（参考课件）呼吸治疗师(精).ppt

RespiratoryTractDisease,ZhangJinDivisionofRespiratoryDiseaseChildrensHospitalofFudanUniversity,1,DividedfromringgristleUpperrespiratorytractnose,nasalsinus,pharynx,epiglottis,larynx,OVERVIEW,2,OVERVIEW,Lowerrespiratorytract,tracheabronchusbronchioleterminalbronchiolerespiratorybronchiolealveolarductsalveolarsacalveolus,气管,支气管,软骨,终末细支气管,肺泡管,肺泡囊,腺泡,3,Thetotalnumberofalveoliincreasesfrom24millionto250millionby4yearsofage,andmostinthefirst2yearsAfter4year,growthisprimarilybyincreaseinsizeofindividualalveoli,Developmentofpulmonarystructure,4,Severalmechanicalproperties-increasedriskofinfantrespiratorycompromise,Smallerandlessfirminairwaymorelikelyobstructioninresponsetoinfectioninflammation,foreignbodyGreatercomplianceofchestwallmorelikelycollapseorlaboredbreathingwhenrespirationobstructedFewerfatigue-resistantdiaphragmaticmusclefibersearlierrespiratorymusclefatigueinresponsetoanincreasedload,5,Nasalobstruction:infant(nasalstenosis,mucosatender)Sinusitis:2y(nasalmucosasinusmucosa)Otitismedia:infantandyoungchildren(eustachiantube:short,wide,straight,horizontal)Tonsillitis:1y(developingafter1yr)Throatedema:infantandyoungchildren(short,cartilagesoft,mucosatender)Expiratorydyspnea,Emphysema:lesselastictissueRespiratoryfailure:lessnumberofalveoliAtelectasis:noKohnInadequatelungexpansion:diaphragm,greatercomplianceofchestwallMediastinalshift:loosesupporttissue,ClinicalSignificance,URT,LRT,Thoracic,6,PhysiologicalCharacteristic,RespiratoryRate:fastslowBreathingPattern:abdominalthoracoabdominalTrachealCaliber:smalllargeAirwayResistance:highlow,7,Physicalexaminationsigns,respiratoryratebreathingpatternbreathsoundscyanosisThoracicdepressionstridor,wheezinggroaningclubbing,8,9,Pneumonia,10,InflammationofthealveoliorinterstitialspacesofthelungCausedbymicroorganismsornoninfectiousagents,Definition,11,bronchialpneumonialobarpneumoniainterstitialpneumonia,Classification,Pathology,12,Etiology,InfectionNon-infectionviralpneumoniaaspirationpneumoniabacterialpneumoniafoodmycoplasmalpneumoniagastricacidchlamydialpneumoniaforeignbodiesfungipneumoniahypersensitivityProtozoapneumoniadrugorradiation-induced,Classification,13,Classification,Community-AcquiredPneumonia(CAP)Hospital-AcquiredPneumonia(HAP)48Hrs,Approach,14,Classification,Typical-Streptococcuspneumoniae,Haemophilusinfluenzae,Staphylococcusaureus,Gram-negativebacilliUntypical-mycoplasmalpneumonia,chlamydialpneumonia,Legionella,Novelcoronavirus,Manifestation,15,FeverCoughingDyspnoeaintercostal,subcostal,suprasternalretractions,nasalflaringcyanosisFixedRales,decreasedbreathsound,Clinicalmanifestation,Commontypeofpneumonia,16,ViralpneumoniaUpperrespiratoryinfectionprodrome(fever,coryza,cough,hoarseness)Myalgia,malaise,headacheWheezingBacterialpneumoniaSignofgeneralizedtoxicityDullnesstopercussionDecreasedbreathsoundPleuralinvolvement,Clinicalmanifestation,17,Severepneumonia,AccompaniedbycardiacfailureRR60b/minHR180r/minIrritable,Cyanosisheartsoundreduced,gallopliverenlargedOliguria/anuria,edema,Clinicalmanifestation,18,Severepneumonia,CNS（toxicencephalopathy)mild:agitation,sleepinesssevere:coma,seizureheadache,fontanelle,pupilconjunctivalcongestion,changesinbreathing,Clinicalmanifestation,Braindysfunction,Increasedintracranialpressure,19,Severepneumonia,DigestivesystemtoxicparalyticileusgastrointestinalbleedingOtherDIC,Clinicalmanifestation,20,empyema:streptococus,G-dyspnealimitedinrespiratorymovementdullnesstopercussiondecreasedbreathsound,Complication,21,pyopneumothorax：AggravationSeverecoughdyspneacyanosisDrumsound/dullnessDecreasedbreathsoundordisappear,Complication,22,pneumatocele：StaphylococcusaureusAsymptomaticacuterespiratorydistress,Complication,23,Chestx-ray,ViralpneumoniahyperinflationincreasedinterstitialmarkingsperibronchialcuffingpatchybronchopneumoniaBacterialpneumoniaLobarconsolidationwithlobarvolumeexpansionPneumatocelesPleuraleffusionAbscesses,24,LaboratoryFindings,BloodroutinetestandCRP(C-reactiveprotein)ViralpneumoniaNormalorslightlyelevatedWBCwithlymphocytepredominanceNormalorslightlyelevatedCRPBacterialpneumoniaElevatedWBCwithgranulocytepredominanceElevatedCRP,25,26,27,1.Bacterialstainandculturenasopharyngealsecretiontrachealaspiration,bronchialbrushing,lungpuncturepleuralfluid,blood2.ViraldetectionRapidviraldiagnosisfluorescentantibodytestorELISAonnasopharyngealsecretionsserologictechnique3.M.pneumoniaeColdagglutinintiters1:64serologictechnique,Specialexamination,LaboratoryFindings,28,DiagnosisandDifferentialdiagnosis,DiagnosisSymptomsignchestx-rayetiologyDifferentialdiagnosisPulmonarytuberculosisBronchialforeignbody,29,1.GeneralTreatment：humidifiedoxygen:toachieveSaO292%hydrationandelectrolytesupplementationnutrition,Treatment,30,2.EtiologicalTreatment:LocalepidemiologicinformationCommunity-acquiredorhospital-acquiredAgeRadiograohicfindingsBasicconditionGramstainandbacteriaculture,antibioticsensitivity,Treatment,31,Pathogen5yearsStreptococcuspneumoniae+Viruses+Entericbacilli+GroupBstreptococci+-Chlamydiatrachomatis+Staphylococcusaureus+Haemophilusinfluenzae+GroupAstreptococci-+Mycoplasmapneumoniae+Chlamydiapneumoniae-+,veryfrequent;+,moderatelyfrequent,+,rare,veryrare;-,absent,PathogenyinCARTIs,32,3.Applicationofadrenalcorticalhormone：4.SymptomaticTreatment：EndotrachealintubationormechanicalventilationEarlychesttubedrainageofempyemafluid,Treatment,33,5.TreatmentforcardiacfailureDigoxin/CedilanidDiuretic(Furosemide)Vasodilator(ACE-enzymeinhibitors)Sedation,Treatment,34,MycoplasmaPneumonia,ThesecondmostcommoncauseofCAPAffectingpatientsover5yearsProminentheadacheisanearlysign.Apersistent,nonproductivecoughbecomethedominantfeaturewithtimePhysicalfindingsareoftentotallyabsentinitially,35,Chestx-ray：1)patchyorconfluentbronchopneumonia2)unilateralmarkedinfiltrateinthelowerlobeColdhemagglutinintiter1:64afourfoldorgreaterriseinacuteandconvalescenceantibodytiterforM.pneumoniaeTreatmentisbyerythromycinfor7-10days,36,37,38,39,Bronchiolitis,Causedbytherespiratorysyncytialvirus(RSV)Annualwinterepidemicsoccurinbabiesaged1-9monthsCough,wheezing,Sign:breatherapidlyandshallowly;nasalflaringretraction,cyanosis,40,Managementofbronchiolitis,41,Mostinfantsmakeafullrecoverywithin2weeksSomehaverecurrentepisodesofcoughandwheezeoverthesubsequentfewyearsinfantswithchroniclungdiseaseandcongenitalheartdiseaseareatparticularriskofbeingseverelyaffected,42,43,StaphylococcalPneumonia,Theorganismisnecrotizing,producingbronchoalveolardestructionSevere,rapidlyprogressingpneumoniawithformationofabscesses,pneumatoceles,andempyemasintypicalofS.aureusFever,tachypnea,dyspnea,tachycardia,cyanosisBeginningwithafocalinfiltrativelesion,progressingtopatchyconsolidationMostoftenonlyonelunginvolved(80%),moreoftentheright,44,Penicillin-sensitive:90%,use-lactamase-resistantpenicillinMethicillin-resistant:usevancomycin,45,46,13hr