pneumonia呼吸系统肺炎英文带教

Contents,（一）、pandect总论3（二）、Pneumoniaingeneral8（三）、Etiology病原学13（四）、Signs症状体征34（五）、Treatment49（六）、Prevention预防58,2020/5/7,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,DefinitionPneumoniaisanacuteinfectionoftheparenchymaprekmofthelung,肺炎是肺实质的急性感染，(lower-respiratorytract)下呼吸道causedbymicroorganismmakr:gnzm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,2020/5/7,Defensemechanismdifensmeknizmoftherespiratorytract（呼吸道防御机制）,Filtrationfiltreinanddepositiondepzn滤除及沉积（nasalfunction鼻功能）pathogenspdnsintheupperairways上呼吸道病原体Coughreflex咳嗽反射Mucociliarymju:kslrclearance黏液纤毛清除macrophagesmkrfed巨噬细胞Humoralhju:mrlandcellularseljl(r)immunity体液及细胞的免疫Oxidativeksdetvmetabolismmtblzmoftheneutrophils中性粒细胞的氧化代谢,RespiratorySystem,（二）、Pneumoniaingeneral,2020/5/7,鼻炎,咽炎,耳炎,扁桃体炎,喉炎,细支气管炎,RespiratorySystem,Sinus/-itissansats鼻窦炎Pharyng/-itis.frndats咽炎Laryng/-itislrndats喉炎Bronch/-itisbrkats支气管炎,2020/5/7,2020/5/7,RespiratorySystem,2020/5/7,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,2020/5/7,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,2020/5/7,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,2020/5/7,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ntstl:Involvementoftheinterstitialtissueofthelungs肺间质组织参与,RespiratorySystem,2020/5/7,Classificationbypathogen按病原体分类,RespiratorySystem,2020/5/7,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。,2020/5/7,Symptoms,CoughDyspnea呼吸困难dspni:Pleuritic肋膜炎的plrtkchestpain胸痛Feverorhypothermia发热或低体温Myalgias肌痛mald,Chills/Sweats发冷/出汗Fatigue疲劳fti:HeadacheDiarrhea腹泄sinusitis鼻窦炎sansatsexpectoration咳痰,RespiratorySystem,2020/5/7,全身,怕冷,湿冷,发青,痰,痰,短气,胸膜炎的plrtk胸痛,咳血hmptss,疲劳fti:,食欲差情绪波动,血管的vskjl(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daltenandcongestion充血kndestnofthecapillaries毛细血管kplrz2,thefibrinous纤维蛋白fabrnsexudate渗出物eksdet,RespiratorySystem,Thisisnotedclinicallyasoedema水肿di:mandcongestion充血inlung,alveolarexudate肺泡渗出,hematidhemtdinfiltration红细胞浸润,leukocytelu:ksatinfiltration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,2020/5/7,Etiologyandpathogenesis,organism,S.pneumoniae,Dynamicbalance,2020/5/7,S.pneumoniaeasthegram-positivebacillus,capsule,itsvirulencesizerelatedtothestructureandcontentofcapsularpolysaccharide,indryphlegmcansurviveformonths,butdirectsunlightfor1hour,heat52degrees10mincanbekilled.,RespiratorySystem,2020/5/7,Etiologyandpathogenesis,ThebodykeepsadynamicequilbriumbetweentheorganismandS.pneumoniaeaswellastheinternalandexternalenvairoment,undernormalconditions,S.pneumoniaesentinthehunmanoralcavityandnasopharynx,theyarecalled“normalflora”.,RespiratorySystem,2020/5/7,Etiologyandpathogenesis,thepathogenicityofS.pneumoniaeisduetothecapsuleinvadetheorganization,firstofall,causetohydropsofalveolarwalls,leukopedesis,overspreadingthelungsegmentandpulmonarylobe.,RespiratorySystem,2020/5/7,Etiologyandpathogenesis,whenthebodyresistanceistooweakforthebodytoadapttoclimaticchange,whenS.pneumoniaeareexcessive,Whenthedynamicequilbriumisdamagedandcannotrestoredimmediately,S.pneumoniaewillbecomepathogenicfactorandleadtotheoccuranceofdisease.,RespiratorySystem,2020/5/7,Streptococcuspneumoniaehigh-riskgroups：,Smokers,dementia,ChronicBronchitis,bronchiectasis,cardiacfailure,chronicdisease,immunosuppressantsusers,theelderly,infantsandyoungchildren,2020/5/7,LaboratoryExaminations实验室检查,WBC(whitebloodcell)白细胞PaO2(动脉血氧分压Arterial动脉的:trlPartial部分的PressureofOxygen)PaCO2(肺泡二氧化碳分压Alveolar肺泡的PartialPressureofCarbonDioxide),2020/5/7,1.TheWBC:(1030)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.,2020/5/7,3.Bloodgasanalysis血气分析:PaO2canbedecreased,PaCO2canbenormalordecreased,metabolicacidosis代谢性酸中毒metbliksidusis.,Whatarepneumoniasymptomsandsigns?,Initiallyhavesymptomsofacold（upperrespiratoryinfection,forexample,sneezing,sorethroat,cough）,whicharethenfollowedbyahighfever（sometimesashighas104F）,shakingchills,andacoughwithsputumproduction.Thesputumisusuallydiscoloredandsometimesbloody,shortnessofbreath.Theindividualsskincolormaychangeandbecomedustyorpurplish（aconditionknownas“cyanosis”）duetotheirblood.,Symptoms,Thispainisusuallysharpandworsenwhentakingadeepbreathandisknownaspleuriticpainorpleurisy.Aworseningcough,headaches,andmuscleachesmaybetheonlysymptoms.Childrenandbabieswhodeveloppneumoniaoftendonothaveanyspecificsignsofachestinfectionbutdevelopafever,appearquiteill,andcanbecomelethargic.,Complications,SeriousandpotentiallylethalPleuraleffusionandempyemaInfectiveshockToxicmyocarditisARDS（AcuteRespiratoryDistressSyndrome)OrganizedpneumoniaPleuritisMeningocephalitis,Howispneumoniadiagnosed？,Coarsebreathingorcrackingsoundswithastethoscope.Wheezingorthesoundsofbreathingmaybefaintinaparticularareaofthechest.AchestX-rayisusuallyorderedtoconfirmthediagnosisofpneumonia.Thelungshavelobes，usuallytwoontheleftandthreeontheright.Whenthepneumoniaaffectsoneoftheselobes，itisoftenreferredtoaslobarpneumonia.,SputumSamples,SputumSamplescanbecollectedandexaminedunderthemicroscope.Pneumoniacausedbybacteriaorfungicanbedetectedbythisexamination.Aswehaveusedantibioticsinabroaderuncontrolledfashion,moreorganismsarebecomingresistanttothecommonlyusedantibiotics.Thesetypesofculturescanhelpindirectingmoreappropriatetherapy.,Abloodtest,Thatmeasureswhitebloodcellcount.Anindividualswhitebloodcellcountcanoftengiveahintastotheseverityofthepneumoniaandwhetheritiscausedbybacteriaoravirus.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,1PrecedinghistoryofcommoncoldorotherURI；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.Respiratoryrate30/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,2020/5/7,Treatment,AntiinfectioustherapySupportivetherapyTherapyofcomplications,2020/5/7,Treatment,Themoreseriouspneumonia,requiresantibioticssuchaspenicillin.,2020/5/7,Treatment,AllpatientswithsuspectedpneumococcalpneumoniashouldbetreatedaspromptlyaspossiblewithpenicillinGThedoseandrouteofdeliverymayhavetobeonthebasisofpatientsstatus/adverserea-ctionorcomplicationthatoccur,2020/5/7,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.,2020/5/7,Treatment,Insomecases,vancomycinmaybeused.Treatmentwithanyeffectiveagentshouldbegivenforatleast5to7dayorafterthepatientshavebeenafebrilefor2-3days,2020/5/7,Supportivemeasure,Supportivemeasurearegenerallyusedintheinitialmanagementofacutepneumo-coccalpneumonia,suchmeasuresinclude-Bedrest-Monitoringvitalsignsandurineoutput-Administeringanoccasionalanalgesic(止痛剂)torelievepleuritic(胸膜炎的)pain-Replacingfluids,ifthepatientisdehydrated(脱水的),2020/5/7,Supportivemeasure,Correctingelectrolytes(电解质)Oxygentherapy,2020/5/7,Treatmentofcomplications,Empyema(脓胸)developsinappoximately5%ofpatientswithpneumococ