肺炎英文版PPT课件.ppt

2020/5/14,.,1,PneumoniaCaseDiscussion,XuChangqingAddress:HangzhouCity,WenzhouRoadNo.16Email：cute1998,2020/5/14,.,2,Theconditionofthepatient,1,YuJinyu,male,64yearsold,2,5monthsago,thepatientstartedcoughingwithoutacause,coughingwhitesputum.Moreseverely:feverwithatemperatureof38.Inthelocalcommunityhospitalhewastreatedfor2dayswithoutanyimprovement.Sohecametoourhospitaltobeadmittedwithpulmonaryinfection.,2020/5/14,.,3,Theconditionofthepatient,3,ExaminationofpulmonaryCT:Doublepneumonialesions,forantiinfection,stopcoughandphlegmandothertreatments.Thetemperaturedroppedgraduallyandtheconditionimproved.4,Thepatientwascarelessastoinhalefoodonemonthbeforehand,thenthepatientbegantocough,sputum,andhavefever.Afterbeinghospitalized,feedingthroughanasogastrictube,antiinfection,andphlegmtreatment.Theconditionimproved.Multiplehospitalizations.,2020/5/14,.,4,Theconditionofthepatient,4,1dayago,thepatientsconditionworsened.Hewasadmittedtothehospitalforfurthertreatment,quasi“Pneumonia,Parkinsonsdisease,admittedtoourdepartment.HasParkinsonsdiseasehistoryfor5years.,2020/5/14,.,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.,2020/5/14,.,6,Theconditionofthepatient,2013-11-27chestCTscan:comparisonofthefrontsheet(2013-10-28)twopulmonaryinfectionswithbilateralpleuraleffusionwasimproved;hintatthethoracicinletendotrachealnodularprotrusion.,2020/5/14,.,7,NormalChestCTScan,Lung:therightlungleftlungtwoleafclover.Thepulmonaryfissures(obliquefissure,horizontalfissure)boundary,appearedaslowdensitypancivascularareaorlinearhighdensityPulmonarysegments:therightlungleftlungisdividedintotensegments,eightsegments.SegmentalbronchusTubeinthelung,pulmonaryarterysegmentcenter.Alveolar:filledwithgas,sothelungshowedlowdensityshadow.Bronchus:fillinggas,thetubularlow-densitygasasthecharacteristicsof.Pulmonaryvascular:pulmonaryintravascularfillingblood,showedhighdensity.,2020/5/14,.,8,ChestCTscanofthepatient2013-11-262014-01-02,Recurrentcough,feverThroughavarietyofantimicrobialtreatment,Thefirst,second,threelineantibioticsPenicillin,Cephalosporinsseflosp:rnz,Fluoroquinolonesflrokwanlonz,Carbapenemsk:bpenemzetc.,2020/5/14,.,9,Thereare4possibilities,1,Thediagnosisisnotclear2,Theolder3,Abnormalimmunefunctions4,Combinedwithvariousunderlyingdiseases,2020/5/14,.,10,Thought,Wecansee,thepatientsconditionhasimproved,butthereisnoobviousimprovementinimaging,Thisischaracteristicofaspirationpneumonia,pulmonarylesionsdifficulttoabsorb,Patientswithlowimmunity,easyrecurrenceofpneumoniaSo,thepatientswithrecurrentpneumonia,sohehastostayinthehospital,2020/5/14,.,11,Thought,Symptomsofbacterialpneumoniaislarger,canbelightweight,determinedbythepathogenandhoststate.Thecommonsymptomswerecough,expectoration,ortheoriginalrespiratorysymptomsincreased,andtheemergenceofpurulentsputumorsputumwithblood,withorwithoutchestpain.,2020/5/14,.,12,Pneumoniadiseaserangecanhavedifficultybreathing,respiratorydistress.Mostofthepatientshavefever.Earlysignshavenoobviousabnormity,seriouspersoncanhavehighrespiratoryrate,flaringofnares,cyanosis.,Thought,2020/5/14,.,13,Clinicalmanifestation,Pulmonaryconsolidationwithtypicalsigns,suchasenhanced,fremituspercussiondullnessandbronchialbreathsounds,canalsobeheardandrales.Pleuraleffusion,ipsilateralchestpercussiondullness,diminishedbreathsounds.,2020/5/14,.,14,Differentialdiagnosis,1,PulmonarytuberculosisManysymptomsofsystemicpoisoning,afternoonfever,nightsweats,fatigue,weakness,weightloss,insomnia,heartpalpitationsandothersymptoms.X-rayvisiblelesionsintheapicalorsupraclavicular,unevendensity,dissipatedslowly,andcanformacavityorintrapulmonaryspread.Mycobacteriumtuberculosiscanbefoundinthesputum.Theconventionalantibiotictherapy.,2020/5/14,.,15,Differentialdiagnosis,2,LungcancerOftenhasahistoryofsmoking.Hasacough,sputum,bloodysputumsymptoms.Whitebloodcellcountisnothigh,iffoundthatthecancercellsinsputumcanbeconfirmed.Beaccompaniedwithobstructivepneumonia,afterantibiotictreatmentinflammationisnoteasytodissipate,orvisiblehilarlymphnodeenlargement,sometimesappearsatelectasis.ItisnecessarytodotheCT,MRI,fiberopticbronchoscopyandsputumcytologicexamination.,2020/5/14,.,16,Differentialdiagnosis,3,AcutepulmonaryabscessTheearlyclinicalmanifestationissimilar.Asthediseaseprogresses,expectorationofpurulentfoulsputumforlungabscess.TheX-rayfilmsshowedtheabscesscavityandfluidlevel.,2020/5/14,.,17,Differentialdiagnosis,4,PulmonarythromboembolismManyriskfactorsforvenousthromboembolism,canoccurhemoptysis,syncope,respiratorydifficultiesareobvious,jugularvenousengorgement.X-rayshowedpartialreductionoflungmarkings,wedge-shapedshadowvisibletippointingtothehilar,commonhypoxemiaandhypocapnia.ThetwoD-dimer,CTpulmonaryangiography,radionuclidelungventilation/perfusionscanandMRIexaminationcanhelpidentify.,2020/5/14,.,18,Differentialdiagnosis,5,NoninfectiouspulmonaryinfiltrationToexcludenoninfectiouspulmonarydiseases,suchaspulmonaryfibrosis,pulmonaryedema,atelectasis,pulmonaryeosinophiliaandpulmonaryvasculitis.,2020/5/14,.,19,Treatment,Astableconditionafterfromintravenoustooraltherapy.Pneumoniaantibiotictreatmentforatleast5days,mostofthepatientsneed7-10daysoralongercourseoftreatment,Ifthetemperatureisnormalfor48-72hours,withoutanyapneumoniaclinicalinstabilitysigns,candisableantibiotics,2020/5/14,.,20,Therapy,InviewofthepatientAntiinfectiontreatmentofpenicillininjectionandCiprofloxacinInjectionfor7days.,2020/5/14,.,21,Therapy,Patientsinadditiontobedrest,drinkinglotsofwater,oxygen,positivesputum,themainaspectsofthetreatmentofpneumoniaisaninfection.Accordingtopatientage,underlyingdiseases,whetherhaveaspirationlevelfactors,seriousillness,selectionofantimicrobialagentsandrouteofadministration.,2020/5/14,.,22,Therapy,Treatmentofbacterialpneumoniapathogens(includingthetreatmentofchoiceinvitroaccordingtosputumcultureanddrugsensitivitytestresults,sensitiveantibiotics).Empiricaltreatment(antibioticsselectionmaycoverthepathogen).,2020/5/14,.,23,Therapy,Suspectedpneumoniaimmediatelygivefirstdoseofantibiotics.Astableconditionaftertheintravenoustooraltherapy.Pneumoniaantibiotictreatmentforatleast5days,themajorityofpatientsto710daysorlongercourseoftreatment,thenormalbodytemperatureof4872hours,withoutanyapneumoniaclinicalinstabilitysigns,candisableantibiotics.,2020/5/14,.,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%,2020/5/14,.,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%,2020/5/14,.,26,Therapy,3,HospitalacquiredpneumoniaThesecond/threegenerationcephalosporins,betalactam/betalactamaseinhibitor,quinolonesorcarbapenems.,2020/5/14,.,27,Therapy,4,SeverepneumoniaThepreferredbroad-spectrumstrongantibacterialdrugs,drugcombinationissufficient.Severecommunityacquiredpneumoniawithbetalactamcombinedwithlargeringvinegarorfluoroquinolones;Hospitalacquiredpneumoniaavailablefluoroquinolonesoraminoglycosidecombinedantipseudomonalbetalactam,ampicillin/betainanykindofamideenzymeinhibitors,carbapenems,whennecessary,canbecombinedwithvancomycin,tei