pneumonia呼吸系统肺炎英文带教ppt课件.ppt

Contents 一 pandect 总论 3 二 Pneumoniaingeneral 8 三 Etiology 病原学 13 四 Signs 症状体征 34 五 Treatment 49 六 Prevention 预防 58 2020 3 25 RespiratorySystem RespiratorySystem nose nas oORrhin o larynx laryn o Lungs pneumon oORpulmo bronchus bronch o diaphragm diaphragm o mediastinum 一 pandect Organs 3 Functions BreathingprocessExchangeofOxygenandCarbonDioxideEnablespeechproduction oxygencarbondioxide Alveolar 0 Hyperpnea Cyanosis 02 co2 RespiratorySystem 一 pandect 4 Theinfluencingfactorsofrespiratorydiseases RespiratorySystem 一 pandect AirpollutionandsmokingInhaledallergensThevariationofetiologyandDrugresistanceincreases Signsandsymptoms CoughLaryngitis bronchitis bronchialasthma chronicobstructivepulmonarydisease COPD lungcancerExpectoration吐痰Lungabscess bronchiectasis pneumoniaHemoptysis咯血pulmonaryTuberculosisDyspneaPneumothorax气胸 pleuraleffusion leftheartfailureStethalgia胸痛hemothorax Pulmonarythromboembolism RespiratorySystem 一 pandect Labandotherinspection Bloodtestsantigenskintestphlegmexaminationpleuraleffusionthoracicopunctureradioexamination RespiratorySystem 一 pandect bronchoscopyThoracoscopelungobiopsysupersonicinspectionrespiratoryfunctiontestPulmometry DefinitionPneumoniaisanacuteinfectionoftheparenchyma p re k m ofthelung 肺炎是肺实质的急性感染 lower respiratorytract 下呼吸道causedbymicroorganism ma kr g n z m 由微生物引起 comeswithfever focalchestsymptoms shadowingonCXR chestX ray胸部x线检查 伴随发热 局灶性胸部症状 胸片阴影 RespiratorySystem 2020 3 25 Defensemechanism di fens mek niz m oftherespiratorytract 呼吸道防御机制 Filtration fil trei n anddeposition dep z n 滤除及沉积 nasalfunction鼻功能 pathogens p d ns intheupperairways上呼吸道病原体Coughreflex咳嗽反射Mucociliary mju k s l r clearance黏液纤毛清除macrophages m kr fe d 巨噬细胞Humoral hju m r l andcellular selj l r immunity体液及细胞的免疫Oxidative ks de t v metabolism m t b l z m oftheneutrophils中性粒细胞的氧化代谢 RespiratorySystem 二 Pneumoniaingeneral 2020 3 25 鼻炎 咽炎 耳炎 扁桃体炎 喉炎 细支气管炎 RespiratorySystem Sinus itis sa n sa t s 鼻窦炎Pharyng itis f r n d a t s 咽炎Laryng itis l r n d a t s 喉炎Bronch itis br ka t s 支气管炎 2020 3 25 2020 3 25 RespiratorySystem 2020 3 25 Etiology病因 Therearetwofactorsinvolvedintheformationofpneumonia 参与肺炎形成的两个因素 includingpathogensandhostdefenses 包括病原体和宿主防御 RespiratorySystem 2020 3 25 Causativeorganisms致病微生物 Bacteria细菌Mycobacteria分枝杆菌Chlamydiae衣原体Mycoplasma支原体Fungi真菌Parasites寄生虫Viruses病毒 2020 3 25 Classification分类 Classificationofanatomy按解剖分类Classificationofpathogen按病原体分类Classificationofacquiredenvironment按患病环境分类 RespiratorySystem 2020 3 25 Classificationbyanatomy按解剖分类 Lobar大叶性 Involvementofanentirelobe一个完整的叶的参与Lobular小叶性 Involvementofpartsofthelobeonly segmentalorofalveolicontiguoustobronchi bronchopneumonia支气管肺炎 只有部分的肺叶 节段性支气管或相连的肺泡受累 Interstitial间质性 nt st l Involvementoftheinterstitialtissueofthelungs肺间质组织参与 RespiratorySystem 2020 3 25 Classificationbypathogen按病原体分类 RespiratorySystem 2020 3 25 Classificationsbyacquiredenvironment按患病环境分类 Community acquiredpneumonia 社区获得性肺炎 Occurincommunitywithin48hour 在社区48小时内发生S pneumoniaisthemostcommonCAPinpeopleolderthan60 Mostcommonduringwinterandspring 60岁以上的老人中最常见肺炎链球菌肺炎 常发生在冬季和春季 Hospital acquiredpneumonia 医院获得性肺炎CertainillnessmaypredisposeHAPbecauseof Impaireddefensesorchronicillness Coma昏迷 malnutrition营养不良 prolonghospitalization住院时间延长 Numerousintervention介入asendotrachealintubation某些疾病导致医院获得性肺炎 受损的防御或慢性疾病 昏迷 营养不良住院时间延长 气管插管等较多的介入治疗 2020 3 25 Symptoms CoughDyspnea呼吸困难 d s pni Pleuritic肋膜炎的 pl r t k chestpain胸痛Feverorhypothermia发热或低体温Myalgias肌痛 ma ld Chills Sweats发冷 出汗Fatigue疲劳 f ti HeadacheDiarrhea腹泄sinusitis鼻窦炎 sa n sa t s expectoration咳痰 RespiratorySystem 2020 3 25 全身 怕冷 湿冷 发青 痰 痰 短气 胸膜炎的 pl r t k 胸痛 咳血 h m pt s s 疲劳 f ti 食欲差情绪波动 血管的 v skj l r 恶心 n zi 呕吐 关节痛 Pneumococcalpneumonia肺炎链球菌肺炎 ThepneumoniathatiscausedbyStreptococcuspneumoniaenearlyhalfofcommunity acquiredpneumonia CAP 由肺炎链球菌引起的肺炎近一半是社区获得性肺炎 Thediseaseonsetisacute起病急andcanbeserious accompanied伴有byhighfever chills寒战 cough bloodysputum痰中带血andchestpain RespiratorySystem Thepathologicalchange病理变化isdividedintofourperiods 分为四个时期 i e congestivestage充血期 redhepatization红色肝样变 grayhepatization灰色肝样变andresolution消散期 121 dilatation扩张 da l te n andcongestion充血 k n d est n ofthecapillaries毛细血管 k p l r z 2 thefibrinous纤维蛋白 fa br n s exudate渗出物 eks de t RespiratorySystem Thisisnotedclinicallyasoedema水肿 di m andcongestion充血inlung alveolarexudate肺泡渗出 hematid hem t d infiltration红细胞浸润 leukocyte lu k sa t infiltration白细胞浸润 Thenthebacterium细菌willbeeliminated消除throughleukocyticphagocytosis白细胞吞噬作用 Atlast thefibrousprotein纤维蛋白isbrokendownandabsorbed thealveolarinflatesagain肺泡重新充气 这是临床表现为肺水肿和肺充血 肺泡渗出 红细胞浸润 白细胞浸润 然后细菌通过白细胞吞噬作用将被淘汰消除 最后 纤维蛋白分解和吸收 肺泡重新充气 RespiratorySystem Infact earlytreatmentbyusingantibacterial抗菌的drugcausehepatization肝样变inpathologicalstagedoesnothavepreciselimits Wehadrarelyseenthistypicalpathologicalstageinclinical 事实上 通过使用抗菌药物引起肝病理阶段早期治疗没有确切的界限 我们很少看到这种典型的临床病理分期 RespiratorySystem 2020 3 25 Etiologyandpathogenesis organism S pneumoniae Dynamicbalance 2020 3 25 S pneumoniaeasthegram positivebacillus capsule itsvirulencesizerelatedtothestructureandcontentofcapsularpolysaccharide indryphlegmcansurviveformonths butdirectsunlightfor1hour heat52degrees10mincanbekilled RespiratorySystem 2020 3 25 Etiologyandpathogenesis ThebodykeepsadynamicequilbriumbetweentheorganismandS pneumoniaeaswellastheinternalandexternalenvairoment undernormalconditions S pneumoniaesentinthehunmanoralcavityandnasopharynx theyarecalled normalflora RespiratorySystem 2020 3 25 Etiologyandpathogenesis thepathogenicityofS pneumoniaeisduetothecapsuleinvadetheorganization firstofall causetohydropsofalveolarwalls leukopedesis overspreadingthelungsegmentandpulmonarylobe RespiratorySystem 2020 3 25 Etiologyandpathogenesis whenthebodyresistanceistooweakforthebodytoadapttoclimaticchange whenS pneumoniaeareexcessive Whenthedynamicequilbriumisdamagedandcannotrestoredimmediately S pneumoniaewillbecomepathogenicfactorandleadtotheoccuranceofdisease RespiratorySystem 2020 3 25 Streptococcuspneumoniaehigh riskgroups Smokers dementia ChronicBronchitis bronchiectasis cardiacfailure chronicdisease immunosuppressantsusers theelderly infantsandyoungchildren 2020 3 25 LaboratoryExaminations实验室检查 WBC whitebloodcell 白细胞PaO2 动脉血氧分压Arterial动脉的 t r l Partial部分的PressureofOxygen PaCO2 肺泡二氧化碳分压Alveolar肺泡的PartialPressureofCarbonDioxide 2020 3 25 1 TheWBC 10 30 x109 L neutrophils中性粒细胞 80 TheWBCcanbenormal butneutrophilsmustbeincreased 2 TheBacteriologicalexamination细菌学检查 directsmear直接涂片 usesputumculture 痰涂片culturewithbloodorpleuraleffusion血液或胸腔积液培养 2020 3 25 3 Bloodgasanalysis血气分析 PaO2canbedecreased PaCO2canbenormalordecreased metabolicacidosis代谢性酸中毒 met b lik sid usis Whatarepneumoniasymptomsandsigns Initiallyhavesymptomsofacold upperrespiratoryinfection forexample sneezing sorethroat cough whicharethenfollowedbyahighfever sometimesashighas104F shakingchills andacoughwithsputumproduction Thesputumisusuallydiscoloredandsometimesbloody shortnessofbreath Theindividual sskincolormaychangeandbecomedustyorpurplish aconditionknownas cyanosis duetotheirblood Symptoms Thispainisusuallysharpandworsenwhentakingadeepbreathandisknownaspleuriticpainorpleurisy Aworseningcough headaches andmuscleachesmaybetheonlysymptoms Childrenandbabieswhodeveloppneumoniaoftendonothaveanyspecificsignsofachestinfectionbutdevelopafever appearquiteill andcanbecomelethargic Complications Seriousandpotentiallylethal Pleuraleffusionandempyema Infectiveshock Toxicmyocarditis ARDS AcuteRespiratoryDistressSyndrome Organizedpneumonia Pleuritis Meningocephalitis Howispneumoniadiagnosed Coarsebreathingorcrackingsoundswithastethoscope Wheezingorthesoundsofbreathingmaybefaintinaparticularareaofthechest AchestX rayisusuallyorderedtoconfirmthediagnosisofpneumonia Thelungshavelobes usuallytwoontheleftandthreeontheright Whenthepneumoniaaffectsoneoftheselobes itisoftenreferredtoaslobarpneumonia SputumSamples SputumSamplescanbecollectedandexaminedunderthemicroscope Pneumoniacausedbybacteriaorfungicanbedetectedbythisexamination Aswehaveusedantibioticsinabroaderuncontrolledfashion moreorganismsarebecomingresistanttothecommonlyusedantibiotics Thesetypesofculturescanhelpindirectingmoreappropriatetherapy Abloodtest Thatmeasureswhitebloodcellcount Anindividual swhitebloodcellcountcanoftengiveahintastotheseverityofthepneumoniaandwhetheritiscausedbybacteriaoravirus Anincreasednumberofneutrophils onetypeofWBC isseeninmostbacterialinfections Whereasanincreaseinlymphocytes anothertypeofWBC isseeninviralinfections fungalinfections andsomebacterialinfections Hematologylaboratory Completebloodcount CBC Redbloodcellcount RBC Hemoglobin Hgb Hematocrit Hct Whitebloodcellcount WBC NeutrophilslymphocytesMonocytesPlateletcount prothrombintimePartialthromboplastintimebloodglucose Bronchoscopy Bronchoscopyisaprocedureinwhichathin flexible lightedviewingtubeisinsertedintothenoseormouthafteralocalanestheticisadministered Usingthisdevice thedoctorcandirectlyexaminethebreathingpassages tracheaandbronchi Simultaneously samplesofsputumortissuefromtheinfectedpartofthelungcanbeobtained Fluidcollects Sometimes fluidcollectsinthepleuralspacearoundthelungasaresultoftheinflammationfrompneumonia Thisfluidiscalledapleuraleffusion Ifasignificantamountoffluiddevelops itcanberemoved Afternumbingtheskinwithlocalanestheticaneedleisinsertedintothechestcavityandfluidcanbewithdrawnandexaminedunderthemicroscope Thisprocedureiscalledathoracentesis Diagnosis 1 PrecedinghistoryofcommoncoldorotherURI 2 Symptoms abruptonset highfever coughwitharustysputum chestpain dyspneaandcoughetc 3 Signs remarkablemoistrale 4 Bloodtest leukocytosis 5 Radiologicstudy Lobarconsolidation 6 Adefinitivediagnosisrequiresdemonstrationofpneumoniainsputumculture blood lungtissue Upperrespiratoryinfection Diffuseinterstitialpneumonia Lobarpneumonia Criteriaofseverepneumonia 1 Respiratoryrate 30 min 2 Bloodpressure7 1mmol L 30mg DL 5 X ray twolobesareinvolved Needforvasopressors RenalFailure Caseouspneumonia lungtuberculosis Differentialdiagnosis Apicallocation Insidiousonsetwithlowerfever nightsweats Fatigueandweightloss Notrespondtoantibiotics Sputumsmearfortuberclebacilli Differentialdiagnosis Lungabscess Copiouspurulentfoul smellingsputum Differentialdiagnosis Obstructivepneumonia superimposedhilarshadow recurrentpneumoniaatthesamesitehappendedinpatientsover40 whichdoesnotrespondwelltotheantibiotictreatment fiberopticbronchoscopy 2020 3 25 Treatment AntiinfectioustherapySupportivetherapyTherapyofcomplications 2020 3 25 Treatment Themoreseriouspneumonia requiresantibioticssuchaspenicillin 2020 3 25 Treatment AllpatientswithsuspectedpneumococcalpneumoniashouldbetreatedaspromptlyaspossiblewithpenicillinGThedoseandrouteofdeliverymayhavetobeonthebasisofpatientsstatus adverserea ctionorcomplicationthatoccur 2020 3 25 Treatment Forpatientswhoarebelievedtobeallergictopenicillin 青霉素 onemayselectthefirstorsecondgenerationcephalosporin 头孢菌素 oradvancedmacrolide 大环内酯物 lactam 内酰胺 orrespiratoryfluoroquinolone 氟喹诺酮 alone 2020 3 25 Treatment Insomecases vancomycinmaybeused Treatmentwithanyeffectiveagentshouldbegivenforatleast5to7dayorafterthepatientshavebeenafebrilefor2 3days 2020 3 25 Supportivemeasure Supportivemeasurearegenerallyusedintheinitialmanagementofacutepneumo coccalpneumonia suchmeasuresinclude Bedrest Monitoringvitalsignsandurineoutput Administeringanoccasionalanalgesic 止痛剂 torelievepleuritic 胸膜炎的 pain Replacingfluids ifthepatientisdehydrated 脱水的 2020 3 25 Supportivemeasure Correctingelectrolytes 电解质 Oxygentherapy 2020 3 25 Treatmentofcomplications Empyema 脓胸 developsinappoximately5 ofpa