pneumonia呼吸系統(tǒng)肺炎全英文 ppt課件

1、Contents（一）、pandect3（二）、Pneumonia in general8（三）、Etiology13（四）、Signs34（五）、Treatment49（六）、Prevention582022-4-17uRespiratory SystemuRespiratory Systemnosenas/o OR rhin/o）larynx (laryn/o)Lungs (pneumon/o OR pulmo )bronchus (bronch/o)diaphragm (diaphragm/o)mediastinum（一（一pandect Organs 3 Functions Breat

2、hing process Exchange of Oxygen and Carbon DioxideEnable speech productionoxygencarbon dioxideAlveolar/0-Alveolar/0-Hyperpnea Cyanosis02co2uRespiratory System（一（一pandect4 The influencing factors of respiratory diseasesuRespiratory System（一（一pandect Air pollution and smoking Inhaled allergens The var

3、iation of etiology and Drug resistance increases Signs and symptoms Cough Laryngitis/ bronchitis/ bronchial asthma/ chronic obstructive pulmonary disease (COPD)/ lung cancer Expectoration Lung abscess/ bronchiectasis/ pneumonia Hemoptysis pulmonary Tuberculosis Dyspnea Pneumothorax/ pleural effusion

4、/ left heart failure Stethalgia hemothorax/ Pulmonary thromboembolismuRespiratory System（一（一pandect Lab and other inspectionBlood testsantigen skin test phlegm examination pleural effusionthoracicopunctureradio examination uRespiratory System（一（一pandectbronchoscopyThoracoscope lungobiopsysupersonic

5、inspectionrespiratory function testPulmometry chest symptoms , shadowing on CXRchest X-ray胸部x線檢查）.伴隨發(fā)熱，局灶性胸部癥狀，胸片陰影。Respiratory System2022-4-17Defense mechanism difens meknizmof the respiratory tract呼吸道防御機制）呼吸道防御機制） Filtrationfiltrein and depositiondepzn 濾除及沉積nasal function鼻功能） pathogenspdns in the

6、upper airways 上呼吸道病原體 Cough reflex 咳嗽反射 Mucociliarymju:kslr clearance 黏液纖毛清除 macrophagesmkrfed 巨噬細胞 Humoralhju:mrl and cellular seljl(r) immunity 體液及細胞的免疫 Oxidative ksdetv metabolism mtblzmof the neutrophils 中性粒細胞的氧化代謝uRespiratory System（二）、Pneumonia in general2022-4-17 鼻炎咽炎耳炎扁桃體炎喉炎細支氣管炎uRespiratory

7、 SystemSinus/-itis sansats 鼻竇炎鼻竇炎 Pharyng/-itis .frndats 咽炎咽炎Laryng/-itis lrndats 喉炎喉炎Bronch/-itis brkats 支氣管炎支氣管炎2022-4-17rootmeaningexamplePneum(o)-Lung,airpneumothoraxnju:m:rks氣胸 pneumonia肺炎 pneumatic nu:mtk充氣的 pneumocystisnjumssts肺囊蟲 pneumonectomynju:mnektm 肺切除術(shù) pneumonrrhagia nju:mrei:d 肺出血 pne

8、umographnju:mgr:f 呼吸描計議 pneumocytenju:mst肺細胞 pneumatocelenju:mtsi:l 肺膨出Pulmo(o)-Pulmonaryplmnri肺的,肺病的Path(o)-pathologyPathobiologypbald 病理學 Pathogenpdn病原體Pathogenesis pdenss 發(fā)病機理 pathologistpldst 病理學家Muc(o)-SlimeMucoidmju:kd粘液樣的 mucociliarymju:kslr 黏液纖毛的 mucositismju:ksats 黏膜炎Myx(o)-Myxomamksm粘液瘤 my

9、xobacteriamksbktr 黏細菌myxiod粘液樣的Bronch(o)-bronchiBronchogenicbrnkdenk 支氣管原的 bronchoscopybrntskp支氣管鏡檢查術(shù) bronchitisbrkats 支氣管炎 bronchospasmbrkspzm支氣管痙攣Bronchoconstrictionbrntknstrkn支氣管狹窄2022-4-17rootmeaningexampledys-有病的、不正常的、有障礙的dyspnea（呼吸困難）dspni: 、dyscrasia（惡病質(zhì)）dskrezj 、dysentry（痢疾）dsntr 、dysplasia（

10、發(fā)育異常）dsple pnea呼吸eupnea（呼吸正常）ju:pni: 、tachypnea（呼吸急促）tkpni: hyper-超出、在之上、高于、過度hyperadenosis（腺增大）haprdnss 、hyperaemia（充血）hapri:m 、hyperinsulinism（胰島素分泌過多）hapnslnzm 、hyperpiesia（血壓過高）hap(:)pazj 、hyperthyroid（甲狀腺功能亢進）hapard hypo-在下、次于、不足hypothermia（低體溫）hap:mi 、hypoglottis（舌下部）hapglts 、hypoacidity （胃）酸過

11、少 hpsdt 、hypocalcemia（低血鈣）hapklsi:m 、hypoglycemia（低血糖）hapglasi:m uRespiratory System2022-4-17Etiology病因 There are two factors involved in the formation of pneumonia ,參與肺炎形成的兩個因素，including pathogens and host defenses.包括病原體和宿主防御 uRespiratory System2022-4-17Causative organisms致病微生物 Bacteria細菌 Mycobacte

12、ria分枝桿菌 Chlamydiae衣原體 Mycoplasma支原體 Fungi真菌 Parasites寄生蟲 Viruses病毒rootmeaningexamplegerm-病菌germicide殺菌劑d:msad bacteri-細菌bacteriology細菌學 bacteriemia菌血癥bktrmj bactericide殺菌劑bktrsad bacill-桿菌bacillemia桿菌血癥bsli:m -coccus球菌diplococcus雙球菌dplkks 、gonococcus淋球菌gnkks strept-鏈streptococcus鏈球菌屬streptkks staphy

13、l-葡萄staphylococcus葡萄球菌屬stflkks 、staphyloma葡萄腫stflm monil-念珠菌moniliasis念珠菌病mnlass fung-真菌fungoid似真菌的，狀的fgd 、fungicide殺真菌劑fngsad myc-霉菌mycoology霉菌學，真菌學 antimycotic抗真菌的2022-4-17Classification分類 Classification of anatomy按解剖分類 Classification of pathogen按病原體分類 Classification of acquired environment按患病環(huán)境分類

14、 uRespiratory System2022-4-17Classification by anatomy按解按解剖分類剖分類 Lobar大葉性大葉性 : Involvement of an entire lobe 一個完整的葉的參與一個完整的葉的參與 Lobular小葉性小葉性 : Involvement of parts of the lobe only, segmental or of alveoli contiguous to bronchi (bronchopneumonia支氣管肺炎支氣管肺炎 ). 只有部分的肺葉，節(jié)段性支氣管或相連的肺只有部分的肺葉，節(jié)段性支氣管或相連的肺泡受

15、累；泡受累； Interstitial間質(zhì)性間質(zhì)性ntstl : Involvement of the interstitial tissue of the lungs肺間質(zhì)組織肺間質(zhì)組織參與參與 uRespiratory System2022-4-17Classification by pathogen按病按病原體分類原體分類Pneumococcal pneumonia ,njumkkl肺炎球菌肺炎Staphylococcal pneumonia stflkkl 葡萄球菌肺炎Mycoplasmal pneumonia肺炎支原體肺炎Chlamydia pneumonia klmidi 肺炎衣原

16、體肺炎 Viral pneumonia病毒性肺炎Pulmonary candidiasis knddass 肺念珠菌病Pulmonary aspergillosisspdilusis 肺曲霉菌病klebsiella pneumoniaklebziel 克雷伯桿菌肺炎legionaires disease li:dne 軍團菌肺炎uRespiratory System2022-4-17Classifications by acquired environment按患病環(huán)境分類按患病環(huán)境分類 Community-acquired pneumonia:社區(qū)獲得性肺炎：。 Occur in commu

17、nity within 48 hour.在社區(qū)48小時內(nèi)發(fā)生 S.pneumonia is the most common CAP in people older than 60. Most common during winter and spring. 60歲以上的老人中最常見肺炎鏈球菌肺炎，常發(fā)生在冬季和春季。 Hospital-acquired pneumonia:醫(yī)院獲得性肺炎 Certain illness may predispose HAP because of:Impaired defenses or chronic illness;Coma昏迷, malnutrition營

18、養(yǎng)不良, prolong hospitalization住院時間延長;Numerous intervention介入 as endotracheal intubation 某些疾病導致醫(yī)院獲得性肺炎：受損的防御或慢性疾??；昏迷，營養(yǎng)不良住院時間延長；氣管插管等較多的介入治療。 2022-4-17Symptoms Cough Dyspnea呼吸困難 dspni: Pleuritic肋膜炎的 plrtk chest pain胸痛 Fever or hypothermia發(fā)熱或低體溫 Myalgias肌痛 mald Chills/Sweats發(fā)冷/出汗 Fatigue疲勞 fti: Headache

19、 Diarrhea腹泄 sinusitis鼻竇炎sansats expectoration咳痰 uRespiratory System2022-4-17全身怕冷濕冷發(fā)青痰痰短氣胸膜炎的plrtk 胸痛咳血hmptss 疲勞fti: 食欲差情緒波動血管的vskjl(r) 惡心n:zi嘔吐 關(guān)節(jié)痛Pneumococcal pneumonia肺炎鏈球菌肺炎 The pneumonia that is caused by Streptococcus pneumoniae nearly half of community-acquired pneumonia(CAP由肺炎鏈球菌引起的肺炎近一半是社區(qū)獲得

20、性肺炎. The disease onset is acute起病急and can be serious,accompanied伴有 by high fever , chills寒戰(zhàn), cough, bloody sputum痰中帶血 and chest pain. uRespiratory System The pathological change病理變化is divided into four periods,分為四個時期，i.e. congestive stage充血期, red hepatization紅色肝樣變, gray hepatization灰色肝樣變and resoluti

21、on消散期. 1 2 1,dilatation擴張dalten and congestion充血kndestn of the capillaries毛細血管 kplrz 2, the fibrinous纖維蛋白fabrns exudate滲出物eksdet uRespiratory System This is noted clinically as oedema水腫di:m and congestion充血 in lung, alveolar exudate肺泡滲出,hematidhemtd infiltration紅細胞浸潤,leukocytelu:ksat infiltration白細胞

22、浸潤.Then the bacterium細菌will be eliminated消除through leukocytic phagocytosis白細胞吞噬作用.At last, the fibrous protein纖維蛋白is broken down and absorbed,the alveolar inflates again肺泡重新充氣. 這是臨床表現(xiàn)為肺水腫和肺充血，肺泡滲出，紅細胞浸潤，白細胞浸潤。然后細菌通過白細胞吞噬作用將被淘汰消除。最后，纖維蛋白分解和吸收，肺泡重新充氣。uRespiratory System In fact, early treatment by usi

23、ng antibacterial抗菌的drug cause hepatization肝樣變 in pathological stage does not have precise limits. We had rarely seen this typical pathological stage in clinical. 事實上，通過使用抗菌藥物引起肝病理階段早期治療沒有確切的界限。我們很少看到這種典型的臨床病理分期。uRespiratory System2022-4-17Etiology and pathogenesis organismS.pneumoniaeDynamic balance

24、 2022-4-17 S.pneumoniae as the gram- positive bacillus, capsule, its 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 System2022-4-17Etiology and pat

25、hogenesis The body keeps a dynamic equilbrium between the organism and 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 System2022-4-17Etiology and pathogen

26、esis the pathogenicity of S. pneumoniae is due to the capsule invade the organization, first of all, cause to hydrops of alveolar walls, leukopedesis, overspreading the lung segment and pulmonary lobe.uRespiratory System2022-4-17Etiology and pathogenesis when the body resistance is too weak for the

27、body to adapt to climatic change,when S.pneumoniae are excessive ,When the dynamic equilbrium is damaged and cannot restored immediately,S. pneumoniae will become pathogenic factor and lead to the occurance of disease .uRespiratory System2022-4-17Streptococcus pneumoniae high-risk groups ： Smokers,

28、dementia, Chronic Bronchitis , bronchiectasis, cardiac failure,chronic disease,immunosuppressants users, the elderly, infants and young children 2022-4-17Laboratory Examinations實驗室檢查 WBC(white blood cell)白細胞 PaO2 (動脈血氧分壓Arterial動脈的 :trl Partial部分的 Pressure of Oxygen ) PaCO2 (肺泡二氧化碳分壓Alveolar肺泡的 Part

29、ial Pressure of Carbon Dioxide)2022-4-17 1.The WBC:( 10 30) x 109 / L, neutrophils中性粒細胞 80%; The WBC can be normal, but neutrophils must be increased. 2.The Bacteriological examination細菌學檢查 : direct smear直接涂片， use sputum culture, 痰涂片 culture with blood or pleural effusion 血液或胸腔積液培養(yǎng).2022-4-17 3. Bloo

30、d gas analysis血氣分析: PaO2 can be decreased, PaCO2 can be normal or decreased, metabolic acidosis代謝性酸中毒metblik sidusis .What are pneumonia symptoms and signs? Initially have symptoms of a coldupper respiratory infection, for example, sneezing, sore throat, cough）,which are then followed by a high feve

31、rsometimes as high as 104 F ）, shaking chills, and a cough with sputum production. The sputum is usually discolored and sometimes bloody, shortness of breath.The individuals skin color may change and become dusty or purplisha condition known as “cyanosis ”）due to their blood.Symptoms This pain is us

32、ually sharp and worsen when taking a deep breath and is known as 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

33、ill,and can become lethargic.Complications Serious and potentially 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

34、stethoscope. Wheezing or the sounds of breathing may be faint in 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 refer

35、red to as lobar pneumonia.Sputum Samples Sputum Samples can be collected 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

36、used antibiotics. These types of cultures can help in directing more 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 num

37、ber of neutrophils, one type of WBC, is seen in most bacterial infections. Whereas an increase in lymphocytes, another type of WBC, is seen in viral infections, fungal infections, and some bacterial infections.Hematology laboratory Complete blood countCBC） Red blood cell countRBC） Hemoglobin （Hgb） H

38、ematocritHct） White blood cell count （WBC） Neutrophils lymphocytes 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

39、is administered. Using this device ,the doctor can directly examine the breathing passagestrachea 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 t

40、he inflammation from pneumonia. This fluid is called a pleural 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

41、is called a thoracentesis. Diagnosis1Preceding history of common 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 diagn

42、osis requires demonstration of pneumonia in sputum culture ,blood ,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

43、 lobes are involved；Need for vasopressorsRenal Failure Caseous pneumonia(lung tuberculosis）Differential diagnosisApicallocationInsidious onset with lower fever，night sweats，F(xiàn)atigue and weight lossNot respond to antibioticsSputum smear for tubercle bacilli(+)Differential diagnosis Lung abscessCopious

44、 purulent foul-smelling sputumDifferential diagnosis Obstructive pneumoniasuperimposed hilar shadowrecurrent pneumonia at the same site happended in patients over 40, which does not respond well to the antibiotic treatmentfiberoptic bronchoscopy2022-4-17Treatment Antiinfectious therapy Supportive th

45、erapy Therapy of complications2022-4-17 Treatment The more serious pneumonia, requires antibiotics such as penicillin. 2022-4-17Treatment 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 th

46、e basis of patients status /adverse rea- ction or complication that occur 2022-4-17Treatment 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(頭孢菌素頭孢菌素) or advanced macrolide(大環(huán)內(nèi)酯物大環(huán)內(nèi)酯物)+ -lactam(-內(nèi)酰胺內(nèi)酰胺) or respiratory fl

47、uoroquinolone(氟喹諾酮氟喹諾酮) alone.2022-4-17Treatment In some cases, 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 days2022-4-17Supportive 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(止痛劑止痛劑) to relieve pleuritic (胸膜炎的胸膜炎的)pain -Replacing fluids, if the patient is dehydrated(脫水的脫水的) 2022-4-17Supportive measure Correcting elec