医学资料肺炎球菌肺炎课件

重庆医科大学附一院肺科重庆医科大学附一院肺科 陈陈 虹虹 Pneumococcal pneumonia Definition 肺炎球菌肺炎球菌 PneumococcusPneumococcus 肺肺大叶性炎变大叶性炎变 肺炎链球菌肺炎链球菌 streptococcus streptococcus pneumoniaepneumoniae 院外感染最常见的肺炎院外感染最常见的肺炎 多见于青壮年多见于青壮年 Inflammation vessel congestion serum RBC /WBC fibrin exudationabsorption (血管充血) (渗出 实变) (吸收) （荚膜致病） Cohn 支气管充气征 Pathology Congestion(充血) Red Hepatization(红色肝样变) Gray Hepatization(灰色肝样变) Resolution (消散) acute onset of II. X-ray findings complications Pluaritis（胸膜炎） Shock : BP, cold extremities, sweat, cyanosis (紫绀), tachycardia(心动过速 ) Toxic myocarditis（中毒性心肌炎） II. X-ray findings Left lower lobe pneumonia Diagnosis Typical features Consolidation signs or rales WBC X-ray findings Sputum and blood culture(+) Differential diagnosis Caseous pneumonia(干酪性肺炎) Obstructive pneumonia（阻塞性肺炎） III. Pneumonia caused by other micro-organisms I. Caseous pneumonia(干酪性肺炎) II. (Tuberculosis) III. Low fever Night sweat(盗汗) Lack of chill Insensitive to antibiotics Tubercle bacilli 结核菌素试验（+） II. Obstructive pneumonia Foreign body / Neoplasm slow absorption recurrent (复发) fibrobrochoscopy(纤维支气管镜检查) III. Pneumonia caused by other microorganisms staphylococcus staphylococcus pneumonia ( 葡萄球菌肺炎) klebsiella klebsiella pneumonia ( 克雷伯杆菌肺炎) legionella legionaires disease （军团菌肺炎） mycoplasma mycoplasmal pneumonia （支原体肺炎） Treatment Pinicillin(青霉素) Allergic or resistant to Pinicillin： Erythromycin(红霉素) or Vancomycin(万古霉素) Qinolones（喹诺酮类）or Cephalothins(头孢菌素) I. Antibiotics Duration: 57 days or 3 days after defeverness(退热) Treatment Duration: 57 days or 3 days after defeverness(退 热) Treatment II. Support therapy Rest , water and nutrition food Alleviation(pain/fever/cough/sputu m) Oxygen Anti-shock therapy Other complications adequate infusion vasoactive agonist(血管活性药物) antibiotics corticosteroid (糖皮质激素):抗过敏，抗休克，抗毒抗过敏，抗休克，抗毒 纠正水、电解质及酸碱平衡紊乱纠正水、电解质及酸碱平衡紊乱 red lips, warm extremty