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1、Contents,（一）、pandect总论3（二）、Pneumonia in general8（三）、Etiology病原学13（四）、Signs症状体征34（五）、Treatment49（六）、Prevention预防58,2022/11/4,Respiratory System,Contents（一）、pandect总论,Respiratory System,nose（nas/o OR rhin/o）,larynx (laryn/o),Lungs (pneumon/o OR pulmo ),bronchus (bronch/o),diaphragm (diaphragm/o),media
2、stinum,（一）pandect,Organs,Respiratory Systemnose（nas/o O,3,Functions,Breathing process Exchange of Oxygen and Carbon DioxideEnable speech production,oxygencarbondioxide,Alveolar/0-,Hyperpnea,Cyanosis,02,co2,Respiratory System,（一）pandect,3 Functions Breathing process,4,The influencing factors of respi
3、ratory diseases,Respiratory System,（一）pandect,Air pollution and smoking Inhaled allergens The variation of etiology and Drug resistance increases,4 The influencing factors Resp,Signs and symptoms,Cough Laryngitis/ bronchitis/ bronchial asthma/ chronic obstructive pulmonary disease (COPD)/ lung cance
4、rExpectoration 吐痰 Lung abscess/ bronchiectasis/ pneumoniaHemoptysis 咯血 pulmonary TuberculosisDyspnea Pneumothorax 气胸/ pleural effusion/ left heart failureStethalgia 胸痛 hemothorax/ Pulmonary thromboembolism,Respiratory System,（一）pandect,Signs and symptomsCoughRespir,Lab and other inspection,Blood tes
5、tsantigen skin testphlegmexamination pleural effusionthoracicopunctureradio examination,Respiratory System,（一）pandect,bronchoscopyThoracoscope lungobiopsysupersonic inspectionrespiratory function testPulmometry,Lab and other inspectionBlood,DefinitionPneumonia is an acute infectionof the parenchymap
6、rekm of the lung,肺炎是肺实质的急性感染 ，(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-ray胸部x线检查）.伴随发热，局灶性胸部症状，胸片阴影。,Respiratory System,DefinitionRespiratory System,2022/11/4,Defense mechanism difens meknizmof the resp
7、iratory tract（呼吸道防御机制）,Filtrationfiltrein and depositiondepzn 滤除及沉积（nasal function鼻功能）pathogenspdns in the upper airways 上呼吸道病原体Cough reflex 咳嗽反射Mucociliarymju:kslr clearance 黏液纤毛清除macrophagesmkrfed 巨噬细胞Humoralhju:mrl and cellular seljl(r) immunity 体液及细胞的免疫Oxidative ksdetv metabolism mtblzmof the ne
8、utrophils 中性粒细胞的氧化代谢,Respiratory System,（二）、Pneumonia in general,2022/10/9Defense mechanism di,2022/11/4,鼻炎,咽炎,耳炎,扁桃体炎,喉炎,细支气管炎,Respiratory System,Sinus/-itis sansats 鼻窦炎 Pharyng/-itis .frndats 咽炎Laryng/-itis lrndats 喉炎Bronch/-itis brkats 支气管炎,2022/10/9,2022/11/4,2022/10/9rootmeaningexamplePne,2022/
9、11/4,Respiratory System,2022/10/9rootmeaningexampledys,2022/11/4,Etiology病因,There are two factors involved in the formation of pneumonia ,参与肺炎形成的两个因素，including pathogens and host defenses.包括病原体和宿主防御,Respiratory System,2022/10/9Etiology病因 There ar,2022/11/4,Causative organisms致病微生物,Bacteria细菌Mycobact
10、eria分枝杆菌Chlamydiae衣原体Mycoplasma支原体Fungi真菌Parasites寄生虫Viruses病毒,2022/10/9Causative organisms致病,2022/11/4,Classification分类,Classification of anatomy按解剖分类Classification of pathogen按病原体分类Classification of acquired environment按患病环境分类,Respiratory System,2022/10/9Classification分类Class,2022/11/4,Classificat
11、ion by anatomy按解剖分类,Lobar大叶性 : Involvement of an entire lobe 一个完整的叶的参与 Lobular小叶性 : Involvement of parts of the lobe only, segmental or of alveoli contiguous to bronchi (bronchopneumonia支气管肺炎 ). 只有部分的肺叶，节段性支气管或相连的肺泡受累； Interstitial间质性ntstl : Involvement of the interstitial tissue of the lungs肺间质组织参与
12、,Respiratory System,2022/10/9Classification by ana,2022/11/4,Classification by pathogen按病原体分类,Respiratory System,2022/10/9Classification by pa,2022/11/4,Classifications by acquired environment按患病环境分类,Community-acquired pneumonia:社区获得性肺炎：。 Occur in community within 48 hour.在社区48小时内发生 S.pneumonia is t
13、he most common CAP in people older than 60. Most common during winter and spring. 60岁以上的老人中最常见肺炎链球菌肺炎，常发生在冬季和春季。 Hospital-acquired pneumonia:医院获得性肺炎 Certain illness may predispose HAP because of:Impaired defenses or chronic illness;Coma昏迷, malnutrition营养不良, prolong hospitalization住院时间延长;Numerous int
14、ervention介入 as endotracheal intubation 某些疾病导致医院获得性肺炎：受损的防御或慢性疾病；昏迷，营养不良住院时间延长；气管插管等较多的介入治疗。,2022/10/9Classifications by ac,2022/11/4,Symptoms,CoughDyspnea呼吸困难 dspni: Pleuritic肋膜炎的 plrtk chest pain胸痛Fever or hypothermia发热或低体温 Myalgias肌痛 mald,Chills/Sweats发冷/出汗Fatigue疲劳 fti: HeadacheDiarrhea腹泄 sinusit
15、is鼻窦炎sansats expectoration咳痰,Respiratory System,2022/10/9SymptomsCoughChills/,2022/11/4,全身,怕冷,湿冷,发青,痰,痰,短气,胸膜炎的plrtk 胸痛,咳血hmptss,疲劳fti:,食欲差情绪波动,血管的vskjl(r),恶心n:zi呕吐,关节痛,2022/10/9全身怕冷湿冷发青痰痰短气胸膜炎的pl,Pneumococcal pneumonia肺炎链球菌肺炎,The pneumonia that is caused by Streptococcus pneumoniae nearly half of c
16、ommunity-acquired pneumonia(CAP）由肺炎链球菌引起的肺炎近一半是社区获得性肺炎. The disease onset is acute起病急and can be serious,accompanied伴有 by high fever , chills寒战, cough, bloody sputum痰中带血 and chest pain.,Respiratory System,Pneumococcal pneumonia肺炎链球菌肺炎,The pathological change病理变化is divided into four periods,分为四个时期，i.e
17、. congestive stage充血期, red hepatization红色肝样变, gray hepatization灰色肝样变and resolution消散期. 1 2 1,dilatation扩张dalten and congestion充血kndestn of the capillaries毛细血管 kplrz 2,the fibrinous纤维蛋白fabrns exudate渗出物eksdet,Respiratory System,The pathological change病理变化is,This is noted clinically as oedema水肿di:m an
18、d congestion充血 in lung, alveolar exudate肺泡渗出,hematidhemtd infiltration红细胞浸润,leukocytelu:ksat infiltration白细胞浸润.Then the bacterium细菌will be eliminated消除through leukocytic phagocytosis白细胞吞噬作用.At last, the fibrous protein纤维蛋白is broken down and absorbed,the alveolar inflates again肺泡重新充气.这是临床表现为肺水肿和肺充血，肺
19、泡渗出，红细胞浸润，白细胞浸润。然后细菌通过白细胞吞噬作用将被淘汰消除。最后，纤维蛋白分解和吸收，肺泡重新充气。,Respiratory System,This is noted clinically as oe,In fact, early treatment by using antibacterial抗菌的drug cause hepatization肝样变 in pathological stage does not have precise limits. We had rarely seen this typical pathological stage in clinical.事
20、实上，通过使用抗菌药物引起肝病理阶段早期治疗没有确切的界限。我们很少看到这种典型的临床病理分期。,Respiratory System,In fact, early treatment by us,2022/11/4,Etiology and pathogenesis,organism,S.pneumoniae,Dynamic balance,2022/10/9Etiology and pathogen,2022/11/4,S.pneumoniae as the gram- positive bacillus, capsule, its virulence size related to th
21、e 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,2022/10/9 S.pneumoniae as the,2022/11/4,Etiology and pathogenesis,The body keeps a dynamic equilbrium between the organis
22、m 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,2022/10/9Etiology and pathogen,2022/11/4,Etiology and pathogenesis,the pathogenicity of S. pneu
23、moniae 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,2022/10/9Etiology and pathogen,2022/11/4,Etiology and pathogenesis,when the body resistance is too weak for the
24、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 .,Respiratory System,2022/10/9Etiology and pathogen,2022/11/4,Streptococcus pneumo
25、niae high-risk groups ：,Smokers, dementia, Chronic Bronchitis , bronchiectasis, cardiac failure,chronic disease,immunosuppressants users, the elderly, infants and young children,2022/10/9Streptococcus pneumon,2022/11/4,Laboratory Examinations实验室检查,WBC(white blood cell)白细胞PaO2 (动脉血氧分压Arterial动脉的 :trl
26、 Partial部分的 Pressure of Oxygen )PaCO2 (肺泡二氧化碳分压Alveolar肺泡的 Partial Pressure of Carbon Dioxide),2022/10/9Laboratory Examinatio,2022/11/4,1.The WBC:( 10 30) x 109 / L, neutrophils中性粒细胞 80%; The WBC can be normal, but neutrophils must be increased.2.The Bacteriological examination细菌学检查 : direct smear直接
27、涂片， use sputum culture, 痰涂片 culture with blood or pleural effusion 血液或胸腔积液培养.,2022/10/91.The WBC:( 10 30),2022/11/4,3. Blood gas analysis血气分析: PaO2 can be decreased, PaCO2 can be normal or decreased, metabolic acidosis代谢性酸中毒metblik sidusis .,2022/10/93. Blood gas analysis,What are pneumonia symptoms
28、 and signs?,Initially have symptoms of a cold（upper respiratory infection, for example, sneezing, sore throat, cough）,which are then followed by a high fever（sometimes as high as 104 F ）, shaking chills, and a cough with sputum production. The sputum is usually discolored and sometimes bloody, short
29、ness of breath.The individuals skin color may change and become dusty or purplish（a condition known as “cyanosis ”）due to their blood.,What are pneumonia symptoms an,Symptoms,This pain is usually sharp and worsen when taking a deep breath and is known as pleuritic pain or pleurisy. A worsening cough
30、, 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 ill,and can become lethargic.,SymptomsThis pain is usually s,Complications,Serious and potentially lethal Pleur
31、al effusion and empyema Infective shock Toxic myocarditis ARDS （Acute Respiratory Distress Syndrome ) Organized pneumonia Pleuritis Meningocephalitis,Complications Serious,How is pneumonia diagnosed？,Coarse breathing or cracking sounds with a stethoscope. Wheezing or the sounds of breathing may be f
32、aint 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 referred to as lobar pneumonia.,How is pneumonia diagnosed？Coa,
33、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 used antibiotics. These ty
34、pes of cultures can help in directing more appropriate therapy.,Sputum SamplesSputum Samples c,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 increas
35、ed 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.,A blood testThat measures whit,Hematology laboratory,Complete blood count（CBC）Red b
36、lood cell count（RBC）Hemoglobin （Hgb）Hematocrit（Hct）White blood cell count （WBC）Neutrophils lymphocytes MonocytesPlatelet count, prothrombin time Partial thromboplastin time blood glucose,Hematology laboratoryComplete,Bronchoscopy,Bronchoscopy is a procedure in which a thin, flexible, lighted viewing
37、 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.,BronchoscopyBronchoscopy i
38、s a,Fluid collects,Sometimes, 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 i
39、nto the chest cavity and fluid can be withdrawn and examined under the microscope. This procedure is called a thoracentesis.,Fluid collectsSometimes, fluid,Diagnosis,1Preceding history of common cold or other URI；2. Symptoms：abrupt onset, high fever,cough with a rusty sputum,chest pain,dyspnea and c
40、ough etc；3.Signs: remarkable moist rale； 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,DiagnosisUpper respiratory inf,Diffuse interstitial pneumonia,
41、Lobar pneumonia,Diffuse interstitial pneumonia,Criteria of severe pneumonia,1. Respiratory rate30/min；2. Blood pressure7.1mmol/L(30mg/DL)；5. X-ray:two lobes are involved；,Need for vasopressors,Renal Failure,Criteria of severe pneumonia1,Caseous pneumonia(lung tuberculosis）,Differential diagnosis,Api
42、callocation,Insidious onset with lower fever，night sweats，Fatigue and weight loss,Not respond to antibiotics,Sputum smear for tubercle bacilli(+),Caseous pneumonia(lung tubercu,Differential diagnosis,Lung abscess,Copious purulent foul-smelling sputum,Differential diagnosisLung ab,Differential diagno
43、sis,Obstructive pneumonia,superimposed hilar shadow,recurrent pneumonia at the same site happended in patients over 40, which does not respond well to the antibiotic treatment,fiberoptic bronchoscopy,Differential diagnosisObstruct,2022/11/4,Treatment,Antiinfectious therapySupportive therapyTherapy o
44、f complications,2022/10/9Treatment,2022/11/4,Treatment,The more serious pneumonia, requires antibiotics such as penicillin.,2022/10/9 TreatmentThe more se,2022/11/4,Treatment,All patients with suspected pneumococcal pneumonia should be treated as promptly as possible with penicillin G The dose and r
45、oute of delivery may have to be on the basis of patients status /adverse rea- ction or complication that occur,2022/10/9TreatmentAll patient,2022/11/4,Treatment,For patients who are believed to be allergic to penicillin(青霉素), one may select the first or second generation cephalosporin(头孢菌素) or advan
46、ced macrolide(大环内酯物)+ -lactam(-内酰胺)or respiratory fluoroquinolone(氟喹诺酮) alone.,2022/10/9Treatment,2022/11/4,Treatment,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 days,2022/10/9Treatm
47、ent,2022/11/4,Supportive 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(止痛剂) to relieve pleuritic (胸膜炎的)pain -Replacing fluids, if
48、 the patient is dehydrated(脱水的),2022/10/9Supportive measure,2022/11/4,Supportive measure,Correcting electrolytes(电解质)Oxygen therapy,2022/10/9Supportive measure,2022/11/4,Treatment of complications,Empyema(脓胸) develops in appoximately 5% of patients with pneumococcal pneumonia, although pleural effus
49、ion(胸膜渗出物) commonly develop in 10%- 20% patientsChest X-ray with lateral decubitus（侧卧位） films are often useful in the early recognition of pleural effusion, pleural fluid that is removed should be subjected to routing examination,2022/10/9Treatment of complica,2022/11/4,Treatment of complications,Ex
50、tra pulmonary（胸部的） complications such as arthritis（关节炎）, endocarditis（心内膜炎） must be excluded, because the therapy requires higher dosages（剂量） Treatment of infections shock,2022/10/9Treatment of complica,2022/11/4,Prevention,The most important preventive tool available is using a pneumococcal vaccine
