呼吸系統(tǒng)教學(xué)資料呼吸病理zhou中文

呼吸系統(tǒng)教學(xué)資料呼吸病理zhou中文文檔pptChronicObstructivepulmonaryDisease(COPD)DefinationCOPD,namelychronicbronchitisandemphysema,arediseasesoriginationintheairwaysornotablyaffectinairwayfunction.慢性阻塞性肺?。–OPD）指由于氣道完全或不完全阻塞，導(dǎo)致通氣阻力增加及肺功能不全的慢性肺疾病。包括慢性支氣管炎和肺氣腫。Chronicbronchitisisdefinedonclinicalgroundsalone,asthepresenceofchronicproductivecoughfor3monthsin2successiveyears,intheabsenceofanyotherexplanationforthissymptom.指氣管、支氣管黏膜及其周圍組織的慢性炎癥。臨床特征為反復(fù)發(fā)作的咳嗽、咳痰、喘息，病程長。如每年發(fā)作時(shí)間起過3個(gè)月連續(xù)兩年以上者，可診斷為慢性支氣管炎。Chronicbronchitis(慢性支氣管炎)Chronicbronchitis(慢性支氣管炎)Etiology（病因?qū)W）

理化因素：長期吸煙、空氣污染

氣候因素

過敏因素

感染因素：病毒、細(xì)菌Chronicbronchitis(慢性支氣管炎)PathologicalChanges（病理改變）纖毛粘連、倒伏、脫失粘膜上皮細(xì)胞變性壞死柱狀上皮出現(xiàn)鱗狀上皮化生杯狀細(xì)胞增多壁增厚腺體增生、肥大、粘液化ChapterⅠ:Chronicbronchitis(慢性支氣管炎)1.粘膜上皮的損傷與修復(fù)2.腺體增生、肥大、粘液化3.管壁炎癥反應(yīng)

粘膜、粘膜下層充血、水腫

淋巴、漿細(xì)胞等浸潤4.管壁其他損害

喘息型患者粘膜下層平滑肌增生、肥大，支氣管變窄，管壁軟骨變性、纖維化、鈣化或骨化

PathologicalChanges（病理改變）Squamousmetaplasiaofchronicbronchitis

Chronicbronchitis(慢性支氣管炎)粘液腺增生，漿液腺粘液化Chronicbronchitis(慢性支氣管炎)臨床病理聯(lián)系咳嗽：支氣管粘膜充血、水腫及粘液分泌物增多刺激支氣管粘膜引起?？忍?（咳大量白色粘痰或漿液泡沫狀，如伴細(xì)菌感染為膿性）：粘液腺增生、肥大；部分漿液腺化生成粘液腺，粘液分泌增多而致氣喘：因支氣管炎癥，刺激支氣管痙攣或粘液阻塞而致。Chronicbronchitis(慢性支氣管炎)并發(fā)癥

支氣管擴(kuò)張：長期支氣管炎癥的破壞，其彈力性和支撐力減弱，加之長期的咳嗽而致。肺氣腫：管腔內(nèi)粘液潴留及粘液栓形成，使末梢肺組織過度充氣而致。肺心?。悍螝饽[引起肺間隔破壞，肺動(dòng)脈高壓，右心室肥大、擴(kuò)張。支氣管肺炎：支氣管壁甚薄，炎癥易于擴(kuò)散而累及肺泡。Chronicbronchitis(慢性支氣管炎)Emphysema(肺氣腫)Defination指呼吸性細(xì)支氣管至肺泡的末梢肺組織因持續(xù)性含氣量增加而呈永久性過度膨脹，伴有肺泡壁彈力組織破壞，間隔斷裂致肺泡相互融合，肺容積增大的病理狀態(tài)。病因和發(fā)病機(jī)理阻塞性通氣障礙α1抗胰蛋白酶缺乏Emphysema(肺氣腫)類型肺泡性肺氣腫(Alveolaremphysema)腺泡中央型(Centriacinaremphysema),

吸煙相關(guān)全腺泡型(Panacinaremphysema),

α1-Antitrypsin↓腺泡周圍型(Periacinaremphysema),

青年人可見不規(guī)則型(Irregularemphsema),

瘢痕旁肺氣腫肺氣腫樣病變：肺大泡間質(zhì)性肺氣腫(Interstitialemphysema)類型↓煙民常見,上中葉病變?yōu)橹鳌?/p>

最嚴(yán)重,下葉病變?yōu)橹餍啬は虏∽優(yōu)橹鳌植科钚圆∽儭鼸mphysema(肺氣腫)大體：

體積增大，邊緣鈍圓，灰白色，柔軟彈性差，切面海綿狀。表面?？梢娎吖菈汉?，壓痕不易消退。觸之捻發(fā)音增強(qiáng)。

-influenzatypesAandBLobarPneumonia(大葉性肺炎)Althoughoriginallyoccurredinalveoli,itwouldspreadintoawholelobeormorelobesrapidly.Bullae(肺大泡,>1cm)Etiology（病因?qū)W）Respiratoryfailurecongestion,edemaPhaseⅢ:GrayHepatization(灰色肝變期)LobularPneumonia(小葉性肺炎)Emphysema(肺氣腫)PathologyandPathogenesis-adenovirus5-6dayswholelobe,hepatizationChronicbronchitis(慢性支氣管炎)擴(kuò)張的肺泡融合成較大的囊腔，間隔變窄，肺泡孔擴(kuò)大，間隔斷裂

Emphysema(肺氣腫)LocalizedEmphysemaIrregularEmphysemaEmphysema(肺氣腫)Bullae(肺大泡,>1cm)(相關(guān)病變：腺泡周圍型肺氣腫)Emphysema(肺氣腫)Pneumonia(肺炎)DefinationPulmonaryinfectionsareintheformofpneumonia,whichiscommondiseaseinrespiratorysystem.指肺組織的急性滲出性炎癥，是呼吸系統(tǒng)的常見病。Pneumonia(肺炎)ClassificationPathogen（病因）Infectionbacteria,virus,fungal,mycoplasmalPhysics&chemistryradio,inhalingmaterialsAllergyhypersusceptibility,rheumatismLesionpositionandrange（累及部位）lobar,lobular,interstitialTypeofinflammation（感染類型）serous,fibrinous,hemorrhagic,caseous,granulomatous肺泡壁血管充血，肺泡腔漿液滲出。Lobarpneumonia指呼吸性細(xì)支氣管至肺泡的末梢肺組織因持續(xù)性含氣量增加而呈永久性過度膨脹，伴有肺泡壁彈力組織破壞，間隔斷裂致肺泡相互融合，肺容積增大的病理狀態(tài)。HyalinemembraneChronicbronchitisisdefinedonclinicalgroundsalone,asthepresenceofchronicproductivecoughfor3monthsin2successiveyears,intheabsenceofanyotherexplanationforthissymptom.-influenzatypesAandBItismuchmoreprevalentattheinfancies,theextremesofage.PathologicalChanges（病理改變）PhaseⅠ:CongestionandEdema（充血水腫）LobarPneumoniaCarnification(肺肉質(zhì)變)1-2daysLobarPneumonia(大葉性肺炎)肺泡性肺氣腫(Alveolaremphysema)wholelobe,hepatizationLobarPneumonia(大葉性肺炎)DefinationLobarpneumoniaisanacutefibrinousinflammationinalveoli.Althoughoriginallyoccurredinalveoli,itwouldspreadintoawholelobeormorelobesrapidly.Ingeneral,youngadultsareinvolvedinthistypeofpneumonia.指肺泡內(nèi)以纖維素滲出為主的急性炎癥，病變始于肺泡，迅速波及一個(gè)肺段或整個(gè)大葉，多見于青壯年。LobarPneumonia(大葉性肺炎)Symptomshighfever,shakingchillscoughrustysputum（鐵銹色痰）chestpaindyspnea,cyanosisraleswithconsolidationpresentationsLobarPneumonia(大葉性肺炎)Etiolgoypathogen-streptococcuspneumoiae(肺炎鏈球菌)-staphylococcus(葡萄球菌)-hemophilusinfluenzae(流感嗜血桿菌)inducingfactors

-cold-excessivetired-anesthesiaLobarPneumonia(大葉性肺炎)Pathogenesis（發(fā)病機(jī)制）Permeabilityofcap.SerousandfibrinousexudationProliferationofbacteriaLobarpneumonia(7-10days)LobarPneumonia(大葉性肺炎)MorphologyGrossViewCitedfromRobbinsBasicPathology(9thEdition)Page489LobarPneumonia(大葉性肺炎)肺泡壁血管充血，肺泡腔漿液滲出。臨床可出現(xiàn)濕性羅音，Ｘ線呈淺薄均勻的陰影。PhaseⅠ:CongestionandEdema（充血水腫）1-2days暗紅、腫大、切面能擠出淡紅色泡沫狀液體LobarPneumonia(大葉性肺炎)PhaseⅠ:CongestionandEdema（充血水腫）1-2days肺泡壁血管顯著充血，肺泡腔充滿大量纖維蛋白和紅細(xì)胞，肺組織實(shí)變、色暗紅如肝。病人開始咳鐵銹色痰，常伴胸痛、呼吸困難等。有肺實(shí)變征。Ｘ線見大片均勻致密陰影。PhaseⅡ:RedHepatization(紅色肝變期)3-4daysLobarPneumonia(大葉性肺炎)暗紅色、腫大質(zhì)地變實(shí)像肝臟切面粗糙呈顆粒狀LobarPneumonia(大葉性肺炎)PhaseⅡ:RedHepatization(紅色肝變期)3-4daysPhaseⅢ:GrayHepatization(灰色肝變期)5-6days肺泡壁血管受壓迫，肺泡腔內(nèi)充滿大量纖維蛋白網(wǎng)，中性白細(xì)胞。肺葉灰白，實(shí)變?nèi)绺巍２∪巳杂蟹螌?shí)變體征。LobarPneumonia(大葉性肺炎)腫大、灰白、切面干燥L(fēng)obarPneumonia(大葉性肺炎)PhaseⅢ:GrayHepatization(灰色肝變期)5-6daysPhaseⅣ:Resolution（溶解消散期）7-10days中性白細(xì)胞崩解，放出蛋白酶，溶解纖維蛋白；巨噬細(xì)胞增多，吞噬活躍，滲出物逐漸吸收，肺組織復(fù)原。LobarPneumonia(大葉性肺炎)PathologicalChanges（病理改變）pathogen-syncytialvirusesCarnification(肺肉質(zhì)變)Itismuchmoreprevalentattheinfancies,theextremesofage.暗紅、腫大、切面能擠出淡紅色泡沫狀液體臨床特征為反復(fù)發(fā)作的咳嗽、咳痰、喘息，病程長。-streptococcuspneumoiae(肺炎鏈球菌)RespiratoryfailureChronicbronchitisViralinclusionwithinthewallsofthealveoliLobularPneumonia(小葉性肺炎)SelfAssesmentPyosepticemia(膿毒血癥)LobarPneumonia(大葉性肺炎)Complications（并發(fā)癥）Carnification

(肺肉質(zhì)變)

Fibrinousexudationsfromlobarpneumoniaconvertedintogranulationtissuesbecauseofthedeficiencyofproteases,whichisnormallysecretedbyneutrophils.Abscess(膿腫)、empyema(化膿性胸膜炎)fibrinouspleurisy(纖維素性胸膜炎)septicemia(敗血癥)

orpyosepticemia(膿毒敗血癥)infectiousshock

LobarPneumonia(大葉性肺炎)肺肉質(zhì)變肺膿腫膿胸LobularPneumonia(小葉性肺炎)DefinationThistypeofpulmonaryinfectioncaninducepurulentexudationmainlyoccurredinlobulearoundingthebronchiole.Soitisalsodefinedasbronchopneumonia.Itismuchmoreprevalentattheinfancies,theextremesofage.常作為一種并發(fā)癥出現(xiàn)，多見于小兒、老人與體弱者。病變起始于細(xì)支氣管，以肺小葉為單位，以支氣管為中凡的肺組織化膿性炎癥。

LobularPneumonia(小葉性肺炎)PathologyandPathogenesisMixedinfectionbymanyweakbacteria,suchasstaphylococusandpseudomonasaeruginosa由多種細(xì)菌混合感染引起。symptomsFever,cough,mucopurulentsputum,dyspnea,cyanosisLobularPneumonia(小葉性肺炎)MorphologyGrossViewCitedfromWikicommonMediaLobularPneumonia(小葉性肺炎)MorphologyMicroscopicalstructure細(xì)支氣管粘膜充血，上皮壞死、脫落，管腔內(nèi)充滿嗜中性粒細(xì)胞、崩解的上皮細(xì)胞及滲出液病灶周圍肺組織充血、水腫代償性肺氣腫LobularPneumonia(小葉性肺炎)LobularPneumonia(小葉性肺炎)LobularPneumonia(小葉性肺炎)ComplicationsRespiratoryfailureHeartfailureAbscess(膿腫)Empyema

(膿胸)Pyosepticemia(膿毒血癥)BronchiectasisLobularPneumonia(小葉性肺炎)DifferencebetweenLobarpneumoniaandbronchopneumonia

LobarPneumoniaLobularPneumoniaPathogenstreptococcuspneumoiaemixedbacteriaAgeyoungadultinfancies,oldes,patientsPositionsinglelobebilateralandbasalComplicationcartificationpulmonaryfailure,heartfailureGrossViewwholelobe,hepatizationscattered,small,redoryellowMicroscopyStructurefibrouspurulentInterstitialPneumonia(間質(zhì)性肺炎)DefinationTheinterstitialpneumoniawasanacuterespiratorydiseasecharacterizedbypatchyinflammatorychangesinthealveolarseptaandpulmonaryinterstitium.Pathogensmycoplasmapneumoniaearethemostcommonchildrenandyoungadultswereusuallyinvolvedviruses