pneumonia呼吸系统肺炎全英文 课件

Contents（一）、pandect··········································3（二）、Pneumoniaingeneral····················8（三）、Etiology··········································13（四）、Signs···············································34（五）、Treatment······································49（六）、Prevention·····································582026/1/25RespiratorySystemRespiratorySystemnose（nas/o

ORrhin/o）larynx(laryn/o)Lungs(pneumon/oORpulmo

)bronchus(bronch/o)diaphragm(diaphragm/o)mediastinum（一）pandectOrgans3

FunctionsBreathingprocessExchangeofOxygenandCarbonDioxideEnablespeechproductionoxygencarbon

dioxideAlveolar/0-HyperpneaCyanosis02co2RespiratorySystem（一）pandect4

TheinfluencingfactorsofrespiratorydiseasesRespiratorySystem（一）pandect

AirpollutionandsmokingInhaledallergensThevariationofetiologyandDrugresistanceincreases

SignsandsymptomsCoughLaryngitis/bronchitis/bronchialasthma/chronicobstructivepulmonarydisease(COPD)/lungcancerExpectoration

Lungabscess/bronchiectasis/pneumoniaHemoptysis

pulmonaryTuberculosisDyspnea

Pneumothorax/pleuraleffusion/leftheartfailureStethalgia

hemothorax/PulmonarythromboembolismRespiratorySystem（一）pandect

LabandotherinspectionBloodtestsantigenskintest

phlegm

examinationpleuraleffusionthoracicopunctureradioexamination

RespiratorySystem（一）pandectbronchoscopyThoracoscopelungobiopsysupersonicinspectionrespiratoryfunctiontestPulmometry

DefinitionPneumoniaisanacuteinfectionoftheparenchyma[pə'reŋkɪmə]ofthelung,肺炎是肺实质的急性感染

，(lower-respiratorytract)下呼吸道causedbymicroorganism[maɪkrəʊ'ɔ:gənɪzəm]

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。RespiratorySystem2026/1/25Defensemechanism[di'fens'mekənizəm]oftherespiratorytract（呼吸道防御机制）

Filtration[fil'treiʃn]anddeposition['depə'zɪʃn]

滤除及沉积（nasalfunction鼻功能）pathogens['pæθədʒəns]intheupperairways上呼吸道病原体Coughreflex咳嗽反射Mucociliary[mju:kəʊ'sɪlɪərɪ]clearance黏液纤毛清除macrophages['mækrəfeɪdʒ]巨噬细胞Humoral['hju:mərəl]andcellular['seljələ(r)]immunity体液及细胞的免疫Oxidative['ɒksɪdeɪtɪv]metabolism[məˈtæbəlɪzəm]ofthe

neutrophils中性粒细胞的氧化代谢RespiratorySystem（二）、Pneumoniaingeneral2026/1/25

鼻炎咽炎耳炎扁桃体炎喉炎细支气管炎RespiratorySystemSinus/-itis['saɪnə'saɪtɪs]鼻窦炎Pharyng/-itis[.færɪn'dʒaɪtɪs]咽炎Laryng/-itis[lærɪn'dʒaɪtɪs]喉炎Bronch/-itis[brɒŋ'kaɪtɪs]支气管炎2026/1/25rootmeaningexamplePneum(o)-Lung,airpneumothorax[nju:mə'θɔ:ræks]气胸pneumonia肺炎pneumatic[nu:'mætɪk]充气的pneumocystis[n'juːməsɪstɪs]肺囊虫pneumonectomy[nju:mə'nektəmɪ]肺切除术pneumonrrhagia[nju:mə'rei:dʒɪə]肺出血pneumograph['nju:məgrɑ:f]呼吸描计议pneumocyte[nju:mə'sɪt]肺细胞pneumatocele['nju:mətəʊsi:l]肺膨出Pulmo(o)-Pulmonary['pʌlmənəri]肺的,肺病的Path(o)-pathologyPathobiology[pæθəbaɪ'ɒlədʒɪ]病理学Pathogen[‘pæθədʒən]病原体Pathogenesis[pæθə‘dʒenɪsɪs]发病机理pathologist[pə’θɒlədʒɪst]病理学家Muc(o)-SlimeMucoid['mju:kɔɪd]粘液样的mucociliary[mju:kəʊ'sɪlɪərɪ]黏液纤毛的mucositis[m'ju:kɒsaɪtɪs]黏膜炎Myx(o)-Myxoma[mɪks'əʊmə]粘液瘤myxobacteria[mɪksəbæk'tɪərɪə]黏细菌myxiod粘液样的Bronch(o)-bronchiBronchogenic[brɒnkəd'ʒenɪk]支气管原的bronchoscopy[b'rɒntʃəskəpɪ]支气管镜检查术bronchitis[brɒŋ’kaɪtɪs]支气管炎bronchospasm['brɒŋkəspæzəm]支气管痉挛Bronchoconstriction[brɒnt'ʃəʊkənstrɪkʃn]支气管狭窄2026/1/25rootmeaningexampledys-有病的、不正常的、有障碍的dyspnea（呼吸困难）[dɪs'pni:ə]

、dyscrasia（恶病质）[dɪs'kreɪzjə]

、dysentry（痢疾）['dɪsntrɪ]

、dysplasia（发育异常）[dɪs'pleɪʒə]

pnea呼吸eupnea（呼吸正常）[ju:p'ni:ə]

、tachypnea（呼吸急促）[tækɪp'ni:ə]

hyper-超出、在······之上、高于、过度hyperadenosis（腺增大）[haɪpərædə'nəʊsɪs]

、hyperaemia（充血）[haɪpə'ri:mɪə]

、hyperinsulinism（胰岛素分泌过多）[haɪpə'ɪnsələnɪzəm]

、hyperpiesia（血压过高）[haɪpə(:)paɪ'ɪzjə]

、hyperthyroid（甲状腺功能亢进）[haɪpə'θaɪrɔɪd]

hypo-在······下、次于、不足hypothermia（低体温）[haɪpə‘θɜ:miə]

、hypoglottis（舌下部）[haɪpə'glɒtɪs]

、hypoacidity（胃）酸过少[hɪpəʊə'sɪdɪtɪ]

、hypocalcemia（低血钙）[haɪpəʊkæl'si:mɪə]

、hypoglycemia（低血糖）[haɪpəʊglaɪ'si:mɪə]

RespiratorySystem2026/1/25Etiology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RespiratorySystem2026/1/25Causativeorganisms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rootmeaningexamplegerm-病菌germicide杀菌剂[’dʒɜ:mɪsaɪd]

bacteri-细菌bacteriology细菌学bacteriemia菌血症[bæktə'rɪəmjə]

bactericide杀菌剂[bæk'tɪərɪsaɪd]

bacill-杆菌bacillemia杆菌血症[bəsɪ'li:mɪə]

-coccus球菌diplococcus双球菌[dɪpləʊ'kɒkəs]

、gonococcus淋球菌['gɒnəʊ'kɒkəs]

strept-链streptococcus链球菌属[streptə'kɒkəs]

staphyl-葡萄staphylococcus葡萄球菌属[stæfɪlə'kɒkəs]

、staphyloma葡萄肿[stæfɪ'ləʊmə]

monil-念珠菌moniliasis念珠菌病[mɒnɪ'laɪəsɪs]

fung-真菌fungoid似真菌的，状的[fʌŋgɔɪd]

、fungicide杀真菌剂[fʌngɪsaɪd]

myc-霉菌mycoology霉菌学，真菌学antimycotic抗真菌的2026/1/25Classification分类Classificationofanatomy按解剖分类Classificationofpathogen按病原体分类Classificationofacquiredenvironment按患病环境分类RespiratorySystem2026/1/25Classificationbyanatomy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[ɪntə’stɪʃl]

:Involvementoftheinterstitialtissueofthelungs肺间质组织参与

RespiratorySystem2026/1/25Classificationbypathogen按病原体分类Pneumococcalpneumonia[,njuːmə'kɒkəl]肺炎球菌肺炎Staphylococcalpneumoniastæfɪləʊ'kɒkəl]

葡萄球菌肺炎Mycoplasmalpneumonia肺炎支原体肺炎Chlamydiapneumonia[klə’midiə]

肺炎衣原体肺炎Viralpneumonia病毒性肺炎Pulmonarycandidiasis{kændə'daɪəsəs]

肺念珠菌病Pulmonaryaspergillosis[æspədʒi‘ləusis]

肺曲霉菌病klebsiellapneumonia[klebzi’elə]

克雷伯杆菌肺炎legionairesdisease[li:dʒə'neə]

军团菌肺炎RespiratorySystem2026/1/25Classificationsbyacquiredenvironment

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。2026/1/25Symptoms CoughDyspnea呼吸困难[dɪs'pni:ə]

Pleuritic肋膜炎的[plʊə'rɪtɪk]

chestpain胸痛Feverorhypothermia发热或低体温Myalgias肌痛[maɪ'ældʒə]

Chills/Sweats发冷/出汗Fatigue疲劳[fəti:ɡ]

HeadacheDiarrhea腹泄sinusitis鼻窦炎[saɪnə‘saɪtɪs]

expectoration咳痰RespiratorySystem2026/1/25全身怕冷湿冷发青痰痰短气胸膜炎的[plʊə'rɪtɪk]

胸痛咳血[hɪ'mɒptəsɪs]

疲劳[fə'ti:ɡ]

食欲差情绪波动血管的[væskjələ(r)]

恶心[nɔ:ziə]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.RespiratorySystemThepathologicalchange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[daɪlə‘teɪʃn]andcongestion充血[kən’dʒestʃən]ofthecapillaries毛细血管['kəpɪlərɪz]

2,

thefibrinous纤维蛋白[‘faɪbrɪnəs]exudate渗出物['eksədeɪt]

RespiratorySystemThisisnotedclinicallyasoedema水肿[ɪ‘di:mə]andcongestion充血inlung,

alveolarexudate肺泡渗出,hematid['hemətɪd]infiltration红细胞浸润,leukocyte['lu:kəsaɪt]infiltration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。RespiratorySystemInfact,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。RespiratorySystem2026/1/25Etiologyandpathogenesis

organismS.pneumoniaeDynamicbalance

2026/1/25S.pneumoniaeasthegram-positivebacillus,capsule,itsvirulencesizerelatedtothestructureandcontentofcapsularpolysaccharide,indryphlegmcansurviveformonths,butdirectsunlightfor1hour,heat52degrees10mincanbekilled.RespiratorySystem2026/1/25EtiologyandpathogenesisThebodykeepsadynamicequilbriumbetweentheorganismandS.pneumoniaeaswellastheinternalandexternalenvairoment,undernormalconditions,S.pneumoniaesentinthehunmanoralcavityandnasopharynx,theyarecalled“normalflora”.

RespiratorySystem2026/1/25EtiologyandpathogenesisthepathogenicityofS.pneumoniaeisduetothecapsuleinvadetheorganization,firstofall,causetohydropsofalveolarwalls,leukopedesis,overspreadingthelungsegmentandpulmonarylobe.RespiratorySystem2026/1/25Etiologyandpathogenesiswhenthebodyresistanceistooweakforthebodytoadapttoclimaticchange,whenS.pneumoniaeareexcessive,Whenthedynamicequilbriumisdamagedandcannotrestoredimmediately,S.pneumoniaewillbecomepathogenicfactorandleadtotheoccuranceofdisease.RespiratorySystem2026/1/25Streptococcuspneumoniaehigh-riskgroups：Smokers,dementia,ChronicBronchitis,bronchiectasis,cardiacfailure,chronicdisease,immunosuppressantsusers,theelderly,infantsandyoungchildren2026/1/25LaboratoryExaminations实验室检查WBC(whitebloodcell)白细胞PaO2(动脉血氧分压Arterial动脉的[ɑ:‘tɪərɪəl]Partial部分的PressureofOxygen)PaCO2(肺泡二氧化碳分压Alveolar肺泡的PartialPressureofCarbonDioxide)2026/1/251.TheWBC:(10~30)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.2026/1/253.Bloodgasanalysis血气分析:PaO2canbedecreased,PaCO2canbenormalordecreased,metabolicacidosis代谢性酸中毒[metə’bɔlik‘æsidəusis]

.Whatarepneumoniasymptomsandsigns?Initiallyhavesymptomsofacold（upperrespiratoryinfection,forexample,sneezing,sorethroat,cough）,whicharethenfollowedbyahighfever（sometimesashighas104F）,shakingchills,andacoughwithsputumproduction.Thesputumisusuallydiscoloredandsometimesbloody,shortnessofbreath.Theindividual’sskincolormaychangeandbecomedustyorpurplish（aconditionknownas“cyanosis”）duetotheirblood.SymptomsThispainisusuallysharpandworsenwhentakingadeepbreathandisknownaspleuriticpainorpleurisy.Aworseningcough,headaches,andmuscleachesmaybetheonlysymptoms.Childrenandbabieswhodeveloppneumoniaoftendonothaveanyspecificsignsofachestinfectionbutdevelopafever,appearquiteill,andcanbecomelethargic.Complications

Seriousandpotentiallylethal·Pleuraleffusionandempyema·Infectiveshock·Toxicmyocarditis·ARDS（AcuteRespiratoryDistressSyndrome)·Organizedpneumonia·Pleuritis·Meningocephalitis

Howispneumoniadiagnosed？Coarsebreathingorcrackingsoundswithastethoscope.Wheezingorthesoundsofbreathingmaybefaintinaparticularareaofthechest.AchestX-rayisusuallyorderedtoconfirmthediagnosisofpneumonia.Thelungshavelobes，usuallytwoontheleftandthreeontheright.Whenthepneumoniaaffectsoneoftheselobes，itisoftenreferredtoaslobarpneumonia.SputumSamplesSputumSamplescanbecollectedandexaminedunderthemicroscope.Pneumoniacausedbybacteriaorfungicanbedetectedbythisexamination.Aswehaveusedantibioticsinabroaderuncontrolledfashion,moreorganismsarebecomingresistanttothecommonlyusedantibiotics.Thesetypesofculturescanhelpindirectingmoreappropriatetherapy.AbloodtestThatmeasureswhitebloodcellcount.Anindividual’swhitebloodcellcountcanoftengiveahintastotheseverityofthepneumoniaandwhetheritiscausedbybacteriaoravirus.Anincreasednumberofneutrophils,onetypeofWBC,isseeninmostbacterialinfections.Whereasanincreaseinlymphocytes,anothertypeofWBC,isseeninviralinfections,fungalinfections,andsomebacterialinfections.HematologylaboratoryCompletebloodcount（CBC）Redbloodcellcount（RBC）Hemoglobin（Hgb）Hematocrit（Hct）Whitebloodcellcount（WBC）NeutrophilslymphocytesMonocytesPlateletcount,prothrombintimePartialthromboplastintimebloodglucoseBronchoscopyBronchoscopyisaprocedureinwhichathin,flexible,lightedviewingtubeisinsertedintothenoseormouthafteralocalanestheticisadministered.Usingthisdevice,thedoctorcandirectlyexaminethebreathingpassages（tracheaandbronchi）.Simultaneously,samplesofsputumortissuefromtheinfectedpartofthelungcanbeobtained.FluidcollectsSometimes,fluidcollectsinthepleuralspacearoundthelungasaresultoftheinflammationfrompneumonia.Thisfluidiscalledapleuraleffusion.Ifasignificantamountoffluiddevelops,itcanberemoved.Afternumbingtheskinwithlocalanestheticaneedleisinsertedintothechestcavityandfluidcanbewithdrawnandexaminedunderthemicroscope.Thisprocedureiscalledathoracentesis.Diagnosis1·PrecedinghistoryofcommoncoldorotherURI；2.Symptoms：abruptonset,

highfever,coughwitharustysputum,chestpain,dyspneaandcoughetc；3.Signs:remarkablemoistrale；

4.Bloodtest：leukocytosis；5.Radiologicstudy:Lobarconsolidation；6.Adefinitivediagnosisrequiresdemonstrationofpneumoniainsputumculture,blood,lungtissue.

UpperrespiratoryinfectionDiffuseinterstitialpneumoniaLobarpneumoniaCriteriaofseverepneumonia1.Respiratoryrate>30/min；2.Bloodpressure<90/60mmHg；3.Bloodgas:PaO2<60mmHg，

PaO2/FiO2

<300mmHg；4.BUN>7.1mmol/L(30mg/DL)；5.X-ray:twolobesareinvolved；NeedforvasopressorsRenalFailureCaseouspneumonia(lungtuberculosis）DifferentialdiagnosisApicallocationInsidiousonsetwithlowerfever，nightsweats，FatigueandweightlossNotrespondtoantibioticsSputumsmearfortuberclebacilli(+)DifferentialdiagnosisLungabscessCopiouspurulentfoul-smellingsputumDifferentialdiagnosisObstructivepneumoniasuperimposedhilarshadowrecurrentpneumoniaatthesamesitehappendedinpatientsover40,whichdoesnotrespondwelltotheantibiotictreatmentfiberopticbronchoscopy2026/1/25TreatmentAntiinfectioustherapySupportivetherapyTherapyofcomplications2026/1/25

TreatmentThemoreseriouspneumonia,requiresantibioticssuchaspenicillin.2026/1/25TreatmentAllpatientswithsuspectedpneumococcalpneumoniashouldbetreatedaspromptlyaspossiblewithpenicillinGThedoseandrouteofdeliverymayhavetobeonthebasisofpatientsstatus/adverserea-ctionorcomplicationthatoccur2026/1/25TreatmentForpatientswhoarebelievedtobeallergictopenicillin(青霉素),onemayselectthefirstorsecondgenerationcephalosporin(头孢菌素)oradvancedmacrolide(大环内酯物)+β

-lactam(β-内酰胺)orrespiratoryfluoroquinolone(氟喹诺酮)alone.2026/1/25TreatmentInsomecases,vancomycinmaybeused.Treatmentwithanyeffectiveagentshouldbegivenforatleast5to7dayorafterthepatientshavebeenafebrilefor2-3days2026/1/25Supportivemeasure

Supportivemeasurearegenerallyusedintheinitialmanagementofacutepneumo-coccalpneumonia,suchmeasuresinclude-Bedrest-Monitoringvitalsignsandurineoutput-Administering