肺炎1完整下载ppt课件

肺炎pneumonia,南京医科大学附属南京第一医院呼吸科乔岩,24.05.2020,.,2,总论generalintroduction肺炎球菌肺炎pneumococcalpneumonia其他肺炎,总论,24.05.2020,.,4,定义definition流行病学epidemiology发病机制pathogenesy病因及分类etiologicalfactoroandtoclassify常见肺炎commonpneumonia常用抗生素commonlyusedantibiotics,总论,24.05.2020,.,5,定义,肺炎（pneumonia）是指包括终末气道、肺泡腔(alveolarspace)及肺间质等在内的肺实质炎症。病因以感染(infection)为最常见。,总论,24.05.2020,.,6,总论,24.05.2020,.,7,24.05.2020,.,8,24.05.2020,.,9,支气管树及肺泡组成,总论,24.05.2020,.,10,流行病学epidemiology,总论,24.05.2020,.,12,流行病学,受感染人群结构的改变感染病原菌的变迁肺炎致病菌的复杂化抗生素使用不当细菌耐药菌株的增加临床表现不典型者增多死亡率增加,总论,24.05.2020,.,13,24.05.2020,.,14,24.05.2020,.,15,24.05.2020,.,16,24.05.2020,.,17,24.05.2020,.,18,24.05.2020,.,19,发病机制nosogenesis,防御机制,多种因素,病原,肺泡毛细血管充血、水肿肺泡内蛋白渗出,总论,24.05.2020,.,20,总论,24.05.2020,.,21,病因,感染infection理化因素免疫损伤immunologicinjury过敏hypersensitiveness药物drug,总论,24.05.2020,.,22,分类,病因originofadisease解剖anatomy感染获得场所place发病方式modality其他,分类因素,总论,24.05.2020,.,23,常用抗生素antibiotic？,总论,24.05.2020,.,24,抗感染药物分类,-内酰胺类-lactam氨基糖甙类aminoglycosides大环内脂类macroring多肽类polypeptide喹诺酮类quinolones其他,总论,24.05.2020,.,25,常见肺炎及治疗,总论,肺炎球菌肺炎pneumococcalpneumonia,24.05.2020,.,27,致病菌,肺炎链球菌streptococcal肺炎双球菌pneumococcaoG+,正常寄生于上呼吸道19型及12型（3型）无内、外毒素荚膜-致病力所在,24.05.2020,.,28,致病菌特点,4070%健康者鼻咽部有该菌寄生,24.05.2020,.,29,易感人群susceptiblepopulation,青壮年人,24.05.2020,.,30,致病条件,冬春季、机体抵抗力差时突然发病上感，受寒，雨淋，醉酒，疲劳，麻醉后，镇静剂过量,24.05.2020,.,31,病理,充血期：12天，肺泡充血水肿，浆液渗出红色肝样变期：34天，纤维蛋白，中性粒细胞，大量redhepatization红细胞灰色肝样变期：第5天，充血缓解，白细胞，纤维蛋白grayhepatization原，死菌，细胞碎片消散期：第7天后，纤维蛋白被酶溶解，细菌被巨噬细胞吞噬,24.05.2020,.,32,肺炎球菌不产生外毒素ectotoxin，不引起原发性肺组织化脓坏死,24.05.2020,.,33,临床表现clinicalmanifestation-全身,寒战ague，高热ardentfever，1/3鼻部单纯性疱疹herpescatarrhalis,24.05.2020,.,34,临床表现clinicalmanifestation-局部,症状：胸痛chestpain，咳嗽cough，铁锈色痰rustyexpectoration体征：肺实变征症状,24.05.2020,.,35,并发症complication,感染性休克septicshock胸腔积液pleuraleffussion心肌炎infectivecardiomyopathy,24.05.2020,.,36,实验室检查laboratoryexamination,白细胞计数lencocytecount中性粒细胞heterophilgranulocyte痰涂片sputumfilmpreparation痰培养sputumculture,24.05.2020,.,37,X线表现,肺段、叶实变,24.05.2020,.,38,诊断标准diagnosticcode,典型症状与体征胸部X线检查病原菌检查,24.05.2020,.,39,鉴别诊断antidiastole,干酪型肺炎cheesepneumonia急性肺脓肿acutelungabscess肺癌bronchogeniccarcinoma其他,24.05.2020,.,40,治疗原则therapeuticprinciple,抗菌药物治疗-原发病的治疗对症治疗symptomatictreatment并发症的治疗营养支持治疗,24.05.2020,.,41,抗生素选择,青霉素penicilin第一代头孢菌素Firstgenerationcephalosporin或第二代头孢菌素,24.05.2020,.,42,休克型肺炎？pneumoniawithshock?,中毒型肺炎休克型,24.05.2020,.,43,中毒性肺炎？toxicpneumonia?,在肺炎的发生发展中，出现严重的全身中毒症状的一种重症肺炎。分休克型和脑水肿型。,24.05.2020,.,44,感染性休克?septicshock？,24.05.2020,.,45,感染性休克的治疗原则,补充血容量blood-volume血管活性物质的应用vasoactivesubstance控制感染feelingofcontrol糖皮质激素的应用glucocorticoid纠正水、电解质紊乱lectrolytedisturbances,其他肺炎,葡萄球菌肺炎,Staphylococcalpneumonia,24.05.2020,.,48,病原菌,是由葡萄球菌引起的急性肺化脓性感染pyogenicinfection革兰氏染色Gramstaining阳性球菌分金黄色和表皮两类有耐药株MRSA、MRSE外毒素ectotoxin：溶血毒素hematoxin、杀白细胞素leukocidin凝固酶阳性coagulasepositive,24.05.2020,.,49,临床特点characteristic,体弱者院内感染hospitalonsetofinfection增多有皮肤感染灶败血症septicaemia和脓毒败血症pyaemiaseptica急骤、高热、病情危重、合并休克肺内多发病灶、伴空洞、液平,24.05.2020,.,50,检查及诊断标准,白细胞增高X线空洞、液平培养阳性,24.05.2020,.,51,治疗,青霉素penicilin新青Oxacillin万古霉素vancomycin,抗球菌药,肺炎克雷伯杆菌肺炎klebsiellapneumonia,肺炎杆菌肺炎,24.05.2020,.,53,病原菌,体弱者产生ESBLs酶肺炎克雷白杆菌（也称肺炎杆菌）有荚膜，可引起组织坏死、液化,24.05.2020,.,54,临床特点,起病急、高热、紫绀、气急、休克粘稠脓性痰、砖红色、胶冻状,24.05.2020,.,55,检查及诊断标准,X线：大叶实变、蜂窝状、叶间隙下坠培养阳性,24.05.2020,.,56,治疗,二、三代头孢菌素氨基甙类,军团菌肺炎,Legionnaiespneumonia,24.05.2020,.,58,病原菌,存于水及土壤中供水系统及空调系统中嗜肺军团菌,24.05.2020,.,59,临床特点,年老体弱者亚急性起病，疲乏无力，肌痛发热疗效不佳,24.05.2020,.,60,检查及诊断标准,培养率低间接免疫荧光抗体检测血清试管沉集实验血清微量凝集实验,两次抗体滴度4倍增长1：1281：160,24.05.2020,.,61,治疗,红霉素,支原体肺炎,mycoplasmapneumoniae,24.05.2020,.,63,病原菌,肺炎支原体无细胞培养基最小微生物通过呼吸道传播,24.05.2020,.,64,临床特点,起病缓慢乏力发热食欲不振阵发性刺激性呛咳,24.05.2020,.,65,检查及诊断标准,冷凝集实验阳性,24.05.2020,.,66,治疗,红霉素,24.05.2020,.,67,谢谢！,24.05.2020,.,68,病因分类,感染性细菌性肺炎bacterialpneumonia病毒性肺炎viralpneumonia支原体肺炎Eatonspneumonia真菌性肺炎Eatonspneumonia其他,非感染性化学性肺炎chemicalpneumonitis放射性肺炎radiationpneumonia过敏性肺炎allergicpneumonia结缔组织疾病connectivetissuediseases药物性肺炎,总论,24.05.2020,.,69,感染性肺炎病因,细菌性肺炎bacterialpneumonia病毒性肺炎viralpneumonia支原体肺炎Eatonspneumonia真菌性肺炎Eatonspneumonia其他,细菌性肺炎非典型病原体肺炎atypiapathogenpneumonia(军团菌,支原体,衣原体,)病毒性肺炎真菌性肺炎其他病原体所致,总论,24.05.2020,.,70,发病场所,社区获得性肺炎(CAP)communityacquiredpneumonia医院内获得性肺炎(HAP)Hospitalacquiredpneumonia,总论,24.05.2020,.,71,院内感染hospitalonsetofinfection,在医院内发生的肺炎住院48后发生的肺炎,总论,24.05.2020,.,72,社区感染,又称“社区获得性肺炎”医院外发生的肺炎,总论,解剖分类,大叶性肺炎lobarpneumonia小叶性肺炎lobularpneumonia间质性肺炎cirrhosisoflung,总论,大叶性肺炎的致病菌？,肺炎球菌葡萄球菌肺炎克雷伯杆菌,总论,易感人群、条件,青壮年人，体质好醉酒、受凉后,总论,24.05.2020,.,76,24.05.2020,.,77,小叶性肺炎的病原菌？,肺炎球菌葡萄球菌支原体杆菌,总论,小叶性肺炎的易感人群,继发于支气管炎、上感长期卧床老人，小孩,总论,24.05.2020,.,80,发病方式,原发性肺炎继发性肺炎secondarypneumonia血源性肺炎脓毒败血症pyaemiaseptica吸入性肺炎误吸、汽油、食物aspiratedpneumonia阻塞性肺炎新生物阻塞支气管obstructivepneumonia,总论,24.05.2020,.,81,其他,老年性肺炎老年人肺炎oldpeoplepneumonia重症肺炎中毒性肺炎toxicpneumonia休克性肺炎机化性肺炎organizedpneumonia非典型肺炎atypicalpneumonia呼吸机相关肺炎(VAP)干酪性肺炎caseouspneumonia,总论,24.05.2020,.,82,非典型病原体,非典型肺炎,传染性非典型肺炎,SARS,总论,24.05.2020,.,83,-内酰胺类,天然青霉素（青霉素G）青霉素类耐霉青霉素（甲氧西林、苯唑西林）广谱青霉素（氨苄西林、哌拉西林）第一代（头孢唑林）头孢菌素类第二代（头孢呋辛）第三代（头孢哌酮）第四代（头孢匹罗）单环类（氨曲南）非典型头霉素（头孢美唑）-内酰胺类头孢烯类碳青烯类（泰能）-内酰胺霉抑制剂,24.05.2020,.,84,氨基糖甙类,第一代链霉素、新霉素、卡那霉素第二代庆大霉素、妥布霉素第三代阿米卡星,总论,24.05.2020,.,85,大环类,14员环红霉素Erythromycin、麦迪霉素Midecamycin、螺旋霉素Spiramycin15员环克拉霉素Clarithromycin16员环阿奇霉素Azithromycin,总论,24.05.2020,.,86,主要的氟喹诺酮抗菌药物,诺氟沙星（Norfloxacin）氧氟沙星（ofloxacin）环丙沙星（ciprofloxacin）培氟沙星（Pefloxacin，甲氟哌酸）依诺沙星（Enoxacin，氟啶酸）左氟沙星（Levofloxacin）洛美沙星（Lomefloxacin）氟罗沙星（Fleroxacin）司帕沙星（Sparfloxacin）加替沙星（Gatifloxacin）莫西沙星(moxifloxacin),总论,24.05.2020,.,87,喹诺酮抗菌药物,第一代奈啶酸第二代吡哌酸pipemidicacid第三代氟派酸三代半左氧氟沙星第四代加替沙星莫西沙星moxifloxacin,呼吸喹诺酮,总论,24.05.2020,.,88,24.05.2020,.,89,24.05.2020,.,90,有,和,无,24.05.2020,.,91,24.05.2020,.,92,24.05.2020,.,93,24.05.2020,.,94,24.05.2020,.,95,24.05.2020,.,96,肺炎,24.05.2020,.,97,24.0