肺炎英文版ppt课件.ppt

2020 3 28 1 PneumoniaCaseDiscussion XuChangqingAddress HangzhouCity WenzhouRoadNo 16Email 2020 3 28 2 Theconditionofthepatient 1 YuJinyu male 64yearsold 2 5monthsago thepatientstartedcoughingwithoutacause coughingwhitesputum Moreseverely feverwithatemperatureof38 Inthelocalcommunityhospitalhewastreatedfor2dayswithoutanyimprovement Sohecametoourhospitaltobeadmittedwithpulmonaryinfection 2020 3 28 3 Theconditionofthepatient 3 ExaminationofpulmonaryCT Doublepneumonialesions forantiinfection stopcoughandphlegmandothertreatments Thetemperaturedroppedgraduallyandtheconditionimproved 4 Thepatientwascarelessastoinhalefoodonemonthbeforehand thenthepatientbegantocough sputum andhavefever Afterbeinghospitalized feedingthroughanasogastrictube antiinfection andphlegmtreatment Theconditionimproved Multiplehospitalizations 2020 3 28 4 Theconditionofthepatient 4 1dayago thepatient sconditionworsened Hewasadmittedtothehospitalforfurthertreatment quasi Pneumonia Parkinson sdisease admittedtoourdepartment HasParkinson sdiseasehistoryfor5years 2020 3 28 5 Theconditionofthepatient Physicalexamination P90 R19 BP119 72mHgT36 6 Clearconsciousness bedrest nasalfeeding Skinandsclerawithoutyellowdye nolipscyanosis asoftandnotswollensuperficiallymphnodeofneck nojugularveinenlargement tracheae nochestdeformity theintercostalspacewithoutbroadening doublelungbreathingsymmetry nochange fremituswithoutchange bilateralpercussionsound twopulmonaryrespirationcrudeandobviously noralesorrhonchi hearthasnoenlargement heartrate90 thelawisneat theabdomenissoft completeabdomentenderness noreboundtenderness belowliverlienalcostalregionwithoutpalpablemass renalareawithoutpercussionpain lowerextremitiesedema neurologicalexamination limbsadverseevents activitiesjointdegreeislimited muscletensionincreased strengthcannotcheck 2020 3 28 6 Theconditionofthepatient 2013 11 27chestCTscan comparisonofthefrontsheet 2013 10 28 twopulmonaryinfectionswithbilateralpleuraleffusionwasimproved hintatthethoracicinletendotrachealnodularprotrusion 2020 3 28 7 NormalChestCTScan Lung therightlungleftlungtwoleafclover Thepulmonaryfissures obliquefissure horizontalfissure boundary appearedaslowdensitypancivascularareaorlinearhighdensityPulmonarysegments therightlungleftlungisdividedintotensegments eightsegments SegmentalbronchusTubeinthelung pulmonaryarterysegmentcenter Alveolar filledwithgas sothelungshowedlowdensityshadow Bronchus fillinggas thetubularlow density gas asthecharacteristicsof Pulmonaryvascular pulmonaryintravascularfillingblood showedhighdensity 2020 3 28 8 ChestCTscanofthepatient2013 11 262014 01 02 Recurrentcough feverThroughavarietyofantimicrobialtreatment Thefirst second threelineantibioticsPenicillin Cephalosporins sef lo s p r nz Fluoroquinolones fl ro kwa n lo nz Carbapenems k b penemz etc 2020 3 28 9 Thereare4possibilities 1 Thediagnosisisnotclear2 Theolder3 Abnormalimmunefunctions4 Combinedwithvariousunderlyingdiseases 2020 3 28 10 Thought Wecansee thepatient sconditionhasimproved butthereisnoobviousimprovementinimaging Thisischaracteristicofaspirationpneumonia pulmonarylesionsdifficulttoabsorb Patientswithlowimmunity easyrecurrenceofpneumoniaSo thepatientswithrecurrentpneumonia sohehastostayinthehospital 2020 3 28 11 Thought Symptomsofbacterialpneumoniaislarger canbelightweight determinedbythepathogenandhoststate Thecommonsymptomswerecough expectoration ortheoriginalrespiratorysymptomsincreased andtheemergenceofpurulentsputumorsputumwithblood withorwithoutchestpain 2020 3 28 12 Pneumoniadiseaserangecanhavedifficultybreathing respiratorydistress Mostofthepatientshavefever Earlysignshavenoobviousabnormity seriouspersoncanhavehighrespiratoryrate flaringofnares cyanosis Thought 2020 3 28 13 Clinicalmanifestation Pulmonaryconsolidationwithtypicalsigns suchasenhanced fremituspercussiondullnessandbronchialbreathsounds canalsobeheardandrales Pleuraleffusion ipsilateralchestpercussiondullness diminishedbreathsounds 2020 3 28 14 Differentialdiagnosis 1 PulmonarytuberculosisManysymptomsofsystemicpoisoning afternoonfever nightsweats fatigue weakness weightloss insomnia heartpalpitationsandothersymptoms X rayvisiblelesionsintheapicalorsupraclavicular unevendensity dissipatedslowly andcanformacavityorintrapulmonaryspread Mycobacteriumtuberculosiscanbefoundinthesputum Theconventionalantibiotictherapy 2020 3 28 15 Differentialdiagnosis 2 LungcancerOftenhasahistoryofsmoking Hasacough sputum bloodysputumsymptoms Whitebloodcellcountisnothigh iffoundthatthecancercellsinsputumcanbeconfirmed Beaccompaniedwithobstructivepneumonia afterantibiotictreatmentinflammationisnoteasytodissipate orvisiblehilarlymphnodeenlargement sometimesappearsatelectasis ItisnecessarytodotheCT MRI fiberopticbronchoscopyandsputumcytologicexamination 2020 3 28 16 Differentialdiagnosis 3 AcutepulmonaryabscessTheearlyclinicalmanifestationissimilar Asthediseaseprogresses expectorationofpurulentfoulsputumforlungabscess TheX rayfilmsshowedtheabscesscavityandfluidlevel 2020 3 28 17 Differentialdiagnosis 4 PulmonarythromboembolismManyriskfactorsforvenousthromboembolism canoccurhemoptysis syncope respiratorydifficultiesareobvious jugularvenousengorgement X rayshowedpartialreductionoflungmarkings wedge shapedshadowvisibletippointingtothehilar commonhypoxemiaandhypocapnia ThetwoD dimer CTpulmonaryangiography radionuclidelungventilation perfusionscanandMRIexaminationcanhelpidentify 2020 3 28 18 Differentialdiagnosis 5 NoninfectiouspulmonaryinfiltrationToexcludenoninfectiouspulmonarydiseases suchaspulmonaryfibrosis pulmonaryedema atelectasis pulmonaryeosinophiliaandpulmonaryvasculitis 2020 3 28 19 Treatment Astableconditionafterfromintravenoustooraltherapy Pneumoniaantibiotictreatmentforatleast5days mostofthepatientsneed7 10daysoralongercourseoftreatment Ifthetemperatureisnormalfor48 72hours withoutanyapneumoniaclinicalinstabilitysigns candisableantibiotics 2020 3 28 20 Therapy InviewofthepatientAntiinfectiontreatmentofpenicillininjectionandCiprofloxacinInjectionfor7days 2020 3 28 21 Therapy Patientsinadditiontobedrest drinkinglotsofwater oxygen positivesputum themainaspectsofthetreatmentofpneumoniaisaninfection Accordingtopatientage underlyingdiseases whetherhaveaspirationlevelfactors seriousillness selectionofantimicrobialagentsandrouteofadministration 2020 3 28 22 Therapy Treatmentofbacterialpneumoniapathogens includingthetreatmentofchoiceinvitroaccordingtosputumcultureanddrugsensitivitytestresults sensitiveantibiotics Empiricaltreatment antibioticsselectionmaycoverthepathogen 2020 3 28 23 Therapy Suspectedpneumoniaimmediatelygivefirstdoseofantibiotics Astableconditionaftertheintravenoustooraltherapy Pneumoniaantibiotictreatmentforatleast5days themajorityofpatientsto7 10daysorlongercourseoftreatment thenormalbodytemperatureof48 72hours withoutanyapneumoniaclinicalinstabilitysigns candisableantibiotics 2020 3 28 24 Therapy 1 YoungadultswithandwithoutunderlyingdiseasesofcommunityacquiredpneumoniaSelectionofpenicillin firstgenerationcephalosporinsantibiotics thedrugresistanceofStreptococcuspneumoniaecanusespecialeffectsonrespiratorytractinfection fluoroquinolonemoxifloxacin levofloxacin 肺炎链球菌 46 流感嗜血杆菌 10 肺炎支原体 25 肺炎衣原体 14 金黄色葡萄球菌 5 2020 3 28 25 Therapy 2 Elderlypeoplehavebasicdiseases orneedtobehospitalizedwithcommunity acquiredpneumoniaThefluorinatedquinolones second threegenerationcephalosporins betalactam betalactamaseinhibitor canbecombinedwithlargeringvinegar 流感嗜血杆菌需氧G杆菌 60 肺炎衣原体 5 金黄色葡萄球菌 卡他莫拉氏菌 5 15 肺炎链球菌 15 2020 3 28 26 Therapy 3 HospitalacquiredpneumoniaThesecond threegenerationcephalosporins betalactam betalactamaseinhibitor quinolonesorcarbapenems 2020 3 28 27 Therapy 4 SeverepneumoniaThepreferredbroad spectrumstrongantibacterialdrugs drugcombinationissufficient Severecommunityacquiredpneumoniawithbetalactamcombinedwithlargeringvinegarorfluoroquinolones Hospitalacquiredpneumoniaavailablefluoroquinolonesoraminoglycosidecombinedantipseudomonalbetalactam ampicillin betainanykindofamideenzymeinhibitors carbapenems whennecessary canbecombinedwithvancomycin