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6257rv7 发表于 2024-6-22 13:50:46

血液系统疾患平常症状--贫血

    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">贫血</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">贫血<span style="color: black;">指的是</span>外周血单位容积内血红蛋白（Hb）浓度、红细胞（RBC）计数和（或）血细胞比容（HCT）<span style="color: black;">小于</span>相同年龄、性别和地区的正常标准。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">通常</span>认为在平原地区，成年男性Hb＜120g/L、RBC＜4.5×10^12/L及（或）HCT＜0.42；女性Hb＜110g/L、RBC＜4.0×10^12/L及（或）HCT＜0.37；孕妇Hb＜100g/L、RBC＜3.5×10^12/L及（或）HCT＜0.3，就可诊断为贫血。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">归类</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">基于不同的临床特点，贫血有不同的临床<span style="color: black;">归类</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">按<span style="color: black;">贫血<span style="color: black;">发展</span>速度</span>分急、慢性贫血；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">按<span style="color: black;">贫血的病因及其发病机制</span>分红细胞生成减少、红细胞破坏<span style="color: black;">太多</span>和失血性贫血（见表一）；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">按<span style="color: black;">红细胞形态</span>分大细胞性贫血、正常细胞性贫血和小细胞性贫血（见表二）。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">贫血<span style="color: black;">平常</span>病因及发病机制（表一）</strong></p>&nbsp;<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">归类</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">病因及发病</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">机制</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">平常</span><span style="color: black;">疾患</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">红细胞</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">生成减少</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.造血干祖细胞<span style="color: black;">反常</span>；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2.造血调节<span style="color: black;">反常</span>；</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3.造血原料不足或利用<span style="color: black;">阻碍</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.再生<span style="color: black;">阻碍</span>性贫血、白血病、淋巴瘤、骨髓瘤；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.慢性病性贫血；</p>

    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3.缺铁性贫血、巨幼细胞贫血。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">红细胞</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">破坏<span style="color: black;">太多</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.红细胞内在缺陷</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.红细胞外在缺陷</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.遗传性球形细胞<span style="color: black;">增加</span>症、地中海贫血等；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.免疫性溶血性贫血；理化性<span style="color: black;">导致</span>的溶血性贫血等。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">失血</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">急性、慢性失血性贫血</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">贫血的细胞形态<span style="color: black;">归类</span>（表二）</strong></p>&nbsp;<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">归类</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">MCV(fl)</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">MCHC(%)</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">平常</span><span style="color: black;">疾患</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">大细胞性</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">贫血</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">＞100</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">32~35</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">巨幼细胞<span style="color: black;">贫血</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">正细胞性</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">贫血</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">80~100</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">32~35</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">再生<span style="color: black;">阻碍</span>性贫血、溶血性贫血等</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">小细胞性</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">贫血</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">＜80</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">＜32</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">缺铁性贫血</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">贫血的特点</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">疲乏、困倦、软弱<span style="color: black;">没</span>力及易疲劳等，常为贫血最<span style="color: black;">平常</span>和最早<span style="color: black;">显现</span>的症状；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">皮肤黏膜表现：口唇、指甲及面色苍白是贫血最典型的体征；缺铁性贫血病人有反甲（匙状甲）；再生<span style="color: black;">阻碍</span>性贫血、白血病等全身皮肤黏膜有散在或密集的瘀点、紫癜、瘀斑；弥散性血管内凝血，有大片瘀斑；溶血性贫血皮肤有黄染。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">神经系统表现：<span style="color: black;">头昏</span>、头痛、耳鸣、眼花、失眠、梦多、记忆力下降、<span style="color: black;">重视</span>力不集中及异食癖（见于缺铁性贫血）等症状。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">呼气</span>、循环系统表现：病人可有心悸、气促、活动后加剧，<span style="color: black;">乃至</span>心前区<span style="color: black;">病痛</span>，心率与<span style="color: black;">心率</span>变化，心脏杂音及心衰等，</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">其他系统表现：食欲减低、恶心、腹胀、口炎等；女性贫血病人<span style="color: black;">大姨妈</span>失调，如闭经、<span style="color: black;">大姨妈</span>过少或<span style="color: black;">太多</span>；肝、脾、淋巴结肿大等。</p>

    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">贫血严重程度的划分标准</strong></p>&nbsp;<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">项目</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">轻度贫血</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中度贫血</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">重度及</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">极重度贫血</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">血红蛋白</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">男＜120g/L</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">女＜110g/L</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">＜90g/L</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">重度＜60g/L</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">极重度＜30g/L</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">皮肤粘膜</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">稍苍白</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">苍白</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">苍白</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">循环系统</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">可<span style="color: black;">没</span><span style="color: black;">显著</span>症状</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">活动后心悸</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">心绞痛、<span style="color: black;">贫血性心脏病、</span><span style="color: black;">心脏扩大</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">呼气</span>系统</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">可<span style="color: black;">没</span><span style="color: black;">显著</span>症状</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">活动后气促、胸闷</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">呼气</span>困难</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">消化系统</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">食欲下降</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">恶心、腹胀、腹泻、便秘</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">可<span style="color: black;">导致</span>肝肿大</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">神经肌肉系统</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">乏力倦怠</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">头昏</span>、耳鸣、记忆力下降</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">晕厥、神志不清、感觉<span style="color: black;">阻碍</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">休憩</span>与活动</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">安排合适的活动量，逐步<span style="color: black;">加强</span>活动耐受水平。轻、中度贫血或贫血<span style="color: black;">出现</span>速度缓慢病人，活动量以不感疲劳、不加重症状为度；当脉搏≥100次/min，应停止活动，严重贫血或<span style="color: black;">出现</span>贫血速度快的病人，<span style="color: black;">必须</span>多卧床<span style="color: black;">休憩</span>，待病情好转后<span style="color: black;">逐步</span><span style="color: black;">增多</span>活动量。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">对症护理</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">膳食</span>：<span style="color: black;">按照</span>不同的<span style="color: black;">原由</span><span style="color: black;">导致</span>贫血，<span style="color: black;">选取</span>合适<span style="color: black;">膳食</span>，如缺铁性贫血，应多食含铁丰富的<span style="color: black;">食品</span>；营养性巨幼细胞贫血应多食<span style="color: black;">饱含</span>叶酸与VitB12食品；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">严重贫血者应给予氧气吸入；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">重度贫血者，<span style="color: black;">必须</span>给予<span style="color: black;">成份</span>血输注。</p><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">扫码关注<span style="color: black;">咱们</span></strong></span></p>

nqkk58 发表于 2024-10-25 14:11:36

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