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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,neumonia呼吸系统肺炎英文带教,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
2、(diaphragm/o),mediastinum,（一）pandect,Organs,neumonia呼吸系统肺炎英文带教,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,neumonia呼吸系统肺炎英文带教,3 Funct
3、ions Breathing process,4,The influencing factors of respiratory diseases,Respiratory System,（一）pandect,Air pollution and smoking Inhaled allergens The variation of etiology and Drug resistance increases,neumonia呼吸系统肺炎英文带教,4 The influencing factors Resp,Signs and symptoms,Cough Laryngitis/ bronchitis
4、/ bronchial asthma/ chronic obstructive pulmonary disease (COPD)/ lung cancerExpectoration 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
5、,（一）pandect,neumonia呼吸系统肺炎英文带教,Signs and symptomsCoughRespir,Lab and other inspection,Blood testsantigen skin testphlegmexamination pleural effusionthoracicopunctureradio examination,Respiratory System,（一）pandect,bronchoscopyThoracoscope lungobiopsysupersonic inspectionrespiratory function testPulmo
6、metry,neumonia呼吸系统肺炎英文带教,Lab and other inspectionBlood,DefinitionPneumonia is an acute infectionof the parenchymaprekm 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
7、灶性胸部症状，胸片阴影。,Respiratory System,neumonia呼吸系统肺炎英文带教,DefinitionRespiratory Systempn,2022/11/4,Defense mechanism difens meknizmof the respiratory 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
8、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 neutrophils 中性粒细胞的氧化代谢,Respiratory System,（二）、Pneumonia in general,neumonia呼吸系统肺炎英文带教,2022/10/2Defense mechanism di,2022/11/4,鼻炎,咽炎,耳炎,扁桃体炎,喉炎,细支气管炎,Respiratory System
9、,Sinus/-itis sansats 鼻窦炎 Pharyng/-itis .frndats 咽炎Laryng/-itis lrndats 喉炎Bronch/-itis brkats 支气管炎,neumonia呼吸系统肺炎英文带教,2022/10/2,2022/11/4,neumonia呼吸系统肺炎英文带教,2022/10/2rootmeaningexamplePne,2022/11/4,Respiratory System,neumonia呼吸系统肺炎英文带教,2022/10/2rootmeaningexampledys,2022/11/4,Etiology病因,There are two
10、 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,neumonia呼吸系统肺炎英文带教,2022/10/2Etiology病因 There ar,2022/11/4,Causative organisms致病微生物,Bacteria细菌Mycobacteria分枝杆菌Chlamydiae衣原体Mycoplasma支原体Fungi真菌Parasites寄生虫Viruses病毒,neumoni
11、a呼吸系统肺炎英文带教,2022/10/2Causative 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,neumonia呼吸系统肺炎英文带教,2022/10/2Classification分类Class,2022/11/4,Classification by anatomy按解剖分类,Lobar大叶性 : I
12、nvolvement 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,Respiratory System,neumonia呼吸系统
13、肺炎英文带教,2022/10/2Classification by ana,2022/11/4,Classification by pathogen按病原体分类,Respiratory System,neumonia呼吸系统肺炎英文带教,2022/10/2Classification 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.pneumoni
14、a is the 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;Numero
15、us intervention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。,neumonia呼吸系统肺炎英文带教,2022/10/2Classifications 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: H
16、eadacheDiarrhea腹泄 sinusitis鼻窦炎sansats expectoration咳痰,Respiratory System,neumonia呼吸系统肺炎英文带教,2022/10/2SymptomsCoughChills/,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,neumonia呼吸系统肺炎英文带教,2022/10/2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 pneumo
17、nia that is caused by Streptococcus pneumoniae nearly half of community-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,neumonia呼吸系统肺炎英文带教,Pneumococcal p
18、neumonia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. 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,Respirator
19、y System,neumonia呼吸系统肺炎英文带教,The pathological change病理变化is,This is noted clinically as oedema水肿di:m and 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,
20、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,neumonia呼吸系统肺炎英文带教,This is noted clinically as oe,In fact, early treatment by using antibacterial抗菌的drug cause hepatization
21、肝样变 in pathological stage does not have precise limits. We had rarely seen this typical pathological stage in clinical.事实上，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,neumonia呼吸系统肺炎英文带教,In fact, early treatment by us,2022/11/4,Etiology and pathogenesis,organism,S.pneumoniae,Dyna
22、mic balance,neumonia呼吸系统肺炎英文带教,2022/10/2Etiology and pathogen,2022/11/4,S.pneumoniae as the gram- positive bacillus, 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 m
23、in can be killed.,Respiratory System,neumonia呼吸系统肺炎英文带教,2022/10/2 S.pneumoniae as the,2022/11/4,Etiology and pathogenesis,The body keeps a dynamic equilbrium between the organism and S.pneumoniae as well as the internal and external envairoment ,under normal conditions,S.pneumoniae sent in the hunma
24、n oral cavity and nasopharynx,they are called “ normal flora”.,Respiratory System,neumonia呼吸系统肺炎英文带教,2022/10/2Etiology and pathogen,2022/11/4,Etiology and pathogenesis,the pathogenicity of S. pneumoniae is due to the capsule invade the organization, first of all, cause to hydrops of alveolar walls,
25、leukopedesis, overspreading the lung segment and pulmonary lobe.,Respiratory System,neumonia呼吸系统肺炎英文带教,2022/10/2Etiology and pathogen,2022/11/4,Etiology and pathogenesis,when the body resistance is too weak for the body to adapt to climatic change,when S.pneumoniae are excessive ,When the dynamic eq
26、uilbrium is damaged and cannot restored immediately,S. pneumoniae will become pathogenic factor and lead to the occurance of disease .,Respiratory System,neumonia呼吸系统肺炎英文带教,2022/10/2Etiology and pathogen,2022/11/4,Streptococcus pneumoniae high-risk groups ：,Smokers, dementia, Chronic Bronchitis , br
27、onchiectasis, cardiac failure,chronic disease,immunosuppressants users, the elderly, infants and young children,neumonia呼吸系统肺炎英文带教,2022/10/2Streptococcus 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 Partial部分的 Pressure of Oxygen )PaCO2 (肺泡二氧化碳分压
28、Alveolar肺泡的 Partial Pressure of Carbon Dioxide),neumonia呼吸系统肺炎英文带教,2022/10/2Laboratory 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直接涂片， use sputum culture, 痰涂片
29、culture with blood or pleural effusion 血液或胸腔积液培养.,neumonia呼吸系统肺炎英文带教,2022/10/21.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 .,neumonia呼吸系统肺炎英文带教,2022/10/23. Blood gas analysis,What are pneumoni
30、a symptoms 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 blo
31、ody, shortness of breath.The individuals skin color may change and become dusty or purplish（a condition known as “cyanosis ”）due to their blood.,neumonia呼吸系统肺炎英文带教,What are pneumonia symptoms an,Symptoms,This pain is usually sharp and worsen when taking a deep breath and is known as pleuritic pain o
32、r 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 fever ,appear quite ill,and can become lethargic.,neumonia呼吸系统肺炎英文带教,SymptomsThis pain is usually s,Co
33、mplications,Serious and potentially lethal Pleural effusion and empyema Infective shock Toxic myocarditis ARDS （Acute Respiratory Distress Syndrome ) Organized pneumonia Pleuritis Meningocephalitis,neumonia呼吸系统肺炎英文带教,Complications Serious,How is pneumonia diagnosed？,Coarse breathing or cracking soun
34、ds 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 affects one of these lobes，it is of
35、ten referred to as lobar pneumonia.,neumonia呼吸系统肺炎英文带教,How is pneumonia diagnosed？Coa,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 fas
36、hion, more organisms are becoming resistant to the commonly used antibiotics. These types of cultures can help in directing more appropriate therapy.,neumonia呼吸系统肺炎英文带教,Sputum SamplesSputum Samples c,A blood test,That measures white blood cell count.An individuals white blood cell count can often gi
37、ve a hint as to the severity of the pneumonia and whether 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
38、bacterial infections.,neumonia呼吸系统肺炎英文带教,A blood testThat measures whit,Hematology laboratory,Complete 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 blo
39、od glucose,neumonia呼吸系统肺炎英文带教,Hematology laboratoryComplete,Bronchoscopy,Bronchoscopy is a procedure in which a thin, flexible, lighted viewing 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（
40、trachea and bronchi）.Simultaneously, samples of sputum or tissue from the infected part of the lung can be obtained.,neumonia呼吸系统肺炎英文带教,BronchoscopyBronchoscopy is a,Fluid collects,Sometimes, fluid collects in the pleural space around the lung as a result of the inflammation from pneumonia. This flu
41、id 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 cavity and fluid can be withdrawn and examined under the microscope. This procedure is called a thoracentesis.,neumonia呼吸系统肺
42、炎英文带教,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 cough etc；3.Signs: remarkable moist rale； 4. Blood test：leukocytosis；5. Radiologic study: Lobar consolidation ；6.A defin
43、itive diagnosis requires demonstration of pneumonia in sputum culture ,blood ,lung tissue.,Upper respiratory infection,neumonia呼吸系统肺炎英文带教,DiagnosisUpper respiratory inf,Diffuse interstitial pneumonia,Lobar pneumonia,neumonia呼吸系统肺炎英文带教,Diffuse interstitial pneumonia,Criteria of severe pneumonia,1. Re
44、spiratory rate30/min；2. Blood pressure7.1mmol/L(30mg/DL)；5. X-ray:two lobes are involved；,Need for vasopressors,Renal Failure,neumonia呼吸系统肺炎英文带教,Criteria of severe pneumonia1,Caseous pneumonia(lung tuberculosis）,Differential diagnosis,Apicallocation,Insidious onset with lower fever，night sweats，Fati
45、gue and weight loss,Not respond to antibiotics,Sputum smear for tubercle bacilli(+),neumonia呼吸系统肺炎英文带教,Caseous pneumonia(lung tubercu,Differential diagnosis,Lung abscess,Copious purulent foul-smelling sputum,neumonia呼吸系统肺炎英文带教,Differential diagnosisLung ab,Differential diagnosis,Obstructive pneumoni
46、a,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,neumonia呼吸系统肺炎英文带教,Differential diagnosisObstruct,2022/11/4,Treatment,Antiinfectious therapySupportive therapyTherapy of com
47、plications,neumonia呼吸系统肺炎英文带教,2022/10/2Treatmentpneumonia呼吸系,2022/11/4,Treatment,The more serious pneumonia, requires antibiotics such as penicillin.,neumonia呼吸系统肺炎英文带教,2022/10/2 TreatmentThe more se,2022/11/4,Treatment,All patients with suspected pneumococcal pneumonia should be treated as promptly
48、 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,neumonia呼吸系统肺炎英文带教,2022/10/2TreatmentAll patient,2022/11/4,Treatment,For patients who are believed to be allergic to penicillin(青霉素), one may se
49、lect the first or second generation cephalosporin(头孢菌素) or advanced macrolide(大环内酯物)+ -lactam(-内酰胺)or respiratory fluoroquinolone(氟喹诺酮) alone.,neumonia呼吸系统肺炎英文带教,2022/10/2Treatmentpneumonia呼吸系,2022/11/4,Treatment,In some cases, vancomycin may be used.Treatment with any effective agent should be give
50、n for at least 5 to 7 day or after the patients have been afebrile for 2-3 days,neumonia呼吸系统肺炎英文带教,2022/10/2Treatmentpneumonia呼吸系,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
