急性肺脓肿的介绍PPT课件.ppt

,急性肺脓肿的概述,肺脓肿是由于多种病原菌引起的肺部化脓性感染，早期为肺组织的感染性炎症，继而坏死、液化、外周有肉芽组织包围形成脓肿。临床特征为高热、咳嗽，脓肿破溃进入支气管后咳出大量脓臭痰。x线显示含气液平的空腔。多发生于壮年，男多于女。自抗生素广泛应用以来，发病率有明显降低。,1,Anoverviewofacutelungabscess,Lungabscesswascausedbyavarietyofpathogenicbacteriasuppurativelunginfection,earlyinfectiontothelungtissueinflammation,andnecrosis,liquefaction,peripheralhassurroundedbygranulationtissueabscessformation.Clinicalfeaturesforhighfever,cough,burstintotheabscessafterbronchialcoughoutalotofpurulentsputum.X-rayshowedcavitycontaininggasandliquidflat.Developsinmature,malemorethanfemale.Sinceantibioticsarewidelyused,hasasignificantlylowerincidence.,2,急性肺脓肿的病因,急性肺脓肿感染的细菌一般与口腔、上呼吸道的常存细菌相一致，包括需氧、兼性厌氧和厌氧细菌。较重要的厌氧菌有胨链球菌、胨球菌、核粒梭形杆菌，产黑色素杆菌、口腔炎杆菌和韦荣球菌等；常见的需氧和兼性厌氧菌为肺炎球菌、金黄色葡萄球菌、溶血性链球菌、克雷白杆菌、大肠杆菌、绿脓杆菌、变形杆菌等。,3,Thecauseofacutelungabscess,Acutelungabscessinfectionofbacteriagenerallyconsistentwithendurethebacteriainthemouth,tongue,upperrespiratorytract,includingaerobic,anaerobicandfacultativeanaerobicbacteria.Ismoreimportant,peptonepeptonestreptococcusaureus,anaerobicbacterianuclearspindlecoli,producesmelaninbacillus,stomatitisWeiRongcoccusandbacillus,etc.;Commonaerobicandfacultativeanaerobicbacteriaforpneumococcus,staphylococcusaureus,hemolyticstreptococcus,whiteclaybacilli,escherichiacoli,pseudomonasaeruginosa,proteus,etc.,4,急性肺脓肿的症状,肺脓肿患者中，有7090的病例为急性起病，且多数有齿、口咽部的感染灶、或手术、劳累、受凉等病史。患者感畏寒、高热，体温达3940，伴有咳嗽、咳粘液痰或粘液脓性痰。炎症累及胸膜可引起胸痛，且与呼吸有关。病变范围大，会出现气急。同时还有精神不振、全身乏力、食欲减退等全身毒性症状。如感染不能及时控制，于发病的1014天，突然咳出大量脓臭痰及坏死组织，每日可达300500ml。臭痰多系厌氧菌感染所致。约有13病人有不同程度的咯血，偶有中、大量咯血而突然窒息致死。一般在咳出大量脓痰后，体温明显下降，全身毒性症状随之减轻，数周内一般情况逐渐恢复正常。部分病人缓慢发病，有一般的呼吸道感染症状，如咳嗽、咳脓痰和咳血，伴高热、胸痛等。,5,Thesymptomsofacutelungabscess,Inpatientswithlungabscess,70%-90%ofcasesofacuteonset,andmostteeth,throatinfectionkitchen,orsurgery,historyofoverworked,catchcoldcatchcold,etc.Patientsarechills,fever,bodytemperatureupto39and40,accompaniedbycough,coughphlegmphlegmandmucusispurulentsputum.Inflammationoftheinvolvementofthepleuracancausechestpain,andassociatedwithbreathing.Largerangeoflesions,therewillbeshortofbreath.Aswellasfatigue,muscleweakness,lossofappetiteandsystemictoxicsymptoms.Suchasinfectionisnotcontrolintime,from10to14daysofthedisease,shesuddenlyproducealargenumberofpurulentsputumandnecrotictissue,canreach300-300mlperday.Stinkingphlegmisduetoanaerobicbacteriainfection.Aboutone-thirdofthepatientshavedifferentdegreeofhaemoptysis,occasionally,alargenumberofhaemoptysisandsuddenlychokedtodeath.Generallyaftercoughoutalotofphlegm,temperaturedecreasedsignificantly,thenreducesystemictoxicitysymptoms,weeksgeneralsituationgraduallyreturnedtonormal.Somepatientsslowlycomeon,haveacommonrespiratoryinfectionsymptoms,suchascoughing,coughingupphlegmandcoughingupblood,withhighfever,chestpain,etc.,6,急性肺脓肿的检查,一.实验室检查：血常规：血白细胞总数达（2030）109l，中性粒细胞在90以上。痰细菌学检查：细菌的药物敏感试验有助于选择有效抗生素。二.x线检查：x线呈大片浓密模糊浸润阴影，边缘不清，或为团片状浓密阴影，分布在一个或整个肺段。或有空腔、液平。三.纤支镜检查：有助于发现病因和及时治疗。,7,Checkwithacutelungabscess,A.Laboratorytests:Routineblood,bloodwhitecelltotal(20-30)x109/l,neutrophilsinmorethan90%.Sputumbacteriologyexamination:bacteria,drugsensitivetesthelpstochooseeffectiveantibiotics.2.X-ray:X-rayshowslargethickfuzzyinfiltratesshadows,edgeisnotclear,orforthegroupsheetthickshade,distributioninoneortheentirelungsegment.Freeorcavity,liquidlevel.3.Thefiberlenscheck:helptofindthecauseandtreatmentintime.,8,急性肺脓肿的治疗,急性肺脓肿的治疗原则是抗菌和痰液引流。1、常规治疗按一般呼吸系统疾病诊疗常规处理。2、抗感染治疗原则上应根据细菌学和药敏试验结果选用抗生素。可先用青霉素G320万960万U/d，分23次静脉滴注，阿米卡星0.40.8g/d，静滴，待细菌学和药敏报告后再调整用药。合并厌氧菌感染者可加大青霉素G剂量或加用林可霉素1.8g/d，加入葡萄糖液内静滴，或0.6g，23/d，肌注，甲硝唑0.4g，3/d，口服。严重者可静滴头孢西丁等。在全身用药基础上可行局部治疗，如经鼻导管或经纤支镜气管内滴药等。总疗程为48周。阿米巴肺脓肿应用甲硝唑等抗阿米巴治疗。,9,Treatmentofacutelungabscess,Acutelungabscesstreatmentprincipleisantibacterialandsputumdrainage.1,theconventionaltreatmentinaccordancewiththenormalprocessinggeneralrespiratorydiseasediagnosisandtreatment.2,anti-infectiontreatmentinprincipleshouldselectantibioticsaccordingtotheresultsofthebacteriumanddrugsensitivetest.CanusefirstpenicillinG3209.6millionU/d,in23intravenousdrip,amikacin0.40.8g/d,thestaticdrop,bacteriologyanddrugsusceptibilityreportaftertheadjustment.MergeroranaerobicbacteriainfectioncanincreasethepenicillinGdosesoflincomycin1.8G/d,joinintotheliquidglucoseisstatic,or0.6G,23/d,muscleinjectionandmetronidazole0.4G,3/d,oral.Severecasescanbestaticdropsofcefoxitin,etc.Basedonsystemicmedicationfeasiblelocaltreatment,suchasnasalendotrachealcatheterorbyflexiblebronchoscopymirrordropping,etc.Totaltreatmentcourseis48weeks.Lungabscesses,amebicfightamoebictreatmentsuchasapplicationofmetronidazole.,10,急性肺脓肿的治疗,3、体位排痰和药物祛痰根据脓肿部位和病情采取体位引流，23/d，每次1530min。给予祛痰药物口服，如必嗽平、沐舒痰等，必要时行超声雾化。4、经纤支镜冲洗脓痰较多或有明显痰液阻塞征象者，可行纤支镜冲洗和吸引。加强支持治疗，必要时少量多次输血。5、中药治疗败脓强肺草，清热益肺、止咳化痰、消痈排脓，主治肺脓肿。6、外科治疗经内科常规治疗3个月以上仍咳脓痰、脓腔无明显改变者，或合并威胁生命的大咯血或不能与肺癌等鉴别时可行手术治疗。治愈标准及随访：发热消退，无脓痰，X线检查示病灶消失或纤维化，认为治愈。病愈出院后，半年内随访检查12次，注意有无复发。,11,Treatmentofacutelungabscess,3,positionrowofphlegmandexpectorantdrugsaccordingtopositionandconditiontotakepositionabscessdrainage,23/d,1530mineverytime.Willgiveoralexpectorantdrugs,suchasflat,MuShuphlegm,etc,necessary:ultrasonicatomizer.4,thefiberlensflushphlegmmoreorhaveobvioussignsofsputumblocking,feasiblebronchoscopywashingandattractmirror.Strengthensupporttreatment,ifnecessary,asmallamountofbloodtransfusionformanytimes.5,Chinesemedicinetreatmentofsepsisisstronglunggrass,heatprofitlung,coughphlegm,antiabscess,lungabscesses,attending.6,surgerymedicalconventionaltreatmentmorethan3monthsstillcoughingupphlegm,puscavityhasnoobviouschange,orcombinedwithlungcancerandotherlife-threateninghemoptys