably, a cold or warm mist vaporizer or humidifier can be placed near the child. To avoid accidental burns, hot water vaporizers should be out of the reach of infants and toddlers. Also effective is having the child breathe in a bathroom steamed up with hot water from the tub or shower. When cough or stridor worsens at night, 10 or 15 minutes sitting or driving in the cool night air can also help the child breathe.

In infants and children, blockage in the nasal passages from mucus can further impair breathing. Careful instillation of saltwater nose drops (¼ teaspoon of table salt in one cup of water) into the nasal openings every few hours, followed by gentle suction using an ear bulb syringe, can be helpful in opening nasal passages.

Decongestants and cough suppressants can be helpful in relieving the congestion and hacking cough. However, the American Academy of Pediatrics recommends avoiding most combination cough and cold medicines especially if they contain dextromethorphan and diphenhydramine (Benadryl). Several studies show that these medicines are ineffective in children. They can potentially cause side effects that could lead to more serious symptoms. Before giving any over-the-counter cold medicine to your child, it is best to consult your health-care professional. Acetaminophen (Liquiprin, Tylenol, Panadol) and ibuprofen (Liquid Motrin, Advil) are also helpful for pain relief and fever. Aspirin is avoided in the treatment of croup and other viral illnesses since aspirin is suspected as being related to the Reye's syndrome in children recovering from influenza virus infection. Reye's syndrome is a serious and mysterious illness, causing kidney, liver, and brain damage, which can lead to the rapid onset of coma. Occasionally, cortisone medications are prescribed for more severe cases of croup. Because croup is usually caused by a virus, antibiotics are reserved for those rare occasions when bacterial infections cause croup or become superimposed on the viral infection.

Even though plenty of fluids are encouraged to avoid dehydration, forcing fluids is generally unnecessary. Popsicles are a popular means of providing fluid. Activity should be restricted to quiet play during the first days of the illness.

Children with croup are most contagious during the first days of fever and illness. Infection spreads easily in a household. Other children in the family will often develop a sore throat or a cough, without necessarily developing the croupy cough and stridor seen in croup. Infants and children may return to school or day care when their temperature is normal and they feel better. A lingering cough can last another two weeks but should not be the reason to keep them at home.

Q:What warning signs should parents look for?
A:The major concern in croup is the accompanying breathing difficulties as the air passages narrow. Close monitoring of the child's breathing is important. The child should be especially observed at night or when napping for breathing difficulty. The doctor should be notified if the child is having breathing difficulty, restlessness, fever over 103 degrees F, or if the parent feels frightened!

The breathing difficulty can progress rapidly, turning into a life-threatening emergency. Some children must be rushed by ambulance into the emergency room because of serious breathing difficulty. Signs of serious trouble include swallowing difficulty, nonstop drooling, bluish discoloration of the skin or lips, sucking in of the chest, and rapid breathing (over 80 breaths per minute).

While most children recover from croup without hospitalization, some children can develop life-threatening breathing difficulties. Therefore, close contact with the doctor during this illness is important.

Q: Can my child get croup more than once?
A: Yes. There are many viruses that can cause croup, including parainfluenza, adenovirus, respiratory syncytial virus (RSV), and influenza (the flu virus), and there are multiple subtypes of each virus, so your child can get croup multiple times as he gets infected with each of these viruses.

However, if your child is getting croup very often, then he may have spasmodic croup (acute spasmodic laryngitis), which can be triggered by viruses, allergies or reflux. Although they may have trouble breathing, children with spasmodic croup often don't have a fever, and get better quickly after several hours.

Q: Is there a cure for croup?
A: No. Like most viral respiratory tract infections in children, there is no cure.

Q: Will antibiotics help children with croup?
A: No. Unless your child has a secondary bacterial infection, such as an ear infection, antibiotics will not be effective against the viruses that cause croup.

Q: How long does croup last?
A: The main symptoms of croup typically last only 2-5 days, but more rarely, they can last several weeks. Once the barking cough and difficulty breathing improve, your child may continue to have cold symptoms for 7-10 days.

Q: How can I prevent my child from getting croup?
A: Although there is no vaccine (except for the flu vaccine) or medication that can prevent your child from getting croup, you can probably decrease the chance that your child will get croup by decreasing his exposure to other people that are sick. Also, strict handwashing and avoiding sharing foods and drinks can help to lessen your child's chances of getting sick.

★ PED的建议

PED提到宝宝出现呼吸困难时,一是将宝宝抱到充满蒸汽的浴室里,洗个热水澡也可以帮助宝宝;二是在宝宝的屋子里使用humidifier或vaporizer;三是宝宝呼吸有困难时,可以试试带宝宝在外面呆几分钟,吸点冷空气会有所帮助。如果宝宝症状不缓解,就要赶紧打电话去医院。

整个过程中,小宝主要是高烧和声音嘶哑(包括异样的咳嗽声),以及后来的呼吸困难,并无明显的感冒症状。其实PED的意见首先还是要给宝宝吃退烧药、室内使用加湿器等措施使宝宝症状缓解,如果不见好转就要及时就医,必要时PED可能会让使用一些扩张气管支气管的药物。

将Wikipedia对Croup的解释附在下面啊:
http://en.wikipedia.org/wiki/Croup

Croup is a group of respiratory diseases that often affects infants and children[1] under age 6. It is characterized by a barking cough; a whistling, obstructive sound (stridor) as the child breathes in; and hoarseness due to obstruction in the region of the larynx. It may be mild, moderate or severe, and severe cases, with breathing difficulty, can be fatal if not treated in a hospital.[2] Another type of croup is known as spasmodic croup. People with spasmodic croup first catch a cold, rarely with fever, and then the croupy cough begins. In some cases spasmodic croup may begin suddenly without any preceding cold symptoms. Unlike viral croup, spasmodic croup usually recurs, can occur in older children, and rarely even in adults. Spasmodic croup is thought to be related to allergies.

1、Presentation

Croup affects 5% of children in the second year of life; the peak incidence is 3 months to 3 years. The group of respiratory diseases consists of spasmodic croup, acute laryngotracheitis, laryngotracheobronchitis (LTB), laryngotracheobronchopneumitis (LTBP), and laryngeal diphtheria. LTB and LTBP, which usually involve a bacterial infection, are usually severe.[2]

The first step in diagnosis is to exclude other acute obstructive illnesses in the region of the larynx, such as epiglottitis, a foreign body, or angioneurotic edema of the epiglottis. Misdiagnosing an obstructive airway disease can be fatal.[2]
[edit] Signs and symptoms

Croup is characterized by a harsh "barking" cough and sneeze, inspiratory stridor (a high-pitched sound heard on inhalation), nausea/vomiting, and fever. Hoarseness is usually present. More severe cases will have respiratory distress.

The "barking" cough (often described as seal-like)[3] of croup is diagnostic. Stridor will be provoked or worsened by agitation or crying. If stridor is also heard when the child is calm, critical narrowing of the airway may be imminent.

In diagnosing croup, it is important for the physician to consider and exclude other causes of shortness of breath and stridor, such as foreign body aspiration and epiglottitis.

On a frontal X-ray of the cervical vertebrae, the steeple sign suggests the diagnosis of croup.

2、Causes

Croup is most often caused by parainfluenza virus, primarily types 1 and 2 (some definitions limit the term "croup" to this pathogen).[4] However, other viral and possibly bacterial infections can also cause it. Approximately 75% of cases are caused by parainfluenza virus. Influenza A and B, Measles, adenovirus and (RSV) respiratory syncytial virus are other viruses that sometimes cause croup. It is most common in the fall and winter but can occur year-round, with a slight predilection for males.

The respiratory distress is caused by the inflammatory response to the infection, rather than by the infection itself. It usually occurs in young children as their airways are smaller and differently shaped than adults', making them more susceptible. There is some element of genetic predisposition as children in some families are more susceptible than others.

An entity known as spasmodic croup also occurs, distinct from the infectious variety, due to laryngeal spasms.

3、Treatment

The treatment of croup depends on the severity of symptoms.

The Alberta Clinical Practice Guideline Working Group has developed guidelines for diagnosing and treating croup, including a scoring system for classifying severity.[5] The severe form (which affected less than 1% of children seen in the emergency department) involves breathing difficulties, indicated by stridor, chest retractions, agitation and distress. Lethargy or decreased level of consciousness is a sign of impending respiratory failure, and requires emergency medical treatment. LTB and LTBP are usually severe, and require treatment in the intensive care unit, with a endotracheal (ET) tube to assist breathing, and antibiotics.[2]

The routinely recommended treatment is with corticosteroids, although corticosteroids suppress the immune system and can predispose the child to infection. There is a debate over how many doses to give, but Cherry in the New England Journal of Medicine recommends one dose, and has observed that children with viral, bacterial and fungal complications have had multiple doses. Epinephrine produces a significant reduction in the croup severity score but the benefit only lasts for 2 hours. Children who have moderate or severe croup with blood oxygen saturation under 92% should receive oxygen.[2]

Since laryngotracheitis is a viral disease (most commonly parainfluenza virus 1) antibiotics have no value.

Croup can be prevented by immunization for influenza and diphtheria. At one time, croup referred to a diphtherial disease, but with vaccination diphtheria is rare.[2]

One of the traditional ways to treat croup is to inhale hot steam. However, studies have found that this is not effective.[2] This was the sole treatment for croup throughout the nineteenth and most of the twentieth century.[citation needed] Hospitals today use a "blowby" apparatus for this purpose. Simpler remedies include taking the child outside in moist night air, or alternatively exposing the child to steam from a hot bath or a humidifier. There is little or no evidence to support their efficacy.

Mild croup with no stridor, or stridor only on agitation, and just a cough may simply be observed, or a dose of inhaled, oral, or injected steroids may be given. When steroids are given, dexamethasone is often used, due to its prolonged physiologic effects.

Moderate to severe croup may require nebulized adrenaline in addition to steroids. Oxygen may be needed if hypoxia develops. Children with moderate or severe croup are typically hospitalized for observation, usually for less than a day. Intubation is rarely needed (less than 1% of hospitalized patients).

4、Prognosis

Viral croup is a self-limited disease, but can very rarely result in death from complete airway obstruction. Symptoms may last up to 7 days, but typically peak around the second day of illness. Rarely, croup can be complicated by, (or confused with) an acute bacterial tracheitis, which is more dangerous.

还有文后参考文献中提到的一本书的下载链接:
Guideline for the Diagnosis and Management of Croup
http://www.topalbertadoctors.org/PDF/complete%20set/Croup/croup_guideline.pdf

看到相应的中文版本,觉得有些生硬,不过对某些生词的翻译可以从此得到参考,链接如下:
http://202.165.105.226/babelfish/translate_url_content?intl=cn&lp=en_zh&trurl=http%3a%2f%2fen.wikipedia.org%2fwiki%2fCroup

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