pneumonia呼吸系統(tǒng)肺炎全英文教學(xué)課件

1、Contents（一）、pandect3（二）、Pneumonia in general8（三）、Etiology13（四）、Signs34（五）、Treatment49（六）、Prevention582022/8/3Respiratory System第1頁，共61頁。Respiratory Systemnose（nas/o OR rhin/o）larynx (laryn/o)Lungs (pneumon/o OR pulmo )bronchus (bronch/o)diaphragm (diaphragm/o)mediastinum（一）pandect Organs 第2頁，共61頁。3

2、Functions Breathing process Exchange of Oxygen and Carbon DioxideEnable speech productionoxygencarbondioxideAlveolar/0-HyperpneaCyanosis02co2Respiratory System（一）pandect第3頁，共61頁。4 The influencing factors of respiratory diseasesRespiratory System（一）pandect Air pollution and smoking Inhaled allergens

3、The variation of etiology and Drug resistance increases 第4頁，共61頁。 Signs and symptomsCough Laryngitis/ bronchitis/ bronchial asthma/ chronic obstructive pulmonary disease (COPD)/ lung cancerExpectoration Lung abscess/ bronchiectasis/ pneumoniaHemoptysis pulmonary TuberculosisDyspnea Pneumothorax/ ple

4、ural effusion/ left heart failureStethalgia hemothorax/ Pulmonary thromboembolismRespiratory System（一）pandect第5頁，共61頁。 Lab and other inspectionBlood testsantigen skin testphlegmexamination pleural effusionthoracicopunctureradio examination Respiratory System（一）pandectbronchoscopyThoracoscope lungobi

5、opsysupersonic inspectionrespiratory function testPulmometry 第6頁，共61頁。DefinitionPneumonia is an acute infectionof the parenchymaprekm of the lung,肺炎是肺實質(zhì)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 , shadowing on CXR（chest X-ra

6、y胸部x線檢查）.伴隨發(fā)熱，局灶性胸部癥狀，胸片陰影。Respiratory System第7頁，共61頁。2022/8/3Defense mechanism difens meknizmof the respiratory tract（呼吸道防御機(jī)制）Filtrationfiltrein and depositiondepzn 濾除及沉積（nasal function鼻功能）pathogenspdns in the upper airways 上呼吸道病原體Cough reflex 咳嗽反射Mucociliarymju:kslr clearance 黏液纖毛清除macrophagesmkrf

7、ed 巨噬細(xì)胞Humoralhju:mrl and cellular seljl(r) immunity 體液及細(xì)胞的免疫Oxidative ksdetv metabolism mtblzmof the neutrophils 中性粒細(xì)胞的氧化代謝Respiratory System（二）、Pneumonia in general第8頁，共61頁。2022/8/3 鼻炎咽炎耳炎扁桃體炎喉炎細(xì)支氣管炎Respiratory SystemSinus/-itis sansats 鼻竇炎 Pharyng/-itis .frndats 咽炎Laryng/-itis lrndats 喉炎Bronch/-i

8、tis brkats 支氣管炎第9頁，共61頁。2022/8/3rootmeaningexamplePneum(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 pneumographnju:mgr:f 呼吸描計議 pneumocytenju:mst肺細(xì)胞 pneumatocelenju:mtsi:l 肺膨出Pulmo(o)-Pulmonarypl

9、mnri肺的,肺病的Path(o)-pathologyPathobiologypbald 病理學(xué) Pathogenpdn病原體Pathogenesis pdenss 發(fā)病機(jī)理 pathologistpldst 病理學(xué)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 myxobacteriamksbktr 黏細(xì)菌myxiod粘液樣的Bronch(o)-bronchiBronchogenicbrnkdenk 支氣管原的 bronchoscopybrnt

10、skp支氣管鏡檢查術(shù) bronchitisbrkats 支氣管炎 bronchospasmbrkspzm支氣管痙攣Bronchoconstrictionbrntknstrkn支氣管狹窄第10頁，共61頁。2022/8/3rootmeaningexampledys-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（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hype

11、radenosis（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(jìn)）hapard hypo-在下、次于、不足hypothermia（低體溫）hap:mi 、hypoglottis（舌下部）hapglts 、hypoacidity （胃）酸過少 hpsdt 、hypocalcemia（低血鈣）hapklsi:m 、hypoglycemia（低血糖）hapglasi:m Respiratory Syste

12、m第11頁，共61頁。2022/8/3Etiology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 Respiratory System第12頁，共61頁。2022/8/3Causative organisms致病微生物 Bacteria細(xì)菌Mycobacteria分枝桿菌Chlamydiae衣原體Mycoplasma支原體Fungi真菌Parasites寄生蟲Viruses病毒rootme

13、aningexamplegerm-病菌germicide殺菌劑d:msad bacteri-細(xì)菌bacteriology細(xì)菌學(xué) 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 staphyl-葡萄staphylococcus葡萄球菌屬stflkks 、staphyloma葡萄腫stflm monil-念珠菌moniliasis念珠

14、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(xué)，真菌學(xué) antimycotic抗真菌的第13頁，共61頁。2022/8/3Classification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 Respiratory System第14頁，共61頁。2022/8/3Classification by anatomy按解剖分

15、類 Lobar大葉性 : Involvement of an entire lobe 一個完整的葉的參與 Lobular小葉性 : Involvement of parts of the lobe only, segmental or of alveoli contiguous to bronchi (bronchopneumonia支氣管肺炎 ). 只有部分的肺葉，節(jié)段性支氣管或相連的肺泡受累； Interstitial間質(zhì)性ntstl : Involvement of the interstitial tissue of the lungs肺間質(zhì)組織參與 Respiratory Syste

16、m第15頁，共61頁。2022/8/3Classification by pathogen按病原體分類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 pneumo

17、niaklebziel 克雷伯桿菌肺炎legionaires disease li:dne 軍團(tuán)菌肺炎Respiratory System第16頁，共61頁。2022/8/3Classifications by acquired environment按患病環(huán)境分類 Community-acquired pneumonia:社區(qū)獲得性肺炎：。 Occur in community 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 win

18、ter 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營養(yǎng)不良, prolong hospitalization住院時間延長;Numerous intervention介入 as endotracheal intubation 某些疾病導(dǎo)致醫(yī)院獲得性肺炎：受損的防御或慢性疾??；昏迷

19、，營養(yǎng)不良住院時間延長；氣管插管等較多的介入治療。 第17頁，共61頁。2022/8/3SymptomsCoughDyspnea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: HeadacheDiarrhea腹泄 sinusitis鼻竇炎sansats expectoration咳痰 Respiratory System第18頁，共61頁。2022/8/3全身怕冷濕冷發(fā)青痰痰短氣胸膜炎的plrtk 胸痛咳

20、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)痛第19頁，共61頁。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)

21、, cough, bloody sputum痰中帶血 and chest pain. Respiratory System第20頁，共61頁。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 resolution消散期. 1 2 1,dilatation擴(kuò)張dalten and congestion充血kndestn of the capillaries毛細(xì)血管 kplr

22、z 2,the fibrinous纖維蛋白fabrns exudate滲出物eksdet Respiratory System第21頁，共61頁。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(xì)胞浸潤,leukocytelu:ksat infiltration白細(xì)胞浸潤.Then the bacterium細(xì)菌will be eliminated消除through leukocytic phagocytosis白細(xì)

23、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(xì)胞浸潤，白細(xì)胞浸潤。然后細(xì)菌通過白細(xì)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。Respiratory System第22頁，共61頁。In fact, early treatment by using antibacterial抗菌的drug cause hepatization肝樣變 in pathological stage d

24、oes 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。Respiratory System第23頁，共61頁。2022/8/3Etiology and pathogenesis organismS.pneumoniaeDynamic balance 第24頁，共61頁。2022/8/3 S.pneumoniae as the gram- positive bacillu

25、s, 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.Respiratory System第25頁，共61頁。2022/8/3Etiology and pathogenesis The body keeps a dynamic equilbrium

26、 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”. Respiratory System第26頁，共61頁。2022/8/3Etiology and pathogenesis the pathogenicity of S. pneumoni

27、ae 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.Respiratory System第27頁，共61頁。2022/8/3Etiology and pathogenesis when the body resistance is too weak for the body to adapt to climatic cha

28、nge,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 .Respiratory System第28頁，共61頁。2022/8/3Streptococcus pneumoniae high-risk groups ： Smokers, dementia, Chronic Bro

29、nchitis , bronchiectasis, cardiac failure,chronic disease,immunosuppressants users, the elderly, infants and young children 第29頁，共61頁。2022/8/3Laboratory Examinations實驗室檢查WBC(white blood cell)白細(xì)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 Partial Pressure of

30、 Carbon Dioxide)第30頁，共61頁。2022/8/31.The WBC:( 10 30) x 109 / L, neutrophils中性粒細(xì)胞 80%; The WBC can be normal, but neutrophils must be increased.2.The Bacteriological examination細(xì)菌學(xué)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).第31頁，共61頁。2022/8/33. Bloo

31、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 .第32頁，共61頁。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

32、 high fever（sometimes 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 purplish（a condition known as “cyanosis ”）due to their blood.第33頁，共61頁。Sy

33、mptomsThis pain is usually 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

34、fever ,appear quite ill,and can become lethargic.第34頁，共61頁。Complications Serious and potentially lethal Pleural effusion and empyema Infective shock Toxic myocarditis ARDS （Acute Respiratory Distress Syndrome ) Organized pneumonia Pleuritis Meningocephalitis 第35頁，共61頁。How is pneumonia diagnosed？Coar

35、se 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 ordered to confirm the diagnosis of pneumonia. The lungs have lobes，usually two on the left and three on the right.When the pneumonia affect

36、s one of these lobes，it is often referred to as lobar pneumonia.第36頁，共61頁。Sputum SamplesSputum 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 or

37、ganisms are becoming resistant to the commonly used antibiotics. These types of cultures can help in directing more appropriate therapy.第37頁，共61頁。A blood testThat measures white blood cell count.An individuals white blood cell count can often give a hint as to the severity of the pneumonia and wheth

38、er 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 of WBC, is seen in viral infections, fungal infections, and some bacterial infections.第38頁，共61頁。Hematology laboratoryCom

39、plete blood count（CBC）Red blood cell count（RBC）Hemoglobin （Hgb）Hematocrit（Hct）White blood cell count （WBC）Neutrophils lymphocytes MonocytesPlatelet count, prothrombin time Partial thromboplastin time blood glucose第39頁，共61頁。BronchoscopyBronchoscopy is a procedure in which a thin, flexible, lighted vi

40、ewing 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）.Simultaneously, samples of sputum or tissue from the infected part of the lung can be obtained.第40頁，共61頁。Fluid collec

41、tsSometimes, 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, it can be removed. After numbing the skin with local anesthetic a needle is inserted into the chest cav

42、ity and fluid can be withdrawn and examined under the microscope. This procedure is called a thoracentesis. 第41頁，共61頁。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

43、； 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第42頁，共61頁。Diffuse interstitial pneumoniaLobar pneumonia第43頁，共61頁。Criteria of severe pneumonia1. Respir

44、atory 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第44頁，共61頁。Caseous pneumonia(lung tuberculosis）Differential diagnosisApicallocationInsidious onset with lower fever，night sweats，F(xiàn)atigue

45、 and weight lossNot respond to antibioticsSputum smear for tubercle bacilli(+)第45頁，共61頁。Differential diagnosisLung abscessCopious purulent foul-smelling sputum第46頁，共61頁。Differential diagnosisObstructive pneumoniasuperimposed hilar shadowrecurrent pneumonia at the same site happended in patients over

46、 40, which does not respond well to the antibiotic treatmentfiberoptic bronchoscopy第47頁，共61頁。2022/8/3TreatmentAntiinfectious therapySupportive therapyTherapy of complications第48頁，共61頁。2022/8/3 TreatmentThe more serious pneumonia, requires antibiotics such as penicillin. 第49頁，共61頁。2022/8/3TreatmentAl

47、l 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 第50頁，共61頁。2022/8/3TreatmentFor patients who are believed to be all

48、ergic to penicillin(青霉素), one may select the first or second generation cephalosporin(頭孢菌素) or advanced macrolide(大環(huán)內(nèi)酯物)+ -lactam(-內(nèi)酰胺)or respiratory fluoroquinolone(氟喹諾酮) alone.第51頁，共61頁。2022/8/3TreatmentIn some cases, vancomycin may be used.Treatment with any effective agent should be given for at

49、 least 5 to 7 day or after the patients have been afebrile for 2-3 days第52頁，共61頁。2022/8/3Supportive measureSupportive 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) to relieve pleuritic (胸膜炎的)pain -Replacing fluids, if the patient is dehydrated(脫水的) 第53頁，共61頁。2022/8/3Supportive measur