中国0至5岁儿童病因不明的急性发热诊断处理指南(标准版)

:167325501(2008)062044920905()121,201102;2,610041,E2mail:[e-mail];,E2mail:[e-mail]11.105(38,1)1.21.3,,,,:,(3),100,8611,8,;3,22,1.4,,:ChiCTR2GP2000000011.5,,1.61.6.1[1,2]:OVID;Medline(1966120088);EMBASE(1980120088);Cochrane(2004120088);NationalGuidelineClearinghouse;SunSearchTRIP;2;;(1997120088)1.6.222412,652,(1),134,2,31.6.31[3]1.6.42007411,05()1aMetaRCTRCTbMetaRCTRCTcMetaRCTRCTa;,,b,,c,,(),9442008113620078152,,,(),20079173(),()200712222320072,,,2200852931,,(),2008754,,()20087158151,200892,,()1.6.5,2,[4]15,[5],,,,,[612]2.12.1.1()1d,3805()()2.1.2[1317](),[18],2.1.3[19,20](a);15[13,17,2132]();,[3357](a,b)2.1.4[5869](a)338639,[70](b)2.1.5[64,65,68,71,72](b)2.1.60.5[14,26](),0.741.34[14](b),1.2[73]()2.25,,,,::2cm[58,59,7477](a)6[60,61,7779](a,b)2.2.1,3s,,[77,8084]();()2.2.2(),,85%[85,86](a)2.2.3(YOS)(YIOS)(2),33(a),,YOS86%89%93%,85%97%96%98%33YOS6,97.4%YOS101515,2.7%26%92.3%[77,79,80,8792]2.2.4(3),3h();1h();4h()2.2.54054ChinJEvidBasedPediatrNovember2008,Vol3,No62(YIOS)(1)(3)(5),,,,(,)2(YOS)2(YOS),2(YOS):()()(),:61250min-1,1240min-195%,:60min-1,3s5d2cmCRP(1)X(39+WBC20109L-1)CRPX4h3h1h4[75,86,93,94]a(OR=5.1)(OR=16.7),2mm(OR=7,OR=37.2),3s(OR=29.4),(OR=6.9)[9597],6:55%,,,17%,12:25%,[98]89%,61%,52%[99104]a(RR=7.73):05:60min-1,12:50min-1,12:40min-1,(RR=8.38)(RR=4.38)(12:OR=2.2)(RR=4.38)95%(RR=3.5)[105]3,31()[106]b,[105]a,[107,108]5d4:()(1.5cm)154200811362.2.6WBCWBC5109L-1(1517.1)109L-1,20%76%,58%100%,RR=1.55.56[91,109120]()[115117],9.6109L-110.6109L-1,50%71%,76%83%,RR=1.56.4(),CRP[112120]1CRP40mgL-195%86%,RR=31.5();180%59%,RR=4.0CRP[122]:CRP40mgL-110%,CRP100mgL-186%(PCT)3,PCTCRPWBC,12hPCTCRP[111113](a)PCT,2gL-1[114](a)CRPPCT,,,3d()2.2.7[91,109,121](a)1313WBC5109L-115109L-12.33[122](a)CRP;;X;2.4,38.5(),()2.4.13:1015mgkg-1(600mg),,4h,4(2.4gd-1)[123](a)3d[122](b)510mgkg-1(400mgd-1),,6h1,4[124,125](a)2.4.2,,46h,0.5h[123,125127](a)2.4.33,RCT,()RCT[128],75,(3d);RCT,[129,130]2.4.4[131,132](a)2.4.5[133137]2.4.62(1)(3d),2mgkg-1,5mgkg-110mgkg-1,17/10(95%CI:3.549/100000);,A(b)[138]2.4.7,6200mgkg-1(a)[139]150mgkg-1d-12d,100mgkg-1d-13d(a),(a)[140]2.4.8[138](b),[141](a)2.4.9,:10mgkg-1,4h15mgkg-1[126](a);12.5mgkg-1,4h5mgkg-1,4h,3d[142](b)2.4.10,[143]()2.4.11(),;,;,Reye[144]()2.4.12[145,146]:1.52.5mgkg-1,13,5d()[147],(b)22140,(10d)[148](c)2.4.13,()2.4.14(1)()[149](b)254ChinJEvidBasedPediatrNovember2008,Vol3,No6(2),,[149](b)(3)(a),;,(b);(a)[1]WilczynskiNL,HaynesRB,HedgesTeam.DevelopingoptimalsearchstrategiesfordetectingclinicallysoundprognosticstudiesinMEDLINE:ananalyticsurvey.BMCMed,2004,2:23[2]DrummondMF,SculpherM,TorranceGW,OBrienBJ,StoddartGL.MethodsfortheEconomicEvaluationofHealthCareProgrammes.3rded.OxfordUniversityPress,2005[3]NationalInstituteforClinicalExcellence.GuidelineDevelopmentMethods:InformationforNationalCollaboratingCentresandGuidelineDevelopers.London:NationalInstituteforClinicalEvidence,2005[4]BaraffLJ.Managementoffeverwithoutsourceininfantsandchildren.AnnEmergMed,2000,36(6):6022614[5]IshimineP.Feverwithoutsourceinchildren0to36monthsofage.PediatrClinNorthAm,2006,53(2):1672194[6]JaeschkeR,GuyattG,SackettDL.Usersguidestothemedicalliterature.III.Howtouseanarticleaboutadiagnostictest.A.Aretheresultsofthestudyvalid?Evidence2BasedMedicineWorkingGroup.JAMA,1994,271(5):3892391[7]OxmanAD,SackettDL,GuyattGH.Usersguidestothemedicalliterature.I.Howtogetstarted.TheEvidence2BasedMedicineWorkingGroup.JAMA,1993,270(17):209322095[8]GuyattGH,SackettDL,CookDJ.Usersguidestothemedicalliterature.II.Howtouseanarticleabouttherapyorprevention.A.Aretheresultsofthestudyvalid?Evidence2BasedMedicineWorkingGroup.JAMA,1993,270(21):259822601[9]GuyattGH,SackettDL,CookDJ.Usersguidestothemedicalliterature.II.Howtouseanarticleabouttherapyorprevention.B.Whatweretheresultsandwilltheyhelpmeincaringformypatients?Evidence2BasedMedicineWorkingGroup.JAMA,1994,271(1):59263[10]SackettDL,StrausSE,RichardsonWS,RosenbergW,HaynesRB.Evidence2BasedMedicine.HowtoPracticeandTeachEBM.3rded.Edinburgh:ChurchillLivingstone,2005[11]JaeschkeR,GuyattGH,SackettDL.Usersguidestothemedicalliterature.III.Howtouseanarticleaboutadiagnostictest.B.Whataretheresultsandwilltheyhelpmeincaringformypatients?TheEvidence2BasedMedicineWorkingGroup.JAMA,1994,271(9):7032707[12]ScottishIntercollegiateGuidelinesNetwork.SIGN502AGuidelinedevelopershandbook.No.50.Edinburgh:ScottishIntercollegiateGuidelineNetwork,2001[13]CraigJV,LancasterGA,WilliamsonPR,etal.Temperaturemeasuredattheaxillacomparedwithrectuminchildrenandyoungpeople:Systematicreview.BMJ,2000,320(7243):117421178[14]CraigJV,LancasterGA,TaylorS,etal.Infraredearthermometrycomparedwithrectalthermometryinchildren:Asystematicreview.Lancet,2002,360(9333):6032609[15]El2RadhiAS,BarryW.Thermometryinpaediatricpractice.ArchDisChild,2006,91(4):3512356[16]PickersgillJ,FowlerH,BoothmanJ,etal.Temperaturetaking:childrenspreferences.PaediatrNurs,2003,15(2):22225[17]BeckstrandRL,WilshawR,MoranS,etal.Supralingua