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1、呼吸系统疾病基础知识概述（英文版）,呼吸系统疾病基础知识概述（英文版）,呼吸系统疾病 Respiratory System Disease,湘雅医院儿科 郑湘榕,呼吸系统疾病湘雅医院儿科 郑湘榕,婴幼儿上感、2种特殊类型上感的特点 支气管肺炎临床表现、重症肺炎特点 支气管肺炎的诊断、治疗 支气管哮喘的临床表现、诊断和治疗,重点,婴幼儿上感、2种特殊类型上感的特点重点,Introduce,In pediatric outpatient, 6o% patients are acute respiratory infections. In pediatric ward, 25% patients a
2、re Pneumonia. 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 outpatie,Why children are so susceptible to acute respiratory infections,?,Why
3、children are so susceptibl,呼吸系统疾病基础知识概述(英文版)课件,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 featu,Children Respiratory System Physiologic Feature,
4、Respiratory rate,Neonate 40-44/min1year 30/min2-3years 24/min4-7years 22/min8-14years 20/min,Children Respiratory System Ph,Children Respiratory System Physiologic Feature,Respiratory type,Respiratory type of abdomen Respiratory type of chest abdomen,Children Respiratory System Ph,hysical examinatio
5、n inspection Change of respiratory rate Cyanopathy Three concave sign uscultation,Examine 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）,Etiology,irus： ccupy 90% acteria： econdary Streptococus pyogens Pneumococcu aemophilus influenzae,Etiology,Commo
6、nAURI,Local symptom is mild,In infant and toddler,Systemic symptom is severe,Complications are common,Clinical Manifestations,Common Local symptom is mild I,CommonAURI,hysical examination,Congestion of pharyngeal portion, antiadoncus (咽部充血，扁桃体肿大)Lymphadenectasis in submaxilla (有时下颌、淋巴结肿大)Rash when e
7、nterovirus infection (肠道病毒感染时可出现皮疹),Clinical Manifestations,Commonhysical examination Con,SpecialAURI,柯萨奇病毒A组感染 夏秋好发 高热、咽痛、流涎 咽腭弓、软腭处有疱疹 疱疹破溃后可形成溃疡 病程 1 周左右,Clinical Manifestations,Herpangina疱疹性咽峡炎,Special 柯萨奇病毒A组感染Clinical Man,Pharyngo-conjunctival fever咽结合膜热,腺病毒 3，7 型所致 春夏发病，可小流行 发热、咽炎、结合膜炎 咽部充血、结
8、合膜充血，颈部、 耳后淋巴结肿大 病程 12 周,Clinical Manifestations,SpecialAURI,Pharyngo- 腺病毒 3，7 型所致Clinic,School age,Tympanitis, sinusitis,Abscess of pharynx posterior-wall,Laryngitis, bronchitis,Infant , toddler,Pneumonia,Glomerulonephritis,Rheumatic fever,Complications,School ageTympanitis, sinusit,Antivirus drugs
9、,Oseltamivir,Ribovirin,3-5 days,Antibiotics,Penicillin,SMZ,3-5 days,Sever symptomatic;,Secondary bacteria affection,Treatment,Antivirus drugs Oseltamivir,Defervesce,Drugs,Physics methods,Febril convulsion,Calm,Stop convulsion,Defervesce,Treatment,DefervesceDrugsPhysics methods,Pneumonia,肺 炎,Pneumoni
10、a肺 炎,Childrenfamiliar disease,In world,Occupy 1/3-1/4 in the death of children under 5 years of age,In china, Occupy more than 1/4 in paediatric ward,The hospitalization number of infant and toddler is 39.5 timesof school age,Pneumonia,In world,Occupy 1/3-1/4 in In,Pneumonia is an inflammation of th
11、e parenchyma of the lungs,It is caused by microorganisms or noninfectious causes,Manifested by fever,cough, tachypnea , respiratory distress and rales,Definition,Pneumonia is an inflammation,On course of illness,Acute： 3 months Deferred：13 months,Classification 1,On courseOn anatomicBronchopne,On th
12、e etiology,Virus RSV(respiratory syncytial virus)AdenovirusInfluenza Parainfluenza,BacteriaStreptococus pneumoniaeStaphylococus aureusHaemophilus influenzae type,Classification 2,On the Virus BacteriaClassifi,On the etiology,Mycoplasma,Chlamydia, parasites ,fungi,Noninfections causes,Classification
13、3,On theMycoplasmaChlamydia, par,On theseverity of illness,Mild symptomatic,Severe symptomaticBesides symptoms of respiratory system, concomitant manifestations of other organ systems are present,Classification 4,On theMild symptomaticSevere,on typical of clinical manifestation,Typical pneumonia,unt
14、ypical pneumoniaSevere acute respiratory syndrome,(SARS)coronavirus,Classification 5,on typicalTypical pneumoniaunt,On Occurrence Region,Community Acquired PneumoniaCAP,Hospital Acquired PneumoniaHAP,Classification 6,On Community Acquired Pneumoni,支气管肺炎,Bronchopneumonia,支气管肺炎 Bronchopneumonia,Etiolo
15、gy,virus,Main cause of pneumonia in developed countryRSV,bacteria,Main cause of pneumonia in developing countryS. pneumoniae,EtiologyvirusMain cause of pne,Pathology,PathologyCommonhyperaemia、edem,呼吸系统疾病基础知识概述(英文版)课件,呼吸系统疾病基础知识概述(英文版)课件,Pathologic physiology,气道炎症,循环系统,神经系统,水电解质,消化系统,肺A压增高,中毒性心肌炎,心衰,
16、代酸,中毒性肠麻痹,胃肠粘膜屏障功能,脑水肿,颅压,呼酸,K+,水钠储留,毒血症,通气不足 PaO2,PaCO2换气障碍 PaO2,Pathologic physiology气道炎症循环系统,Clinical manifestation,Mild symptomatic,respiratory system,fever,respiratory distressnasal flaring, retractions,cyonosis,tachypnea,cough,rales,5 years RR30次/分,Clinical manifestationMild res,Clinical manif
17、estation,Severe symptomatic,circular systemsymptom,Cardiac muscleinflammation,Heart failure,Clinical manifestationSevereci,Clinical manifest,Severe symptomatic,Heart failure,呼吸突然加快，60次/分心率突然增快 婴儿180次/分幼儿160次/分突然烦躁不安、面色发灰心音明显低钝，奔马率，颈静脉怒张肝大肋下3cm以上尿少、下肢浮肿,Clinical manifestSevereHeart呼吸,Clinical manifes
18、t,nerval system,Light hypoxia：irritability，lethargy,Sever hypoxia：hydrocephalus,digestive system,alimentary canal bleeding,Poisoning intestine palsy,Severe symptomatic,Clinical manifestnerval Light,Clinical manifest,DIC,Bp,四肢凉，脉速弱，出血,SLADH,Na + 130mmol/L渗透压 270mOsm/L,Edema,Severe symptomatic,Clinica
19、l manifest DICBp四肢凉，脉速弱,Complications,Complication,pneumatocele,pyopneumothorax,empyema,ComplicationsComplicationpneum,Laboratory data,Blood,blood routine,bacteria infect：WBC、N left shift of nucleus virus infect：WBC、Labnormal lymph cell,bacteria infect ： CRP virus infect ：CRP normal,CRP,NBT,bacteria
20、 infect ： 10%virus infect ： 10%,Pathogeny,virus separate,Germiculture,sputum for Gram stain and culture,Laboratory dataBloodbloodbacte,Laboratory data,X-ray,shadow of dot and spote,emphysema atelectasis,Laboratory dataX-rayshadow of,支气管肺炎,正常胸片,支气管肺炎正常胸片,大叶性肺炎,正常胸片,大叶性肺炎正常胸片,fever,cough, tachypnea ,
21、respiratory distress and rales,X-ray,diagnosis,fever,cough, tachypnea , X-ray,Differentiation,foreign bodies in bronchi,history of foreign bodies、sudden cough、respiratory distress、lower of breath tone or wheezing,Differentiationacute rales、tac,Treatment,general treatment,Balance of water and electro
22、lyte3%Nacl 12ml/LNa+10mmol/L,Temperature 18-20 Humidity 60%Food nutritive,Treatmentgeneral Balance of wa,Treatment,Control infection,virus：no ideal drug like virozol,mycoplasma、chlamydia select erythromycin,bactrria：the principle of sensitivityefficiency、full period of treatment,first select Penicci
23、lin,TreatmentControl virus：no idea,Treatment,抗生素使用原则,根据药敏选药adopt sensitive drugs on the basis of pathogenic bacterium 用下呼吸道浓度高的药物adopt drugs which can finally infiltratelung tissue 足量足疗程重症静脉给药in severe case,drugs should be administedby vein , full dose, full period,Treatment抗生素根据药敏选药,Treatment,抗生素选择
24、,肺炎链球菌：PNC,阿莫西林，红霉素金黄色葡萄球菌：苯唑西林、氯唑西林、万古、利福平 流感嗜血杆菌：阿莫西林+克拉维酸钾或舒巴坦大肠杆菌和肺炎杆菌：头孢曲松或头孢噻肟绿脓杆菌：替卡西林钠克拉维酸钾或头孢哌酮肺炎支原体或衣原体：大环内酯,Treatment抗生素肺炎链球菌：PNC,阿莫西林，红霉素,Treatment,full periodof treatment,after temperature normal 5 7days or clinical symptom disappearing 3 daysMycoplasma pneumonia： 23 weeksStaphylococus
25、aureus ： after temperature normal 2 weeks ， full period is 6 weeks,Treatmentfull periodafter temp,treat against symptoms,Treatment,oxygentreat,PaO2：dyspnea、 cyanosis、asthma suppress、toxic appearance, methods: by nose canal 0.5 1 L /min，40%；by veil 24 L/min,50%60%mechanism ventilate（ respire failture
26、）,holding respiratory tract unobstructed,remove sputum、pulverization 、relieve spasmensure liquid absorb,treat TreatmentoxygenPaO2：dys,Treatment,treat ofother symp,defervesce calm,treat ofwindy,supply KaliumPoisoning intestine palsy：fasting、decompress of stomach and intestine 酚妥拉明 0.5 mg/kg ivgtt 10%
27、GS 20 ml,treat against symptoms,Treatmenttreat ofdefervescetre,Treatment,treat ofHeart failure,镇静给氧强心：西地兰减轻心脏负荷,treat against symptoms,Treatmenttreat of镇静treat,Treatment,合并中毒性脑病的治疗,脱水：甘露醇改善通气改善脑微循环止痉：地西泮地塞米松营养神经,treat against symptoms,Treatment合并中毒性脑病脱水：甘露醇treat,Treatment,糖皮质激素应用,适应症：喘憋重,呼吸衰竭全身中毒症状重
28、感染性休克 脑水肿,琥珀酸氢化可的松5 10 mg/kg.d地塞米松0.1 0.3 mg/kg.d ivgtt23 次/日35 天甲基强的松龙 2 4 mg/kg.次,Treatment糖皮质激素适应症：琥珀酸氢化可的松5 ,Response to treatment in otherwise uncomplicated CAP?,Fever- falls in 2 daysLeucocytosis- decreases in 4 days Physical findings persist slightly longerChest radiographic abnormalities may
29、 take4-12 weeks to resolve,Response to treatment in other,What if patients fails to recover?,You should consider-,Noninfectious conditionResistance to drugNew nosocomial pathogen,What if patients fails to reco,病毒性肺炎,呼吸道合胞病毒肺炎,腺病毒肺炎,2岁，2 6月多见喘憋、呼吸困难，可合并呼衰、心衰哮鸣音，细湿罗音小点片状影，肺气肿肺不张间质性肺炎,6月 2岁中毒症状重，稽留热，咳剧
30、，喘憋，呼吸困难出现晚，湿罗音或肺实变 胸片改变出现早，肺气肿，片状影或融合,年龄,症状,胸片,体征,病毒性呼吸道合胞病毒肺炎腺病毒肺炎2岁，2 6月多见6月,细菌性肺炎,葡萄球菌肺炎,新生儿，婴幼儿急、重、快，弛张热或稽留热，咳嗽，呼吸困难，呻吟，易致迁徒化脓病灶，并发脓胸，脓气胸，肺大疱中细湿罗音，出现早，皮疹浸润影，持续时间较长，易变，可见多发性肺脓肿，脓胸，脓气胸等,4岁慢，重，发热，痉挛性咳嗽，呼吸困难，发绀。易致迁徒化脓病灶，易并发脓胸湿罗音或实变大叶性肺炎、支气管肺炎、肺实变,年龄,症状,体征,胸片,革兰阴性杆菌肺炎,细菌性葡萄球菌肺炎新生儿，婴幼儿4岁年龄症状体征胸片革兰阴,肺
31、炎支原体肺炎,年长儿，婴幼儿发热、刺激性咳嗽，多系统病变不明显，婴幼儿可有呼吸困难，喘憋，哮鸣音，湿罗音肺门影增浓；支气管肺炎改变；间质性肺炎；均一实变影,6月起病慢，无发热，先URI症状后咳、喘、气促，部分伴结膜炎湿罗音，持续时间长间质性炎症，过度充气、片状影，持续时间长,年龄,症状,体征,胸片,沙眼衣原体肺炎,支衣原体肺炎,肺炎支原体肺炎年长儿，婴幼儿6月年龄症状体征胸片沙眼衣原体,支气管哮喘 bronchial asthma,支气管哮喘,发展史,asthma-喘息，2000年前就有对哮喘的详细描述过去认为是一种平滑肌功能异常性疾病80年代以来通过支气管黏膜活检， 认识到哮喘是气道慢性炎症
32、性疾病,发展史asthma-喘息，2000年前就有对哮喘的详细描述,Definition,chronic airway inflammation,airway hyperreactivity(AHR) reversible airway obstruction,manifested by wheezing, respiratory distress ,cough,Definitionchronic airway infla,特征,气道慢性炎症：此为哮喘主要特征可逆性的气流受限：指气流受限可被支气管 扩张剂所逆转气道高反应性：对正常气道无反应或很小反 （AHR） 应的刺激产生收缩反应,特征气道慢
33、性炎症：此为哮喘主要特征,pathology,naked eye：emphysema,mucus blotscope: inflammatory cell infiltrate， gland hyper plasia basal membrance thickening,pathologynaked eye：emphysema,m,病理生理,急性支气管痉挛：速发型哮喘反应（IgE依赖）气道壁肿胀：迟发型哮喘反应（炎症诱导）粘液栓形成：难治疗的气流受限气道重塑：不可逆的气道狭窄,核心,气流受限,病理生理急性支气管痉挛：速发型哮喘反应（IgE依赖）核心气流,atopy,是指对普通环境中常见的变应原
34、产生IgE介导反应的易感性，有明显的家族遗传倾向。,特应性,哮喘、过敏性鼻炎、湿疹、食物过敏等,导致哮喘发生最确定的危险因素,atopy是指对普通环境中常见的变应原产生IgE介导反应的易,pathogenesis,immunity factor,atopy,IgE ,nerve energyfactor,- adrenal gland nerve, - adrenal gland nerve,Pneumogastric nerve,various inflammatory cells into airway,AHR,Inheritfactor,genetic disease,family hi
35、story,pathogenesisimmunity atopy,IgE,Clinical manifest,older children sensitizin induce infant and toddler viral infection induce,period of onset symptoms of bronchial spasm- cough ,gasp catabasis may no signs and symptoms,rapid serious attack, reasonable utilize para-sympathesis drug cannot relief
36、in 24 hours,status asthmaticus,Clinical manifest older childr,auxiliary examination,X-ray,lung function,skin test,FEV1/FVC（一秒用力呼气容积/ 用力肺活量 ，低于70-75提示气流受限）,PEFR（呼气风流速，其日间变异率20%,使用支扩剂后增加20% 可诊断哮喘）,auxiliary examinationX-raylung,Diagnose of childfood asthma,gasp recurrent attacks lung wheezing ralesbro
37、nchodilators is validexclude other disease that can cause gasp,Diagnose of childfood asthmaga,cough1month,antibiotics treat is invalidbronchodilators can relieve coughhypersensitive history or allergia family historyairway is hyperreactivityexclude other cough disease,Diagnose of cough variant asthm
38、a,cough1month,antibiotics treat,therapy,Principle: long-term 、 persistence、standard、individuationPeriod of onset:antiinflammatory、calm gaspcatabasis:long-term 、 antiinflammatory、avoid trigger factor、self-careto spread Global Initiative for Asthma，GINA(全球哮 喘防治创议),therapyPrinciple: long-term 、,drug,gl
39、ucocorticoid-first select bronchodilators immunosuppressant other drug,drug glucocorticoid-first se,inhale：beclometasone 100 g，24times/day oral：prednisone12 mg/kg/day，17daysevere casepersistent attackanti-asthmatic cannot control intravenous drip：Cetacort 510 mg/kg/time Medrat 12 mg/kg/ time, BidTid
40、 severe attack,glucocorticoid usage,inhale：beclometasone 100 g，,drug,bronchodilators para-adrenal drug inhale 0.5% albuterol 0.010.03 ml/kg/次 atomization q46 h theocin aminofilina 45 mg/kg/次 immunosuppressant-methotrexate -cyclosporin other drug-disodium cromoglycate -ketotifen,drug bronchodilators,Status asthmaticus,inhale oxygencalmfluid replace,correct acidosiscortine dripbronchodilators,cortine inhaletheocin driprespirator,Status,prevent relapse,avoid sensitizin and trigger factor inhale cortin 6 months2years immunotherapy- desensitization self-management,prevent avoid sensitizin and,
