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小兒肺結核如何預防

出處：媽媽育兒網(wǎng)日期：2015-10-22 13:19:05編輯：Chen

據(jù)統(tǒng)計，一個開放性肺結核患者每年可傳染20—30個健康人，我國全年將會有2000萬—4000萬健康人感染結核菌。

現(xiàn)一致認為，結核病的傳染源，主要是指涂片陽性的肺結核病人。痰涂片陰性、培養(yǎng)陽性的病人傳染性較小。所以大量排菌的肺結核病人在大聲說話、咳嗽、咯痰、打噴嚏時，通過飛沫（直接傳染）或落在地面帶菌排泄物，隨塵埃吸入（間接傳染）傳染給他人。

小兒肺結核的預防

1.加強初級保健 要依靠城鄉(xiāng)基層醫(yī)療網(wǎng)的力量，充分發(fā)揮各級醫(yī)生包括空村醫(yī)生的作用。臨床證明，結核的發(fā)病與小兒健康狀況和生活環(huán)境有密切關系，應注意合理的營養(yǎng)、良好的衛(wèi)生習慣，以及對麻疹、百日咳的預防等措施。

2.發(fā)現(xiàn)病例及早防治 早期發(fā)現(xiàn)是患兒早期治療的先決條件。定期作體格檢查以早期發(fā)現(xiàn)疾病。接觸活動性肺結核患者的小兒，其感染率、發(fā)病率與患病率都較一般小鍺顯著為高。

3.進行宣教，重視隔離 進行廣泛衛(wèi)生宣教工作，使群眾對結核病有正確的認識，作好結核病人家庭的消毒隔離工作，保護小兒使不受傳染。此外注意其他預防措施，如乳牛的管理、乳品消毒、婚前檢查、孕期檢查、宣傳不隨地吐痰等。

卡介苗（BCG）接種

（1）皮內(nèi)法：結核菌素試驗陰性者用0.1mlBCG（內(nèi)含菌量0.05～0.075mg）在左臂三角肌下端外緣皮內(nèi)注射（切忌皮下注射）。2個月內(nèi)的新生兒無結核病接觸史者可免作結素試驗。接種后6周內(nèi)應避免小兒與結核病患者接觸，以防在未產(chǎn)生免疫力前遭受傳染的危險。

接種BCG后3～4周，接種處可發(fā)生堅實的紅色丘疹，逐漸形成小膿皰或小潰瘍，逐漸干枯結痂，至1～2月后可愈合。反應較重的丘疹中心可有壞死局部淋巴結可發(fā)生寒性膿腫，破潰后形成較深潰瘍，愈合較慢。

（2）皮上劃痕法：用每1ml內(nèi)含菌量50～75mg的BCG一滴滴在左臂三角肌外緣下端，在皮上劃一個各第1～1.5cm的“井”字劃痕，以不出血而呈紅痕為宜，劃后將菌苗在劃痕處輕輕涂勻。待菌苗干后（10分鐘左右）再穿衣袖，此法操作簡便，易于普及推廣，局部反應輕，淋巴結反應較少。

（3）口服法：只限于出生后2個月以內(nèi)的嬰兒。卡氏最初發(fā)明BCG，即采用新生兒口服法，因為新生兒腸粘膜組織尚未完全發(fā)育，BCG容易通過而進入腸系膜淋巴系統(tǒng)而發(fā)生免疫力。BCG口服法現(xiàn)已很少應用。

以上三種方法以皮內(nèi)法和口服法陽轉(zhuǎn)率較高。皮骨法陽性持續(xù)時間較皮上劃痕法為長。除2個月以內(nèi)的嬰兒外，接種前應先做皮內(nèi)結素試驗（一般用5個結核菌素單位）。

BCG接種的禁忌證：陽性結核菌素反應、發(fā)熱、腹瀉、注射局部有濕疹或有全身性皮膚病，急性傳染病后1個月內(nèi)，有過敏性疾患，患嚴重肝、腎、心臟病及早產(chǎn)兒、低體重新生兒及產(chǎn)傷兒等均不宜接種。免疫缺陷患兒可并發(fā)致死性播散性卡介苗病，尤應禁種。

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