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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58,2019/6/27,Respiratory System,Respiratory System,nose（nas/o OR rhin/o）,larynx (laryn/o),Lungs (pneumon/o OR pulmo ),bronchus (bronch/o),diaphragm (diaphragm/o),mediastinum,（一）pandect
2、,Organs,3,Functions,Breathing process Exchange of Oxygen and Carbon Dioxide Enable speech production,oxygen carbon dioxide,Alveolar/0-,Hyperpnea,Cyanosis,02,co2,Respiratory System,（一）pandect,4,The influencing factors of respiratory diseases,Respiratory System,（一）pandect,Air pollution and smoking Inh
3、aled 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 Pn
4、eumothorax 气胸/ pleural effusion/ left heart failure Stethalgia 胸痛 hemothorax/ Pulmonary thromboembolism,Respiratory System,（一）pandect,Lab and other inspection,Blood tests antigen skin test phlegm examination pleural effusion thoracicopuncture radio examination,Respiratory System,（一）pandect,bronchosc
5、opy Thoracoscope lungobiopsy supersonic inspection respiratory function test Pulmometry,Definition Pneumonia is an acute infection of the parenchymaprekm of the lung, 肺炎是肺实质的急性感染 ，(lower-respiratory tract) 下呼吸道 caused by microorganism makr:gnzm 由微生物引起, comes with fever , focal chest symptoms , shado
6、wing on CXR（chest X-ray胸部x线检查）. 伴随发热，局灶性胸部症状，胸片阴影。,Respiratory System,2019/6/27,Defense mechanism difens meknizmof the respiratory tract（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 咳嗽反射 Mucociliarymju:kslr clearance
7、 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,Respiratory System,（二）、Pneumonia in general,2019/6/27,鼻炎,咽炎,耳炎,扁桃体炎,喉炎,细支气管炎,Respiratory System,Sinus/-itis sansats 鼻窦炎 Pharyng/-itis .frndats 咽炎 Lary
8、ng/-itis lrndats 喉炎 Bronch/-itis brkats 支气管炎,2019/6/27,2019/6/27,Respiratory System,2019/6/27,Etiology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,Respiratory System,2019/6/27,Causative organisms致病微生物,Bacteria细菌 Mycoba
9、cteria分枝杆菌 Chlamydiae衣原体 Mycoplasma支原体 Fungi真菌 Parasites寄生虫 Viruses病毒,2019/6/27,Classification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,Respiratory System,2019/6/27,Classification by anatomy按解剖分类,Lobar大叶性 : Involvement of an enti
10、re lobe 一个完整的叶的参与 Lobular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ntstl : Involvement of the interstitial tissue of the lungs肺间质组织参与,Respiratory System,2019/6/27,Classification by patho
11、gen按病原体分类,Respiratory System,2019/6/27,Classifications by acquired environment 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 older 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。
12、Hospital-acquired pneumonia: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 endotracheal 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。,2019/6/27,Symptoms,Co
13、ugh 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,Respiratory System,2019/6/27,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,关节痛
14、,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 by high fever , chills寒战, cough, bloody sputum痰中带血 and chest pain.,Respirator
15、y 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 capillaries毛细血管 kplrz 2, the fibrinous纤维蛋白fabrns exudate渗出物eksdet,Respiratory Syst
16、em,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 phagocytosis白细胞吞噬作用.At last, the fibrous protein纤维蛋白is broken down and absorbed,the
17、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。,Respiratory System,In fact, early treatment by using antibacterial抗菌的drug cause hepatization肝样变 in pathological stage does not have precise limits. We had rarely seen this typical pathological sta
18、ge 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。,Respiratory System,2019/6/27,Etiology and pathogenesis,organism,S.pneumoniae,Dynamic balance,2019/6/27,S.pneumoniae as the gram- positive bacillus, capsule, its virulence size related to the structure and content of capsular polysacch
19、aride, in dry phlegm can survive for months, but direct sunlight for 1 hour, heat 52 degrees 10 min can be killed.,Respiratory System,2019/6/27,Etiology and pathogenesis,The body keeps a dynamic equilbrium between the organism and S.pneumoniae as well as the internal and external envairoment ,under
20、normal conditions,S.pneumoniae sent in the hunman oral cavity and nasopharynx,they are called “ normal flora”.,Respiratory System,2019/6/27,Etiology and pathogenesis,the pathogenicity of S. pneumoniae is due to the capsule invade the organization, first of all, cause to hydrops of alveolar walls, le
21、ukopedesis, overspreading the lung segment and pulmonary lobe.,Respiratory System,2019/6/27,Etiology and pathogenesis,when the body resistance is too weak for the body to adapt to climatic change,when S.pneumoniae are excessive ,When the dynamic equilbrium is damaged and cannot restored immediately,
22、S. pneumoniae will become pathogenic factor and lead to the occurance of disease .,Respiratory System,2019/6/27,Streptococcus pneumoniae high-risk groups ：,Smokers, dementia, Chronic Bronchitis , bronchiectasis, cardiac failure,chronic disease,immunosuppressants users, the elderly, infants and young
23、 children,2019/6/27,Laboratory 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),2019/6/27,1.The WBC:( 10 30) x 109 / L, neutrophils中性粒细胞 80%; The WBC can be normal, but neutrophils m
24、ust 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.,2019/6/27,3. Blood gas analysis血气分析: PaO2 can be decreased, PaCO2 can be normal or decreased, metabolic acidosis代谢性酸中毒metblik sidusis .,What are pneu
25、monia 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 sputum production. The sputum is usually discolored and sometimes
26、 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 pleuritic pain or pleurisy. A worsening cough, headaches, and
27、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 potentially lethal Pleural effusion and empyema Infective shock Toxic m
28、yocarditis 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 a particular area of the chest. A chest X-ray is usually orde
29、red 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 collected and examined under the microscope. Pneumonia caused
30、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 more appropriate therapy.,A blood test,That measures white bl
31、ood 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 infections. Whereas an increase in lymphocytes, another type
32、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 lymphocytes Monocytes Platelet count, prothrombin time Partial th
33、romboplastin time blood glucose,Bronchoscopy,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 examine the breathing passages（trachea and bronchi）.Simulta
34、neously, 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 pleural effusion. If a significant amount of fluid develops, i
35、t 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.,Diagnosis,1Preceding history of common cold or other URI； 2. Symptoms：abrupt onset, high f
36、ever,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 ,blood ,lung tissue.,Upper respiratory infection,Diff
37、use interstitial pneumonia,Lobar pneumonia,Criteria of severe pneumonia,1. Respiratory rate30/min； 2. Blood pressure7.1mmol/L(30mg/DL)； 5. X-ray:two lobes are involved；,Need for vasopressors,Renal Failure,Caseous pneumonia(lung tuberculosis）,Differential diagnosis,Apical location,Insidious onset wit
38、h lower fever，night sweats， Fatigue and weight loss,Not respond to antibiotics,Sputum smear for tubercle bacilli(+),Differential diagnosis,Lung abscess,Copious purulent foul-smelling sputum,Differential diagnosis,Obstructive pneumonia,superimposed hilar shadow,recurrent pneumonia at the same site ha
39、ppended in patients over 40, which does not respond well to the antibiotic treatment,fiberoptic bronchoscopy,2019/6/27,Treatment,Antiinfectious therapy Supportive therapy Therapy of complications,2019/6/27,Treatment,The more serious pneumonia, requires antibiotics such as penicillin.,2019/6/27,Treat
40、ment,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 complication that occur,2019/6/27,Treatment,For patients who are believed to be all
41、ergic to penicillin(青霉素), one may select the first or second generation cephalosporin(头孢菌素) or advanced macrolide(大环内酯物)+ -lactam(-内酰胺) or respiratory fluoroquinolone(氟喹诺酮) alone.,2019/6/27,Treatment,In some cases, vancomycin may be used. Treatment with any effective agent should be given for at lea
42、st 5 to 7 day or after the patients have been afebrile for 2-3 days,2019/6/27,Supportive 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 ana
43、lgesic(止痛剂) to relieve pleuritic (胸膜炎的)pain -Replacing fluids, if the patient is dehydrated(脱水的),2019/6/27,Supportive measure,Correcting electrolytes(电解质) Oxygen therapy,2019/6/27,Treatment of complications,Empyema(脓胸) develops in appoximately 5% of patients with pneumococcal pneumonia, although ple
44、ural effusion(胸膜渗出物) commonly develop in 10%- 20% patients Chest X-ray with lateral decubitus（侧卧位） films are often useful in the early recognition of pleural effusion, pleural fluid that is removed should be subjected to routing examination,2019/6/27,Treatment of complications,Extra pulmonary（胸部的） c
45、omplications such as arthritis（关节炎）, endocarditis（心内膜炎） must be excluded, because the therapy requires higher dosages（剂量） Treatment of infections shock,2019/6/27,Prevention,The most important preventive tool available is using a pneumococcal vaccine（疫苗） in those with chronic lung diseases, chronic l
46、iver diseases, splenectomy（脾切除术）, diabetes mellitus（糖尿病患者） and aged,2019/6/27,Prevention,The germs（微生物） that cause many of the different types of pneumonia can be contagious（有传染性的） and are spread through coughing and sneezing. You can prevent pneumonia by following good hygiene habits, such as: -Cou
47、gh or sneeze into a tissue. -Use separate drinking glasses and eating utensils. -Wash your hands frequently with warm soapy water.,2019/6/27,Prevention,Do not visit sick patients with pneumonia. If you have pneumonia, do not visit older people, visit older people, babies or sick people.,2019/6/27,Prevention,Improve immunity ： follow these well-known measures to stay healthy and keep the immune system ready: -Eat healthy -Sleep well -Avoid smoking -Exercise -Reduce stress -Do not drink alcohol in excess,2019/6/27,Thank You !,