pneumonia呼吸系统肺炎英文带教

1、Contents（一）、pandect总论3（二）、Pneumonia in general8（三）、Etiology病原学13（四）、Signs症状体征34（五）、Treatment49（六）、Prevention预防582021-7-19uRespiratory SystemuRespiratory Systemnose（nas/o OR rhin/o）larynx (laryn/o)Lungs (pneumon/o OR pulmo )bronchus (bronch/o)diaphragm (diaphragm/o)mediastinum（一）（一）pandect Organs 3 F

2、unctions Breathing process Exchange of Oxygen and Carbon DioxideEnable speech productionoxygencarbon dioxideAlveolarAlveolar/ /0-0-Hyperpnea Cyanosis02co2uRespiratory System（一）（一）pandect4 The influencing factors of respiratory diseasesuRespiratory System（一）（一）pandect Air pollution and smoking Inhale

3、d allergens The variation of etiology and Drug resistance increases Signs and symptoms Cough Laryngitis/ bronchitis/ bronchial asthma/ chronic obstructive pulmonary disease (COPD)/ lung cancer Expectoration 吐痰 Lung abscess/ bronchiectasis/ pneumonia Hemoptysis 咯血 pulmonary Tuberculosis Dyspnea Pneum

4、othorax 气胸/ pleural effusion/ left heart failure Stethalgia 胸痛 hemothorax/ Pulmonary thromboembolismuRespiratory System（一）（一）pandect Lab and other inspectionBlood testsantigen skin test phlegm examination pleural effusionthoracicopunctureradio examination uRespiratory System（一）（一）pandectbronchoscopy

5、Thoracoscope lungobiopsysupersonic inspectionrespiratory function testPulmometry Respiratory System2021-7-19Defense mechanism difens meknizmof the respiratory tract（呼吸道防御机制）（呼吸道防御机制） Filtrationfiltrein and depositiondepzn 滤除及沉积（nasal function鼻功能）pathogenspdns in the upper airways 上呼吸道病原体Cough reflex

6、 咳嗽反射 Mucociliarymju:kslr clearance 黏液纤毛清除 macrophagesmkrfed 巨噬细胞 Humoralhju:mrl and cellular seljl(r) immunity 体液及细胞的免疫 Oxidative ksdetv metabolism mtblzmof the neutrophils 中性粒细胞的氧化代谢uRespiratory System（二）、Pneumonia in general2021-7-19 鼻炎咽炎耳炎扁桃体炎喉炎细支气管炎uRespiratory SystemSinus/-itis sansats 鼻窦炎鼻窦炎

7、Pharyng/-itis .frndats 咽炎咽炎Laryng/-itis lrndats 喉炎喉炎Bronch/-itis brkats 支气管炎支气管炎2021-7-19rootmeaningexamplePneum(o)-Lung,airpneumothoraxnju:m:rks气胸 pneumonia肺炎 pneumatic nu:mtk充气的 pneumocystisnjumssts肺囊虫 pneumonectomynju:mnektm 肺切除术 pneumonrrhagia nju:mrei:d 肺出血 pneumographnju:mgr:f 呼吸描计议 pneumocyte

8、nju:mst肺细胞 pneumatocelenju:mtsi:l 肺膨出Pulmo(o)-Pulmonaryplmnri肺的,肺病的Path(o)-pathologyPathobiologypbald 病理学 Pathogenpdn病原体Pathogenesis pdenss 发病机理 pathologistpldst 病理学家Muc(o)-SlimeMucoidmju:kd粘液样的 mucociliarymju:kslr 黏液纤毛的 mucositismju:ksats 黏膜炎Myx(o)-Myxomamksm粘液瘤 myxobacteriamksbktr 黏细菌myxiod粘液样的Bro

9、nch(o)-bronchiBronchogenicbrnkdenk 支气管原的 bronchoscopybrntskp支气管镜检查术 bronchitisbrkats 支气管炎 bronchospasmbrkspzm支气管痉挛Bronchoconstrictionbrntknstrkn支气管狭窄2021-7-19rootmeaningexampledys-有病的、不正常的、有障碍的dyspnea（呼吸困难）dspni: 、dyscrasia（恶病质）dskrezj 、dysentry（痢疾）dsntr 、dysplasia（发育异常）dsple pnea呼吸eupnea（呼吸正常）ju:pn

10、i: 、tachypnea（呼吸急促）tkpni: hyper-超出、在之上、高于、过度hyperadenosis（腺增大）haprdnss 、hyperaemia（充血）hapri:m 、hyperinsulinism（胰岛素分泌过多）hapnslnzm 、hyperpiesia（血压过高）hap(:)pazj 、hyperthyroid（甲状腺功能亢进）hapard hypo-在下、次于、不足hypothermia（低体温）hap:mi 、hypoglottis（舌下部）hapglts 、hypoacidity （胃）酸过少 hpsdt 、hypocalcemia（低血钙）hapklsi:

11、m 、hypoglycemia（低血糖）hapglasi:m uRespiratory System2021-7-19Etiology病因 There are two factors involved in the formation of pneumonia ,参与肺炎形成的两个因素，including pathogens and host defenses.包括病原体和宿主防御 uRespiratory System2021-7-19Causative organisms致病微生物 Bacteria细菌 Mycobacteria分枝杆菌 Chlamydiae衣原体 Mycoplasma支原

12、体 Fungi真菌 Parasites寄生虫 Viruses病毒rootmeaningexamplegerm-病菌germicide杀菌剂d:msad bacteri-细菌bacteriology细菌学 bacteriemia菌血症bktrmj bactericide杀菌剂bktrsad bacill-杆菌bacillemia杆菌血症bsli:m -coccus球菌diplococcus双球菌dplkks 、gonococcus淋球菌gnkks strept-链streptococcus链球菌属streptkks staphyl-葡萄staphylococcus葡萄球菌属stflkks 、st

13、aphyloma葡萄肿stflm monil-念珠菌moniliasis念珠菌病mnlass fung-真菌fungoid似真菌的，状的fgd 、fungicide杀真菌剂fngsad myc-霉菌mycoology霉菌学，真菌学 antimycotic抗真菌的2021-7-19Classification分类 Classification of anatomy按解剖分类 Classification of pathogen按病原体分类 Classification of acquired environment按患病环境分类 uRespiratory System2021-7-19Class

14、ification by anatomy按解剖按解剖分类分类 Lobar大叶性大叶性 : Involvement of an entire lobe 一个完整的叶的参与 Lobular小叶性小叶性 : Involvement of parts of the lobe only, segmental or of alveoli contiguous to bronchi (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间质性间质性ntstl : Involvement of the interstitial tissue

15、 of the lungs肺间质组织参与 uRespiratory System2021-7-19Classification by pathogen按病原体分按病原体分类类Pneumococcal pneumonia ,njumkkl肺炎球菌肺炎Staphylococcal pneumonia stflkkl 葡萄球菌肺炎Mycoplasmal pneumonia肺炎支原体肺炎Chlamydia pneumonia klmidi 肺炎衣原体肺炎 Viral pneumonia病毒性肺炎Pulmonary candidiasis knddass 肺念珠菌病Pulmonary aspergill

16、osisspdilusis 肺曲霉菌病klebsiella pneumoniaklebziel 克雷伯杆菌肺炎legionaires disease li:dne 军团菌肺炎uRespiratory System2021-7-19Classifications by acquired environment按患病环境分类按患病环境分类 Community-acquired pneumonia:社区获得性肺炎：。 Occur in community within 48 hour.在社区48小时内发生 S.pneumonia is the most common CAP in people ol

17、der than 60. Most common during winter and spring. 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-acquired pneumonia:医院获得性肺炎医院获得性肺炎 Certain illness may predispose HAP because of:Impaired defenses or chronic illness;Coma昏迷, malnutrition营养不良, prolong hospitalization住院时间延长;Numerous intervention介入 as endotrach

18、eal intubation 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。 2021-7-19Symptoms Cough Dyspnea呼吸困难 dspni: Pleuritic肋膜炎的 plrtk chest pain胸痛 Fever or hypothermia发热或低体温 Myalgias肌痛 mald Chills/Sweats发冷/出汗 Fatigue疲劳 fti: Headache Diarrhea腹泄 sinusitis鼻窦炎sansats expectoration咳痰 uRespiratory System2021

19、-7-19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呕吐呕吐 关节痛Pneumococcal pneumonia肺炎链球菌肺炎 The pneumonia that is caused by Streptococcus pneumoniae nearly half of community-acquired pneumonia(CAP）由肺炎链球菌引起的肺炎近一半是社区获得性肺炎. The disease onset is acute起病急and can be serious,accompanied伴有 b

20、y high fever , chills寒战, cough, bloody sputum痰中带血 and chest pain. uRespiratory System The pathological change病理变化is divided into four periods,分为四个时期，i.e. congestive stage充血期, red hepatization红色肝样变, gray hepatization灰色肝样变and resolution消散期. 1 2 1,dilatation扩张dalten and congestion充血kndestn of the capil

21、laries毛细血管 kplrz 2, the fibrinous纤维蛋白fabrns exudate渗出物eksdet uRespiratory System This is noted clinically as oedema水肿di:m and congestion充血 in lung, alveolar exudate肺泡渗出,hematidhemtd infiltration红细胞浸润,leukocytelu:ksat infiltration白细胞浸润.Then the bacterium细菌will be eliminated消除through leukocytic phagoc

22、ytosis白细胞吞噬作用.At last, the fibrous protein纤维蛋白is broken down and absorbed,the alveolar inflates again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。uRespiratory System In fact, early treatment by using antibacterial抗菌的drug cause hepatization肝样变 in pathological stage

23、does not have precise limits. We had rarely seen this typical pathological stage in clinical. 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。uRespiratory System2021-7-19Etiology and pathogenesis organismS.pneumoniaeDynamic balance 2021-7-19 S.pneumoniae as the gram- positive bacillus, capsule, its

24、 virulence size related to the structure and content of capsular polysaccharide, in dry phlegm can survive for months, but direct sunlight for 1 hour, heat 52 degrees 10 min can be killed.uRespiratory System2021-7-19Etiology and pathogenesis The body keeps a dynamic equilbrium between the organism a

25、nd S.pneumoniae as well as the internal and external envairoment ,under normal conditions,S.pneumoniae sent in the hunman oral cavity and nasopharynx,they are called “ normal flora”. uRespiratory System2021-7-19Etiology and pathogenesis the pathogenicity of S. pneumoniae is due to the capsule invade

26、 the organization, first of all, cause to hydrops of alveolar walls, leukopedesis, overspreading the lung segment and pulmonary lobe.uRespiratory System2021-7-19Etiology and pathogenesis when the body resistance is too weak for the body to adapt to climatic change,when S.pneumoniae are excessive ,Wh

27、en the dynamic equilbrium is damaged and cannot restored immediately,S. pneumoniae will become pathogenic factor and lead to the occurance of disease .uRespiratory System2021-7-19Streptococcus pneumoniae high-risk groups ： Smokers, dementia, Chronic Bronchitis , bronchiectasis, cardiac failure,chron

28、ic disease,immunosuppressants users, the elderly, infants and young children 2021-7-19Laboratory Examinations实验室检查 WBC(white blood cell)白细胞 PaO2 (动脉血氧分压Arterial动脉的 :trl Partial部分的 Pressure of Oxygen ) PaCO2 (肺泡二氧化碳分压Alveolar肺泡的 Partial Pressure of Carbon Dioxide)2021-7-19 1.The WBC:( 10 30) x 109 /

29、L, neutrophils中性粒细胞 80%; The WBC can be normal, but neutrophils must be increased. 2.The Bacteriological examination细菌学检查 : direct smear直接涂片， use sputum culture, 痰涂片 culture with blood or pleural effusion 血液或胸腔积液培养.2021-7-19 3. Blood gas analysis血气分析: PaO2 can be decreased, PaCO2 can be normal or de

30、creased, metabolic acidosis代谢性酸中毒metblik sidusis .What are pneumonia symptoms and signs? Initially have symptoms of a cold（upper respiratory infection, for example, sneezing, sore throat, cough）,which are then followed by a high fever（sometimes as high as 104 F ）, shaking chills, and a cough with sp

31、utum production. The sputum is usually discolored and sometimes bloody, shortness of breath.The individuals skin color may change and become dusty or purplish（a condition known as “cyanosis ”）due to their blood.Symptoms This pain is usually sharp and worsen when taking a deep breath and is known as

32、pleuritic pain or pleurisy. A worsening cough, headaches, and muscle aches may be the only symptoms. Children and babies who develop pneumonia often do not have any specific signs of a chest infection but develop a fever ,appear quite ill,and can become lethargic.Complications Serious and potentiall

33、y lethal Pleural effusion and empyema Infective shock Toxic myocarditis ARDS （Acute Respiratory Distress Syndrome ) Organized pneumonia Pleuritis Meningocephalitis How is pneumonia diagnosed？ Coarse breathing or cracking sounds with a stethoscope. Wheezing or the sounds of breathing may be faint in

34、a particular area of the chest. A chest X-ray is usually ordered to confirm the diagnosis of pneumonia. The lungs have lobes，usually two on the left and three on the right.When the pneumonia affects one of these lobes，it is often referred to as lobar pneumonia.Sputum Samples Sputum Samples can be co

35、llected and examined under the microscope. Pneumonia caused by bacteria or fungi can be detected by this examination. As we have used antibiotics in a broader uncontrolled fashion, more organisms are becoming resistant to the commonly used antibiotics. These types of cultures can help in directing m

36、ore appropriate therapy.A blood test That measures white blood cell count.An individuals white blood cell count can often give a hint as to the severity of the pneumonia and whether it is caused by bacteria or a virus. An increased number of neutrophils, one type of WBC, is seen in most bacterial in

37、fections. Whereas an increase in lymphocytes, another type of WBC, is seen in viral infections, fungal infections, and some bacterial infections.Hematology laboratory Complete blood count（CBC） Red blood cell count（RBC） Hemoglobin （Hgb） Hematocrit（Hct） White blood cell count （WBC） Neutrophils lymphoc

38、ytes Monocytes Platelet count, prothrombin time Partial thromboplastin time blood glucoseBronchoscopy Bronchoscopy is a procedure in which a thin, flexible, lighted viewing tube is inserted into the nose or mouth after a local anesthetic is administered. Using this device ,the doctor can directly ex

39、amine the breathing passages（trachea and bronchi）.Simultaneously, samples of sputum or tissue from the infected part of the lung can be obtained.Fluid collects Sometimes, fluid collects in the pleural space around the lung as a result of the inflammation from pneumonia. This fluid is called a pleura

40、l effusion. If a significant amount of fluid develops, it can be removed. After numbing the skin with local anesthetic a needle is inserted into the chest cavity and fluid can be withdrawn and examined under the microscope. This procedure is called a thoracentesis. Diagnosis1Preceding history of com

41、mon cold or other URI；2. Symptoms：abrupt onset, high fever,cough with a rusty sputum,chest pain,dyspnea and cough etc；3.Signs: remarkable moist rale； 4. Blood test：leukocytosis；5. Radiologic study: Lobar consolidation ；6.A definitive diagnosis requires demonstration of pneumonia in sputum culture ,b

42、lood ,lung tissue. Upper respiratory infectionDiffuse interstitial pneumoniaLobar pneumoniaCriteria of severe pneumonia1. Respiratory rate30/min；2. Blood pressure90/60mmHg；3. Blood gas :PaO260mmHg， PaO2/FiO2 7.1mmol/L(30mg/DL)；5. X-ray:two lobes are involved；Need for vasopressorsRenal Failure Caseou

43、s pneumonia(lung tuberculosis）Differential diagnosisApicallocationInsidious onset with lower fever，night sweats，Fatigue and weight lossNot respond to antibioticsSputum smear for tubercle bacilli(+)Differential diagnosis Lung abscessCopious purulent foul-smelling sputumDifferential diagnosis Obstruct

44、ive pneumoniasuperimposed hilar shadowrecurrent pneumonia at the same site happended in patients over 40, which does not respond well to the antibiotic treatmentfiberoptic bronchoscopy2021-7-19Treatment Antiinfectious therapy Supportive therapy Therapy of complications2021-7-19 Treatment The more se

45、rious pneumonia, requires antibiotics such as penicillin. 2021-7-19Treatment All patients with suspected pneumococcal pneumonia should be treated as promptly as possible with penicillin G The dose and route of delivery may have to be on the basis of patients status /adverse rea- ction or complicatio

46、n that occur 2021-7-19Treatment For patients who are believed to be allergic to penicillin(青霉素青霉素), one may select the first or second generation cephalosporin(头孢菌素头孢菌素) or advanced macrolide(大环内酯物大环内酯物)+ -lactam(-内酰胺内酰胺) or respiratory fluoroquinolone(氟喹诺酮氟喹诺酮) alone.2021-7-19Treatment In some case

47、s, vancomycin may be used. Treatment with any effective agent should be given for at least 5 to 7 day or after the patients have been afebrile for 2-3 days2021-7-19Supportive measure Supportive measure are generally used in the initial management of acute pneumo-coccal pneumonia, such measures include -Bed rest-Monitoring vital signs and urine output -Administering an occasional analgesic(止痛剂止痛剂) to relieve pleuritic (胸膜炎的胸膜炎的)pain -Replacing fluids, if the patient is dehydrated(脱水的脱水的) 2021-7-19Supportive measure Correcting electrolytes(电解质电解质