呼吸系統(tǒng)疾病基礎(chǔ)知識(shí)概述(英文版)課件

1、呼吸系統(tǒng)疾病基礎(chǔ)知識(shí)概述（英文版）呼吸系統(tǒng)疾病基礎(chǔ)知識(shí)概述（英文版）呼吸系統(tǒng)疾病 Respiratory System Disease湘雅醫(yī)院兒科 鄭湘榕 呼吸系統(tǒng)疾病湘雅醫(yī)院兒科 鄭湘榕 嬰幼兒上感、2種特殊類(lèi)型上感的特點(diǎn) 支氣管肺炎臨床表現(xiàn)、重癥肺炎特點(diǎn) 支氣管肺炎的診斷、治療 支氣管哮喘的臨床表現(xiàn)、診斷和治療 重點(diǎn) 嬰幼兒上感、2種特殊類(lèi)型上感的特點(diǎn)重點(diǎn)IntroduceIn pediatric outpatient, 6o% patients are acute respiratory infections. In pediatric ward, 25% patients are Pn

2、eumonia. The first cause of childrens death in China is Pneumonia. Pneumonia is the worlds leading cause of death among children. It kills nearly two million children under age five every year. IntroduceIn pediatric outpatieWhy children are so susceptible to acute respiratory infections?Why children

3、 are so susceptibl呼吸系統(tǒng)疾病基礎(chǔ)知識(shí)概述(英文版)課件anatomic physiological features The childrens respiratory lumens are narrow, blood flow is abundant.The childrens repertory ability is low.The childrens local immunity is low.anatomic physiological featuChildren Respiratory System Physiologic Feature Respiratory

4、rateNeonate 40-44/min1year 30/min2-3years 24/min4-7years 22/min8-14years 20/minChildren Respiratory System PhChildren Respiratory System Physiologic Feature Respiratory type Respiratory type of abdomen Respiratory type of chest abdomen Children Respiratory System Ph hysical examination inspection Ch

5、ange of respiratory rate Cyanopathy Three concave sign uscultationExamine Method hysical examinationExamine急性上呼吸道感染（AURI） Acute Upper Respiratory Infection急性上呼吸道感染（AURI）Etiologyirus： ccupy 90% acteria： econdary Streptococus pyogens Pneumococcu aemophilus influenzaeEtiologyCommonAURI Local symptom is

6、 mild In infant and toddlerSystemic symptom is severeComplications are commonClinical ManifestationsCommon Local symptom is mild ICommonAURIhysical examination Congestion of pharyngeal portion, antiadoncus (咽部充血，扁桃體腫大)Lymphadenectasis in submaxilla (有時(shí)下頜、淋巴結(jié)腫大)Rash when enterovirus infection (腸道病毒感染

7、時(shí)可出現(xiàn)皮疹)Clinical ManifestationsCommonhysical examination ConSpecialAURI 柯薩奇病毒A組感染 夏秋好發(fā) 高熱、咽痛、流涎 咽腭弓、軟腭處有皰疹 皰疹破潰后可形成潰瘍 病程 1 周左右Clinical ManifestationsHerpangina皰疹性咽峽炎Special 柯薩奇病毒A組感染Clinical ManPharyngo-conjunctival fever咽結(jié)合膜熱 腺病毒 3，7 型所致 春夏發(fā)病，可小流行 發(fā)熱、咽炎、結(jié)合膜炎 咽部充血、結(jié)合膜充血，頸部、 耳后淋巴結(jié)腫大 病程 12 周Clinical Ma

8、nifestationsSpecialAURIPharyngo- 腺病毒 3，7 型所致ClinicSchool ageTympanitis, sinusitisAbscess of pharynx posterior-wall Laryngitis, bronchitisInfant , toddlerPneumoniaGlomerulonephritisRheumatic feverComplicationsSchool ageTympanitis, sinusitAntivirus drugs Oseltamivir Ribovirin3-5 daysAntibioticsPenicil

9、linSMZ3-5 daysSever symptomatic;Secondary bacteria affectionTreatmentAntivirus drugs Oseltamivir DefervesceDrugsPhysics methodsFebril convulsionCalmStop convulsionDefervesceTreatmentDefervesceDrugsPhysics methodsPneumonia肺 炎 Pneumonia肺 炎 Childrenfamiliar diseaseIn world,Occupy 1/3-1/4 in the death o

10、f children under 5 years of ageIn china, Occupy more than 1/4 in paediatric ward The hospitalization number of infant and toddler is 39.5 timesof school age PneumoniaIn world,Occupy 1/3-1/4 in In Pneumonia is an inflammation of the parenchyma of the lungs It is caused by microorganisms or noninfecti

11、ous causes Manifested by fever,cough, tachypnea , respiratory distress and ralesDefinitionPneumonia is an inflammation On course of illness On anatomic basisBronchopneumoniaLobar pneumonia Interstitial pneumonia Acute： 3 months Deferred：13 monthsClassification 1On courseOn anatomicBronchopneOn the e

12、tiologyVirus RSV(respiratory syncytial virus)AdenovirusInfluenza ParainfluenzaBacteriaStreptococus pneumoniaeStaphylococus aureusHaemophilus influenzae type Classification 2On the Virus BacteriaClassifiOn the etiologyMycoplasmaChlamydia, parasites ,fungiNoninfections causesClassification 3On theMyco

13、plasmaChlamydia, parOn theseverity of illnessMild symptomaticSevere symptomaticBesides symptoms of respiratory system, concomitant manifestations of other organ systems are presentClassification 4On theMild symptomaticSevere on typical of clinical manifestationTypical pneumoniauntypical pneumoniaSev

14、ere acute respiratory syndrome,(SARS)coronavirusClassification 5on typicalTypical pneumoniauntOn Occurrence RegionCommunity Acquired PneumoniaCAPHospital Acquired PneumoniaHAPClassification 6On Community Acquired Pneumoni支氣管肺炎 Bronchopneumonia支氣管肺炎 BronchopneumoniaEtiologyvirusMain cause of pneumoni

15、a in developed countryRSVbacteriaMain cause of pneumonia in developing countryS. pneumoniae EtiologyvirusMain cause of pnePathologyCommonBroncho-pneumoniahyperaemia、edema、inflammatory effution of alveolusInterstitial pneumoniahyperaemia、edema、inflammatory effution of bronchia wall、bronchiole wall、 a

16、lveolus wallPathologyCommonhyperaemia、edem呼吸系統(tǒng)疾病基礎(chǔ)知識(shí)概述(英文版)課件呼吸系統(tǒng)疾病基礎(chǔ)知識(shí)概述(英文版)課件Pathologic physiology氣道炎癥循環(huán)系統(tǒng)神經(jīng)系統(tǒng)水電解質(zhì)消化系統(tǒng)肺A壓增高中毒性心肌炎心衰代酸中毒性腸麻痹胃腸粘膜屏障功能腦水腫顱壓呼酸K+水鈉儲(chǔ)留毒血癥通氣不足 PaO2,PaCO2換氣障礙 PaO2Pathologic physiology氣道炎癥循環(huán)系統(tǒng)Clinical manifestationMild symptomaticrespiratory systemfeverrespiratory distress

17、nasal flaring, retractions,cyonosistachypnea cough rales5 years RR30次/分Clinical manifestationMild resClinical manifestationSevere symptomaticcircular systemsymptomCardiac muscleinflammationHeart failureClinical manifestationSevereciClinical manifestSevere symptomaticHeart failure呼吸突然加快，60次/分心率突然增快 嬰

18、兒180次/分幼兒160次/分突然煩躁不安、面色發(fā)灰心音明顯低鈍，奔馬率，頸靜脈怒張肝大肋下3cm以上尿少、下肢浮腫Clinical manifestSevereHeart呼吸Clinical manifestnerval systemLight hypoxia：irritability，lethargySever hypoxia：hydrocephalusdigestive systemalimentary canal bleedingPoisoning intestine palsySevere symptomaticClinical manifestnerval Light Clinic

19、al manifest DICBp四肢涼，脈速弱，出血SLADHNa + 130mmol/L滲透壓 270mOsm/LEdemaSevere symptomaticClinical manifest DICBp四肢涼，脈速弱ComplicationsComplicationpneumatocelepyopneumothoraxempyemaComplicationsComplicationpneumLaboratory dataBloodblood routinebacteria infect：WBC、N left shift of nucleus virus infect：WBC、Labno

20、rmal lymph cellbacteria infect ： CRP virus infect ：CRP normalCRPNBTbacteria infect ： 10%virus infect ： 10%Pathogenyvirus separateGermiculturesputum for Gram stain and cultureLaboratory dataBloodbloodbacteLaboratory dataX-rayshadow of dot and spoteemphysema atelectasisLaboratory dataX-rayshadow of 支氣

21、管肺炎正常胸片支氣管肺炎正常胸片大葉性肺炎正常胸片大葉性肺炎正常胸片fever,cough, tachypnea , respiratory distress and ralesX-raydiagnosisfever,cough, tachypnea , X-rayDifferentiationacute bronchitisrales、tachypneaforeign bodies in bronchihistory of foreign bodies、sudden cough、respiratory distress、lower of breath tone or wheezingtube

22、rculosishistory of TB contact、PPD test、PPD-IgGIgM、X-ray、ralesDifferentiationacute rales、tacTreatmentgeneral treatmentBalance of water and electrolyte3%Nacl 12ml/LNa+10mmol/L Temperature 18-20 Humidity 60%Food nutritiveTreatmentgeneral Balance of waTreatmentControl infectionvirus：no ideal drug like v

23、irozolmycoplasma、chlamydia select erythromycinbactrria：the principle of sensitivityefficiency、full period of treatment,first select PeniccilinTreatmentControl virus：no ideaTreatment抗生素使用原則 根據(jù)藥敏選藥adopt sensitive drugs on the basis of pathogenic bacterium 用下呼吸道濃度高的藥物adopt drugs which can finally infil

24、tratelung tissue 足量足療程重癥靜脈給藥in severe case,drugs should be administedby vein , full dose, full period Treatment抗生素根據(jù)藥敏選藥Treatment抗生素選擇 肺炎鏈球菌：PNC,阿莫西林，紅霉素金黃色葡萄球菌：苯唑西林、氯唑西林、萬(wàn)古、利福平 流感嗜血桿菌：阿莫西林+克拉維酸鉀或舒巴坦大腸桿菌和肺炎桿菌：頭孢曲松或頭孢噻肟綠膿桿菌：替卡西林鈉克拉維酸鉀或頭孢哌酮肺炎支原體或衣原體：大環(huán)內(nèi)酯 Treatment抗生素肺炎鏈球菌：PNC,阿莫西林，紅霉素Treatmentfull per

25、iodof treatmentafter temperature normal 5 7days or clinical symptom disappearing 3 daysMycoplasma pneumonia： 23 weeksStaphylococus aureus ： after temperature normal 2 weeks ， full period is 6 weeksTreatmentfull periodafter temptreat against symptomsTreatmentoxygentreatPaO2：dyspnea、 cyanosis、asthma s

26、uppress、toxic appearance, methods: by nose canal 0.5 1 L /min，40%；by veil 24 L/min,50%60%mechanism ventilate（ respire failture）holding respiratory tract unobstructed remove sputum、pulverization 、relieve spasmensure liquid absorbtreat TreatmentoxygenPaO2：dysTreatmenttreat ofother sympdefervesce calmt

27、reat ofwindysupply KaliumPoisoning intestine palsy：fasting、decompress of stomach and intestine 酚妥拉明 0.5 mg/kg ivgtt 10%GS 20 ml treat against symptomsTreatmenttreat ofdefervescetreTreatmenttreat ofHeart failure鎮(zhèn)靜給氧強(qiáng)心：西地蘭減輕心臟負(fù)荷 treat against symptomsTreatmenttreat of鎮(zhèn)靜treat Treatment合并中毒性腦病的治療脫水：甘露醇改

28、善通氣改善腦微循環(huán)止痙：地西泮地塞米松營(yíng)養(yǎng)神經(jīng)treat against symptomsTreatment合并中毒性腦病脫水：甘露醇treat Treatment糖皮質(zhì)激素應(yīng)用適應(yīng)癥：喘憋重,呼吸衰竭全身中毒癥狀重感染性休克 腦水腫琥珀酸氫化可的松5 10 mg/kg.d地塞米松0.1 0.3 mg/kg.d ivgtt23 次/日35 天甲基強(qiáng)的松龍 2 4 mg/kg.次Treatment糖皮質(zhì)激素適應(yīng)癥：琥珀酸氫化可的松5 Response to treatment in otherwise uncomplicated CAP?Fever- falls in 2 daysLeucocy

29、tosis- decreases in 4 days Physical findings persist slightly longerChest radiographic abnormalities may take4-12 weeks to resolveResponse to treatment in otherWhat if patients fails to recover?You should consider-Noninfectious conditionResistance to drugNew nosocomial pathogenWhat if patients fails

30、 to reco病毒性肺炎呼吸道合胞病毒肺炎腺病毒肺炎2歲，2 6月多見(jiàn)喘憋、呼吸困難，可合并呼衰、心衰哮鳴音，細(xì)濕羅音小點(diǎn)片狀影，肺氣腫肺不張間質(zhì)性肺炎6月 2歲中毒癥狀重，稽留熱，咳劇，喘憋，呼吸困難出現(xiàn)晚，濕羅音或肺實(shí)變 胸片改變出現(xiàn)早，肺氣腫，片狀影或融合年齡癥狀胸片體征病毒性呼吸道合胞病毒肺炎腺病毒肺炎2歲，2 6月多見(jiàn)6月細(xì)菌性肺炎葡萄球菌肺炎新生兒，嬰幼兒急、重、快，弛張熱或稽留熱，咳嗽，呼吸困難，呻吟，易致遷徒化膿病灶，并發(fā)膿胸，膿氣胸，肺大皰中細(xì)濕羅音，出現(xiàn)早，皮疹浸潤(rùn)影，持續(xù)時(shí)間較長(zhǎng)，易變，可見(jiàn)多發(fā)性肺膿腫，膿胸，膿氣胸等 4歲慢，重，發(fā)熱，痙攣性咳嗽，呼吸困難，發(fā)紺。易致

31、遷徒化膿病灶，易并發(fā)膿胸濕羅音或?qū)嵶兇笕~性肺炎、支氣管肺炎、肺實(shí)變 年齡癥狀體征胸片革蘭陰性桿菌肺炎細(xì)菌性葡萄球菌肺炎新生兒，嬰幼兒4歲年齡癥狀體征胸片革蘭陰肺炎支原體肺炎年長(zhǎng)兒，嬰幼兒發(fā)熱、刺激性咳嗽，多系統(tǒng)病變不明顯，嬰幼兒可有呼吸困難，喘憋，哮鳴音，濕羅音肺門(mén)影增濃；支氣管肺炎改變；間質(zhì)性肺炎；均一實(shí)變影6月起病慢，無(wú)發(fā)熱，先URI癥狀后咳、喘、氣促，部分伴結(jié)膜炎濕羅音，持續(xù)時(shí)間長(zhǎng)間質(zhì)性炎癥，過(guò)度充氣、片狀影，持續(xù)時(shí)間長(zhǎng)年齡癥狀體征胸片沙眼衣原體肺炎支衣原體肺炎肺炎支原體肺炎年長(zhǎng)兒，嬰幼兒20%,使用支擴(kuò)劑后增加20% 可診斷哮喘）auxiliary examinationX-raylu

32、ngDiagnose of childfood asthmagasp recurrent attacks lung wheezing ralesbronchodilators is validexclude other disease that can cause gaspDiagnose of childfood asthmagacough1month,antibiotics treat is invalidbronchodilators can relieve coughhypersensitive history or allergia family historyairway is hyperreactivityexclude other cough disease Diagnose of cough variant asthmacough1month,antibiotics treattherapyPrinciple: long-term 、 persistence、standard、individuationPeriod