肺炎英文版課件

Pneumonia

CaseDiscussionXuChangqingAddress:HangzhouCity,WenzhouRoadNo.16Email：2022/12/221Theconditionofthepatient1,YuJinyu,male,64yearsold,2,5monthsago,thepatientstartedcoughingwithoutacause,coughingwhitesputum.Moreseverely:feverwithatemperatureof38℃.Inthelocalcommunityhospitalhewastreatedfor2dayswithoutanyimprovement.Sohecametoourhospitaltobeadmittedwithpulmonaryinfection.2022/12/222Theconditionofthepatient3,ExaminationofpulmonaryCT:Doublepneumonialesions,forantiinfection,stopcoughandphlegmandothertreatments.Thetemperaturedroppedgraduallyandtheconditionimproved.4,Thepatientwascarelessastoinhalefoodonemonthbeforehand,thenthepatientbegantocough,sputum,andhavefever.Afterbeinghospitalized,feedingthroughanasogastrictube,antiinfection,andphlegmtreatment.Theconditionimproved.Multiplehospitalizations.2022/12/223TheconditionofthepatientPhysicalexamination:P90/R19/BP119/72mHgT36.6.Clearconsciousness,bedrest,nasalfeeding.Skinandsclerawithoutyellowdye,nolipscyanosis,asoftandnotswollensuperficiallymphnodeofneck,nojugularveinenlargement,tracheae,nochestdeformity,theintercostalspacewithoutbroadening,doublelungbreathingsymmetry,nochange,fremituswithoutchange,bilateralpercussionsound,twopulmonaryrespirationcrudeandobviously,noralesorrhonchi;hearthasnoenlargement,heartrate90,thelawisneat;theabdomenissoft,completeabdomentenderness,noreboundtenderness,belowliverlienalcostalregionwithoutpalpablemass,renalareawithoutpercussionpain;lowerextremitiesedema,neurologicalexamination:limbsadverseevents,activitiesjointdegreeislimited,muscletensionincreased,strengthcannotcheck.2022/12/225Theconditionofthepatient2013-11-27chestCTscan:comparisonofthefrontsheet(2013-10-28)twopulmonaryinfectionswithbilateralpleuraleffusionwasimproved;hintatthethoracicinletendotrachealnodularprotrusion.2022/12/226NormalChestCTScan2022/12/227Lung:therightlungleftlungtwoleafclover.Thepulmonaryfissures(obliquefissure,horizontalfissure)boundary,appearedaslowdensitypancivascularareaorlinearhighdensityPulmonarysegments:therightlungleftlungisdividedintotensegments,eightsegments.SegmentalbronchusTubeinthelung,pulmonaryarterysegmentcenter.Alveolar:filledwithgas,sothelungshowedlowdensityshadow.Bronchus:fillinggas,thetubularlow-density"gas"asthecharacteristicsof.Pulmonaryvascular:pulmonaryintravascularfillingblood,showedhighdensity.ChestCTscanofthepatient2013-11-262014-01-022022/12/228Recurrentcough,feverThroughavarietyofantimicrobialtreatmentThefirst,second,threelineantibioticsPenicillin,Cephalosporins[sef?lo?s'p?:r?nz],Fluoroquinolones[fl??ro?kwa?n?'lo?nz],Carbapenems[kɑ:b?'penemz]etc.ThoughtWecansee,thepatient'sconditionhasimproved,butthereisnoobviousimprovementinimaging,Thisischaracteristicofaspirationpneumonia,pulmonarylesionsdifficulttoabsorb,Patientswithlowimmunity,easyrecurrenceofpneumoniaSo,thepatientswithrecurrentpneumonia,sohehastostayinthehospital2022/12/2210Pneumoniadiseaserangecanhavedifficultybreathing,respiratorydistress.Mostofthepatientshavefever.Earlysignshavenoobviousabnormity,seriouspersoncanhavehighrespiratoryrate,flaringofnares,cyanosis.2022/12/2212ThoughtDifferentialdiagnosis1,PulmonarytuberculosisManysymptomsofsystemicpoisoning,afternoonfever,nightsweats,fatigue,weakness,weightloss,insomnia,heartpalpitationsandothersymptoms.X-rayvisiblelesionsintheapicalorsupraclavicular,unevendensity,dissipatedslowly,andcanformacavityorintrapulmonaryspread.Mycobacteriumtuberculosiscanbefoundinthesputum.Theconventionalantibiotictherapy.2022/12/2214Differentialdiagnosis2,LungcancerOftenhasahistoryofsmoking.Hasacough,sputum,bloodysputumsymptoms.Whitebloodcellcountisnothigh,iffoundthatthecancercellsinsputumcanbeconfirmed.Beaccompaniedwithobstructivepneumonia,afterantibiotictreatmentinflammationisnoteasytodissipate,orvisiblehilarlymphnodeenlargement,sometimesappearsatelectasis.ItisnecessarytodotheCT,MRI,fiberopticbronchoscopyandsputumcytologicexamination.2022/12/2215Differentialdiagnosis3,AcutepulmonaryabscessTheearlyclinicalmanifestationissimilar.Asthediseaseprogresses,expectorationofpurulentfoulsputumforlungabscess.TheX-rayfilmsshowedtheabscesscavityandfluidlevel.2022/12/2216Differentialdiagnosis4,PulmonarythromboembolismManyriskfactorsforvenousthromboembolism,canoccurhemoptysis,syncope,respiratorydifficultiesareobvious,jugularvenousengorgement.X-rayshowedpartialreductionoflungmarkings,wedge-shapedshadowvisibletippointingtothehilar,commonhypoxemiaandhypocapnia.ThetwoD-dimer,CTpulmonaryangiography,radionuclidelungventilation/perfusionscanandMRIexaminationcanhelpidentify.2022/12/2217Differentialdiagnosis5,NoninfectiouspulmonaryinfiltrationToexcludenoninfectiouspulmonarydiseases,suchaspulmonaryfibrosis,pulmonaryedema,atelectasis,pulmonaryeosinophiliaandpulmonaryvasculitis.2022/12/2218TherapyInviewofthepatientAntiinfectiontreatmentofpenicillininjectionandCiprofloxacinInjectionfor7days.2022/12/2220TherapyPatientsinadditiontobedrest,drinkinglotsofwater,oxygen,positivesputum,themainaspectsofthetreatmentofpneumoniaisaninfection.Accordingtopatientage,underlyingdiseases,whetherhaveaspirationlevelfactors,seriousillness,selectionofantimicrobialagentsandrouteofadministration.2022/12/2221TherapySuspectedpneumoniaimmediatelygivefirstdoseofantibiotics.Astableconditionaftertheintravenoustooraltherapy.Pneumoniaantibiotictreatmentforatleast5days,themajorityofpatientsto7~10daysorlongercourseoftreatment,thenormalbodytemperatureof48~72hours,withoutanyapneumoniaclinicalinstabilitysigns,candisableantibiotics.2022/12/2223Therapy1,YoungadultswithandwithoutunderlyingdiseasesofcommunityacquiredpneumoniaSelectionofpenicillin,firstgenerationcephalosporinsantibiotics,thedrugresistanceofStreptococcuspneumoniaecanusespecialeffectsonrespiratorytractinfection(fluoroquinolonemoxifloxacin,levofloxacin).肺炎鏈球菌46%流感嗜血桿菌10%肺炎支原體25%肺炎衣原體14%金黃色葡萄球菌5%2022/12/2224Therapy3,HospitalacquiredpneumoniaThesecond/threegenerationcephalosporins,betalactam/betalactamaseinhibitor,quinolonesorcarbapenems.2022/12/2226Therapy4,SeverepneumoniaThepreferredbroad-spectrumstrongantibacterialdrugs,drugcombinationissufficient.Severecommunityacquiredpneumoniawithbetalactamcombinedwithlargeringvinegarorfluoroquinolones;Hospitalacquiredpneumoniaavailablefluoroquinolonesoraminoglycosidecombinedantipseudomonalbetalactam,ampicillin/betainanykindofamideenzymeinhibitors,carbapenems,whennecessary,ca