【哮吼】

為了說明接下的故事，今天先做哮吼的介紹，之後看故事會更有感覺......


｜病因｜


哮吼 (croup) ，全名是「喉頭氣管支氣管炎 (laryngotracheal bronchitis)」， 是常見的幼童上呼吸道感染疾病，副流感第一和第三型病毒 (parainfluenza virus types 1 and 3) 是主因，其餘的感染源是 A 型流感病毒 (influenza A)、呼吸道融合病毒 (RSV：respiratory syncytial virus) 、腺病毒 (adenovirus)。


｜症狀和診斷｜


好發於 2 歲以下的幼童，病毒感染造成的發炎反應會引發聲門下呼吸道水腫甚至阻塞，症狀從輕微到嚴重都有，較為嚴重的病人會有明顯的吸氣喘鳴聲 (inspiratory stridor)，聲音沙啞 (hoarseness) 和狗吠聲咳嗽 (barking cough) 。在最嚴重的病人身上會發現呼吸時有胸骨上凹陷 (suprasternal retraction) 和肋骨間凹陷 (intercostal retraction)。此外，大部分哮吼病人在出現上述典型症狀前會出現低溫發燒、咳嗽、流鼻水等一般感冒症狀。


診斷主要依靠病史和醫師的理學檢查，頸部 X 光可能出現「尖塔狀 ( steeple sign)」，可以幫忙診斷，但不能是唯一的診斷依據。通常不會流口水 (drooling)，若出現，要和會厭炎 (epiglottitis) 做鑑別診斷。


｜治療方式｜


症狀輕微的哮吼病人，必須好好補充水分，並需要吸潮濕的空氣潤滑呼吸道和讓痰液不要太黏稠。


病人休息時喘鳴聲或呼吸時胸骨凹陷，是較為嚴重的哮吼病人，吸入「氣化腎上腺素」收縮黏膜血管，幫助呼吸道黏膜消腫緩解症狀，但治療後建議在醫院觀察 2 至 6 小時，觀察可能發生的「症狀反彈現象」。注射或是口服類固醇是安全有效的輔助治療，可以降低需要插管的機率。


嚴重的哮吼，通常需要住院觀察。萬一病人嚴重到需要插管急救，因為呼吸道水腫狹窄，氣管內管的大小建議選擇比正常大小「小半號」。反覆哮吼或插管後困難拔管，建議做「喉鏡和支氣管鏡」排除其他病因。


｜其他資料｜


https://www.facebook.com/notes/dr-e-%E5%B0%8F%E5%85%92%E6%80%A5%E8%A8%BA%E5%AE%A4%E6%97%A5%E8%AA%8C/%E5%AE%B9%E6%98%93%E5%92%8C%E6%B0%A3%E5%96%98%E6%B7%B7%E6%B7%86%E7%9A%84%E7%96%BE%E7%97%85-%E5%93%AE%E5%90%BC-croup/196175780527906/


部落格文章網址：
https://ethan-hsieh.blogspot.com/2019/04/croup.html

認識兒童異常呼吸音

1. Stridor(喘鳴): 高音調聲音，通常是上呼吸道阻塞所發出之聲音，在吸氣期時可聽見。另外剛拔完管的病患也要注意是否有stridor。

2. Croup (哮吼): 哮吼是一種常見兒童上呼吸道阻塞疾病，引起幼兒聲音沙啞(hoarse voice ) 、吠狀咳嗽(barking cough) 、吸氣喘鳴聲 (inspiratory stridor ) 、及呼吸窘迫症狀。

3. Wheezing(喘息)(連續音): 一種呼吸時可聽見之高音調的口哨音。主要是當氣流經過狹窄的呼吸道造成之，常見原因是呼吸道發炎水腫，支氣管狹窄，或是外物吸入。

4. Grunting（呻吟聲）則表示嬰兒有可能有呼吸窘迫

5. Rales(crackles)(濕囉音): 一種水泡破裂音(bubbling)，可在小呼吸道(肺泡區)可聽到，主要是因肺泡充滿水或痰液，常見疾病如肺水腫或肺炎。

今天想跟大家介紹兒科門診常見的疾病__哮吼 ( croup )。

哮吼 (Croup) 是一種兒童常見的上呼吸道阻塞性疾病，典型的臨床表現是聲音沙啞 (hoarse voice)、犬吠樣咳嗽 (barking cough)、吸氣性喘鳴(inspiratory strider )及呼吸窘迫症狀。

許多家長試圖告訴我孩子的咳嗽有多奇怪，卻常常不知道如何形容。我只能猜測地詢問是不是像狗在吠一樣的乾咳？ 常常還是雞同鴨講，一直到小孩因為檢查時害怕哭泣而倒吸一口氣時聽到吸氣喘鳴聲才確定診斷。

以下影片請大家仔細聽聽看甚麼叫狗吠性咳嗽？ 什麼是哭泣時倒吸一口氣時的狹窄喘鳴聲。

https://www.youtube.com/watch?v=MPgCxPyeTkk

治療方式主要是 :
1、 保持安靜，給氧： 血氧飽和度在92%以下，或嚴重患者需住院治療觀察。

2、 冷濕氧氣罩治療：可降低黏膜炎症，減少呼吸道分泌物和及其黏稠度。

3、 腎上腺素吸入治療 ：可減少吸氣喘嗚聲和過度使用肋間肌呼吸，用於嚴重患者，在用藥後10~30min後可見效果，但只能維持2hrs。

4、 類固醇治療：使用肌肉注射給予類固醇或口服類固醇幾天，可降低喉頭黏膜水腫現象。

5、 氣管插管：對於嚴重呼吸道阻塞患者，氣管插管可解除嚴重喉頭水腫情況，以維持呼吸道暢通

6、 抗生素治療：若是合併細菌感染時必要性使用

前回はビックスクーターで、登場、
今回からXXで、
タイヤ交換のためにタイヤ積んでます、
CBR1100XX SuperBlackbird (Shebearl Dableccssuparbraccbard) is a motorcycle of four strokes and displacements 1,137cc that Honda Motor Co., Ltd. was manufacturing. Both domestic sales and export have ended now though it was treated as a flagship in the CBR series. Outline

Honda Motor Co., Ltd. appears in restyling from CBR1000F in 1996. In that case, a pet name "Super-blackbird" was given in the meaning said that was connected to "Blackbird" that was the pet name of surveillance plane "SR-71" of an American air force that was the aircraft at the velocity of the world, and it exceeded. Therefore, the cooperation of the U.S. Air Force is received in the pop promo of this car, and CBR1100XX and SR-71 accomplish competing in the air base.

As a concept

1. Comfortable livability in super-high-speed region
2. Overwhelming absolute performance
3. The middle class level is handled though it is a large displacement car.

It was a car of mass-producing on the market of the world best performance
where was had both.

Four 1137cc water-cooled series cylinder engine of the new design that adopts two axis balancer achieves the highest 164ps in the world at that time. Maximum speed is one that doesn't come up slightly by actual measurement at 300 km/h though excelled from ZZR1100 of Kawasaki who was the rival at the development this time to a high-speed performance.

It comes to transfer the seat at the velocity of the world from Kawasaki by the appearance of ninja ZX-12R the GSX1300R falcon's appearing from the sea bass in 1999, and continuously while leaving the name of the car of mass-producing on the market at the velocity of the world wanted in 2000 at the sale this time. The self-imposed restraint of which 300 km/h is a maximum speed upper bound of the motorcycle in 2001 has started, a big restyling is not done to the production stoppage in 2007, and the character as Haispedotsarar has become strong. Moreover, it is used as a development vehicle of VCM (Variable Cylinder Management: cylinder stop system) that is next generation's fuel fuel cost improvement technology, and 2 in the magazine medium from which impression is open to the public.

It is a motorcycle that Isao Yamanaka who had invented a lot of great cars as an engineer of HONDA developed at the end, and 3 said, "It is a compilation to invest everything current, and the happiest motorcycle".
The headlight of the top and bottom two step is adopted for the full caul body that thoroughly pursued aerodynamic. The synchronization brake is equipped normally before and after being called D-CBS. For the tone of red to lighten in 1998, and to prevent over cool in the cold district, the by-pass of Rageetar was added. Even the model is a carburetor specification in 1998, and it is a model to whom the chalk is only attached in CBR1100XX. The accelerating force and the response are sharper than the injection model since the second generation though a maximum speed region doesn't change. In the founder blackbird, as a motorcycle of the carburetor specification, on the market, acceleration and maximum speed are the fastest models. Low-speed..gear..Red Zone..blow..at the same time as..accelerating force..further..increase..power..band..use regularly..user..partially..core..acceleration..mania..rocket engine..missile..acceleration..criticize.Not a rapid response like the carburetor specification but the getting on taste has smoothed very much though this characteristic has been succeeded since the second generation made FI.

The direct air intake (ram air) has not taken side with the founder. The inspiratory port where the wire net under the headlight attached sends oil cooler the running style though it often makes a mistake. Because the cold wind doesn't hit oil cooler as it is because oil cooler has adhered behind the radiator, the inflow road of air is installed in this manner. (From the motorcycle technical journal 'Young machine' at the sale this time. )

前回はビックスクーターで、登場、
今回からXXで、
タイヤ交換のためにタイヤ積んでます、
CBR1100XX SuperBlackbird (Shebearl Dableccssuparbraccbard) is a motorcycle of four strokes and displacements 1,137cc that Honda Motor Co., Ltd. was manufacturing. Both domestic sales and export have ended now though it was treated as a flagship in the CBR series. Outline

Honda Motor Co., Ltd. appears in restyling from CBR1000F in 1996. In that case, a pet name "Super-blackbird" was given in the meaning said that was connected to "Blackbird" that was the pet name of surveillance plane "SR-71" of an American air force that was the aircraft at the velocity of the world, and it exceeded. Therefore, the cooperation of the U.S. Air Force is received in the pop promo of this car, and CBR1100XX and SR-71 accomplish competing in the air base.

As a concept

1. Comfortable livability in super-high-speed region
2. Overwhelming absolute performance
3. The middle class level is handled though it is a large displacement car.

It was a car of mass-producing on the market of the world best performance
where was had both.

Four 1137cc water-cooled series cylinder engine of the new design that adopts two axis balancer achieves the highest 164ps in the world at that time. Maximum speed is one that doesn't come up slightly by actual measurement at 300 km/h though excelled from ZZR1100 of Kawasaki who was the rival at the development this time to a high-speed performance.

It comes to transfer the seat at the velocity of the world from Kawasaki by the appearance of ninja ZX-12R the GSX1300R falcon's appearing from the sea bass in 1999, and continuously while leaving the name of the car of mass-producing on the market at the velocity of the world wanted in 2000 at the sale this time. The self-imposed restraint of which 300 km/h is a maximum speed upper bound of the motorcycle in 2001 has started, a big restyling is not done to the production stoppage in 2007, and the character as Haispedotsarar has become strong. Moreover, it is used as a development vehicle of VCM (Variable Cylinder Management: cylinder stop system) that is next generation's fuel fuel cost improvement technology, and 2 in the magazine medium from which impression is open to the public.

It is a motorcycle that Isao Yamanaka who had invented a lot of great cars as an engineer of HONDA developed at the end, and 3 said, "It is a compilation to invest everything current, and the happiest motorcycle".
The headlight of the top and bottom two step is adopted for the full caul body that thoroughly pursued aerodynamic. The synchronization brake is equipped normally before and after being called D-CBS. For the tone of red to lighten in 1998, and to prevent over cool in the cold district, the by-pass of Rageetar was added. Even the model is a carburetor specification in 1998, and it is a model to whom the chalk is only attached in CBR1100XX. The accelerating force and the response are sharper than the injection model since the second generation though a maximum speed region doesn't change. In the founder blackbird, as a motorcycle of the carburetor specification, on the market, acceleration and maximum speed are the fastest models. Low-speed..gear..Red Zone..blow..at the same time as..accelerating force..further..increase..power..band..use regularly..user..partially..core..acceleration..mania..rocket engine..missile..acceleration..criticize.Not a rapid response like the carburetor specification but the getting on taste has smoothed very much though this characteristic has been succeeded since the second generation made FI.

The direct air intake (ram air) has not taken side with the founder. The inspiratory port where the wire net under the headlight attached sends oil cooler the running style though it often makes a mistake. Because the cold wind doesn't hit oil cooler as it is because oil cooler has adhered behind the radiator, the inflow road of air is installed in this manner. (From the motorcycle technical journal 'Young machine' at the sale this time. )

CBR1100XX SuperBlackbird (Shebearl Dableccssuparbraccbard) is a motorcycle of four strokes and displacements 1,137cc that Honda Motor Co., Ltd. was manufacturing. Both domestic sales and export have ended now though it was treated as a flagship in the CBR series. Outline

Honda Motor Co., Ltd. appears in restyling from CBR1000F in 1996. In that case, a pet name "Super-blackbird" was given in the meaning said that was connected to "Blackbird" that was the pet name of surveillance plane "SR-71" of an American air force that was the aircraft at the velocity of the world, and it exceeded. Therefore, the cooperation of the U.S. Air Force is received in the pop promo of this car, and CBR1100XX and SR-71 accomplish competing in the air base.

As a concept

1. Comfortable livability in super-high-speed region
2. Overwhelming absolute performance
3. The middle class level is handled though it is a large displacement car.

It was a car of mass-producing on the market of the world best performance
where was had both.

Four 1137cc water-cooled series cylinder engine of the new design that adopts two axis balancer achieves the highest 164ps in the world at that time. Maximum speed is one that doesn't come up slightly by actual measurement at 300 km/h though excelled from ZZR1100 of Kawasaki who was the rival at the development this time to a high-speed performance.

It comes to transfer the seat at the velocity of the world from Kawasaki by the appearance of ninja ZX-12R the GSX1300R falcon's appearing from the sea bass in 1999, and continuously while leaving the name of the car of mass-producing on the market at the velocity of the world wanted in 2000 at the sale this time. The self-imposed restraint of which 300 km/h is a maximum speed upper bound of the motorcycle in 2001 has started, a big restyling is not done to the production stoppage in 2007, and the character as Haispedotsarar has become strong. Moreover, it is used as a development vehicle of VCM (Variable Cylinder Management: cylinder stop system) that is next generation's fuel fuel cost improvement technology, and 2 in the magazine medium from which impression is open to the public.

It is a motorcycle that Isao Yamanaka who had invented a lot of great cars as an engineer of HONDA developed at the end, and 3 said, "It is a compilation to invest everything current, and the happiest motorcycle".
The headlight of the top and bottom two step is adopted for the full caul body that thoroughly pursued aerodynamic. The synchronization brake is equipped normally before and after being called D-CBS. For the tone of red to lighten in 1998, and to prevent over cool in the cold district, the by-pass of Rageetar was added. Even the model is a carburetor specification in 1998, and it is a model to whom the chalk is only attached in CBR1100XX. The accelerating force and the response are sharper than the injection model since the second generation though a maximum speed region doesn't change. In the founder blackbird, as a motorcycle of the carburetor specification, on the market, acceleration and maximum speed are the fastest models. Low-speed..gear..Red Zone..blow..at the same time as..accelerating force..further..increase..power..band..use regularly..user..partially..core..acceleration..mania..rocket engine..missile..acceleration..criticize.Not a rapid response like the carburetor specification but the getting on taste has smoothed very much though this characteristic has been succeeded since the second generation made FI.

The direct air intake (ram air) has not taken side with the founder. The inspiratory port where the wire net under the headlight attached sends oil cooler the running style though it often makes a mistake. Because the cold wind doesn't hit oil cooler as it is because oil cooler has adhered behind the radiator, the inflow road of air is installed in this manner. (From the motorcycle technical journal 'Young machine' at the sale this time. )