呼吸系统疾病基础知识概述（英文版）

同学们好！,呼吸系统疾病RespiratorySystemDisease,湘雅医院儿科郑湘榕,婴幼儿上感、2种特殊类型上感的特点支气管肺炎临床表现、重症肺炎特点支气管肺炎的诊断、治疗支气管哮喘的临床表现、诊断和治疗,重点,Introduce,Inpediatricoutpatient,6o%patientsareacuterespiratoryinfections.Inpediatricward,25%patientsarePneumonia.ThefirstcauseofchildrensdeathinChinaisPneumonia.Pneumoniaistheworldsleadingcauseofdeathamongchildren.Itkillsnearlytwomillionchildrenunderagefiveeveryyear.,Whychildrenaresosusceptibletoacuterespiratoryinfections,?,anatomicphysiologicalfeatures,Thechildrensrespiratorylumensarenarrow,bloodflowisabundant.Thechildrensrepertoryabilityislow.Thechildrenslocalimmunityislow.,ChildrenRespiratorySystemPhysiologicFeature,Respiratoryrate,Neonate40-44/min60次/分心率突然增快婴儿180次/分幼儿160次/分突然烦躁不安、面色发灰心音明显低钝，奔马率，颈静脉怒张肝大肋下3cm以上尿少、下肢浮肿,Clinicalmanifest,nervalsystem,Lighthypoxia：irritability，lethargy,Severhypoxia：hydrocephalus,digestivesystem,alimentarycanalbleeding,Poisoningintestinepalsy,Severesymptomatic,Clinicalmanifest,DIC,Bp,四肢凉，脉速弱，出血,SLADH,Na+130mmol/L渗透压270mOsm/L,Edema,Severesymptomatic,Complications,Complication,pneumatocele,pyopneumothorax,empyema,Laboratorydata,Blood,bloodroutine,bacteriainfect：WBC、Nleftshiftofnucleusvirusinfect：WBC、Labnormallymphcell,bacteriainfect：CRPvirusinfect：CRPnormal,CRP,NBT,bacteriainfect：10%virusinfect：10%,Pathogeny,virusseparate,Germiculture,sputumforGramstainandculture,Laboratorydata,X-ray,shadowofdotandspote,emphysemaatelectasis,支气管肺炎,正常胸片,大叶性肺炎,正常胸片,fever,cough,tachypnea,respiratorydistressandrales,X-ray,diagnosis,Differentiation,foreignbodiesinbronchi,historyofforeignbodies、suddencough、respiratorydistress、lowerofbreathtoneorwheezing,Treatment,generaltreatment,Balanceofwaterandelectrolyte3%Nacl12ml/LNa+10mmol/L,Temperature18-20Humidity60%Foodnutritive,Treatment,Controlinfection,virus：noidealdruglikevirozol,mycoplasma、chlamydiaselecterythromycin,bactrria：theprincipleofsensitivityefficiency、fullperiodoftreatment,firstselectPeniccilin,Treatment,抗生素使用原则,根据药敏选药adoptsensitivedrugsonthebasisofpathogenicbacterium用下呼吸道浓度高的药物adoptdrugswhichcanfinallyinfiltratelungtissue足量足疗程重症静脉给药inseverecase,drugsshouldbeadministedbyvein,fulldose,fullperiod,Treatment,抗生素选择,肺炎链球菌：PNC,阿莫西林，红霉素金黄色葡萄球菌：苯唑西林、氯唑西林、万古、利福平流感嗜血杆菌：阿莫西林+克拉维酸钾或舒巴坦大肠杆菌和肺炎杆菌：头孢曲松或头孢噻肟绿脓杆菌：替卡西林钠克拉维酸钾或头孢哌酮肺炎支原体或衣原体：大环内酯,Treatment,fullperiodoftreatment,aftertemperaturenormal57daysorclinicalsymptomdisappearing3daysMycoplasmapneumonia：23weeksStaphylococusaureus：aftertemperaturenormal2weeks，fullperiodis6weeks,treatagainstsymptoms,Treatment,oxygentreat,PaO2：dyspnea、cyanosis、asthmasuppress、toxicappearance,methods:bynosecanal0.51L/min，40%；byveil24L/min,50%60%mechanismventilate（respirefailture）,holdingrespiratorytractunobstructed,removesputum、pulverization、relievespasmensureliquidabsorb,Treatment,treatofothersymp,defervescecalm,treatofwindy,supplyKaliumPoisoningintestinepalsy：fasting、decompressofstomachandintestine酚妥拉明0.5mg/kgivgtt10%GS20ml,treatagainstsymptoms,Treatment,treatofHeartfailure,镇静给氧强心：西地兰减轻心脏负荷,treatagainstsymptoms,Treatment,合并中毒性脑病的治疗,脱水：甘露醇改善通气改善脑微循环止痉：地西泮地塞米松营养神经,treatagainstsymptoms,Treatment,糖皮质激素应用,适应症：喘憋重,呼吸衰竭全身中毒症状重感染性休克脑水肿,琥珀酸氢化可的松510mg/kg.d地塞米松0.10.3mg/kg.divgtt23次/日35天甲基强的松龙24mg/kg.次,ResponsetotreatmentinotherwiseuncomplicatedCAP?,Fever-fallsin2daysLeucocytosis-decreasesin4daysPhysicalfindingspersistslightlylongerChestradiographicabnormalitiesmaytake4-12weekstoresolve,Whatifpatientsfailstorecover?,Youshouldconsider-,NoninfectiousconditionResistancetodrugNewnosocomialpathogen,病毒性肺炎,呼吸道合胞病毒肺炎,腺病毒肺炎,2岁，26月多见喘憋、呼吸困难，可合并呼衰、心衰哮鸣音，细湿罗音小点片状影，肺气肿肺不张间质性肺炎,6月2岁中毒症状重，稽留热，咳剧，喘憋，呼吸困难出现晚，湿罗音或肺实变胸片改变出现早，肺气肿，片状影或融合,年龄,症状,胸片,体征,细菌性肺炎,葡萄球菌肺炎,新生儿，婴幼儿急、重、快，弛张热或稽留热，咳嗽，呼吸困难，呻吟，易致迁徒化脓病灶，并发脓胸，脓气胸，肺大疱中细湿罗音，出现早，皮疹浸润影，持续时间较长，易变，可见多发性肺脓肿，脓胸，脓气胸等,4岁慢，重，发热，痉挛性咳嗽，呼吸困难，发绀。易致迁徒化脓病灶，易并发脓胸湿罗音或实变大叶性肺炎、支气管肺炎、肺实变,年龄,症状,体征,胸片,革兰阴性杆菌肺炎,肺炎支原体肺炎,年长儿，婴幼儿发热、刺激性咳嗽，多系统病变不明显，婴幼儿可有呼吸困难，喘憋，哮鸣音，湿罗音肺门影增浓；支气管肺炎改变；间质性肺炎；均一实变影,20%,使用支扩剂后增加20%可诊断哮喘）,Diagnoseofchildfoodasthma,gasprecurrentattackslungwheezingralesbronchodilatorsisvalidexcludeotherdiseasethatcancausegasp,cough1month,antibioticstreatisinvalidbronchodilatorscanrelievecoughhypersensitivehistoryorallergiafamilyhistoryairwayishyperreactivityexcludeothercoughdisease,Diagnoseofcoughvariantasthma,therapy,Principle:long-term、persistence、standard、individuationPeriodofonset:antiinflammatory、calmgaspcatabasis:long-term、antiinflammatory、avoidtriggerfactor、self-caretospreadGlobalInitiativeforAsthma，GINA(全球哮喘防治创议),drug,glucocorticoid-firstselectbronchodilatorsimmunosuppressantotherdrug,inhale：beclometasone100g，24times/dayoral：prednisone12mg/kg/day，17dayseverecasepersistentattackanti-asthmaticcannotcontrolintravenousdrip：Cetacort510mg/kg/timeMedrat12mg/kg/time,BidTidsevereattack,glucocorticoidusage,drug,bronchodilatorspara-adrenaldruginhale0.5%albuterol0.010.03ml/kg/次atomizationq46htheocinaminofilina45mg/kg/次immunosuppressant-methotrexate-cyclosporinotherdrug-disodiumcromoglycate