1、Contents（一）、pandect3（二）、Pneumonia in general8（三）、Etiology13（四）、Signs34（五）、Treatment49（六）、Prevention582022-7-30uRespiratory SystemuRespiratory Systemnose（nas/o OR rhin/o）larynx(laryn/o)Lungs (pneumon/o OR pulmo)bronchus (bronch/o)diaphragm(diaphragm/o)mediastinum（一）（一）pandect Organs 3 Functions Breat
2、hing process Exchange of Oxygen and Carbon DioxideEnable speech productionoxygencarbon dioxideAlveolarAlveolar/0-0-Hyperpnea Cyanosis02co2uRespiratory System（一）（一）pandect4 The influencing factors of respiratory diseasesuRespiratory System（一）（一）pandect Air pollution and smoking Inhaled allergens The
3、variation of etiology and Drug resistance increases Signs and symptoms Cough Laryngitis/bronchitis/bronchial asthma/chronic obstructive pulmonary disease(COPD)/lung cancer Expectoration Lung abscess/bronchiectasis/pneumonia Hemoptysis pulmonary Tuberculosis Dyspnea Pneumothorax/pleural effusion/left
4、 heart failure Stethalgia hemothorax/Pulmonary thromboembolismuRespiratory System（一）（一）pandect Lab and other inspectionBlood testsantigen skin test phlegm examination pleural effusionthoracicopunctureradio examination uRespiratory System（一）（一）pandectbronchoscopyThoracoscope lungobiopsysupersonic ins
5、pectionrespiratory function testPulmometry Respiratory System2022-7-30Defense mechanism difens meknizmof the respiratory tract（呼吸道防御机制）（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
6、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uRespiratory System（二）、Pneumonia in general2022-7-30 鼻炎咽炎耳炎扁桃体炎喉炎细支气管炎uRespiratory SystemSinus/-itis sansats 鼻窦炎鼻窦炎 Pharyng/-itis.frndats 咽炎咽炎Laryng/-itis l
7、rndats 喉炎喉炎Bronch/-itis brkats 支气管炎支气管炎2022-7-30rootmeaningexamplePneum(o)-Lung,airpneumothoraxnju:m:rks气胸 pneumonia肺炎 pneumatic nu:mtk充气的 pneumocystisnjumssts肺囊虫 pneumonectomynju:mnektm 肺切除术 pneumonrrhagia nju:mrei:d 肺出血 pneumographnju:mgr:f 呼吸描计议 pneumocytenju:mst肺细胞 pneumatocelenju:mtsi:l 肺膨出Pulm
8、o(o)-Pulmonaryplmnri肺的,肺病的Path(o)-pathologyPathobiologypbald 病理学 Pathogenpdn病原体Pathogenesis pdenss 发病机理 pathologistpldst 病理学家Muc(o)-SlimeMucoidmju:kd粘液样的 mucociliarymju:kslr 黏液纤毛的 mucositismju:ksats 黏膜炎Myx(o)-Myxomamksm粘液瘤 myxobacteriamksbktr 黏细菌myxiod粘液样的Bronch(o)-bronchiBronchogenicbrnkdenk 支气管原的
9、bronchoscopybrntskp支气管镜检查术 bronchitisbrkats 支气管炎 bronchospasmbrkspzm支气管痉挛Bronchoconstrictionbrntknstrkn支气管狭窄2022-7-30rootmeaningexampledys-有病的、不正常的、有障碍的dyspnea（呼吸困难）dspni:、dyscrasia（恶病质）dskrezj、dysentry（痢疾）dsntr、dysplasia（发育异常）dsple pnea呼吸eupnea（呼吸正常）ju:pni:、tachypnea（呼吸急促）tkpni:hyper-超出、在之上、高于、过度hy
10、peradenosis（腺增大）haprdnss、hyperaemia（充血）hapri:m、hyperinsulinism（胰岛素分泌过多）hapnslnzm、hyperpiesia（血压过高）hap(:)pazj、hyperthyroid（甲状腺功能亢进）hapard hypo-在下、次于、不足hypothermia（低体温）hap:mi、hypoglottis（舌下部）hapglts、hypoacidity（胃）酸过少 hpsdt、hypocalcemia（低血钙）hapklsi:m、hypoglycemia（低血糖）hapglasi:m uRespiratory System2022-
11、7-30Etiology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 uRespiratory System2022-7-30Causative 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rootmeaningexamplegerm-病
12、菌germicide杀菌剂d:msad bacteri-细菌bacteriology细菌学 bacteriemia菌血症bktrmj bactericide杀菌剂bktrsad bacill-杆菌bacillemia杆菌血症bsli:m-coccus球菌diplococcus双球菌dplkks、gonococcus淋球菌gnkks strept-链streptococcus链球菌属streptkks staphyl-葡萄staphylococcus葡萄球菌属stflkks、staphyloma葡萄肿stflm monil-念珠菌moniliasis念珠菌病mnlass fung-真菌fungo
13、id似真菌的，状的fgd、fungicide杀真菌剂fngsad myc-霉菌mycoology霉菌学，真菌学 antimycotic抗真菌的2022-7-30Classification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 uRespiratory System2022-7-30Classification by anatomy按解剖按解剖分类分类 Lobar大叶性大叶性:Involvement of an
14、 entire lobe 一个完整的叶的参与 Lobular小叶性小叶性: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间质性间质性ntstl :Involvement of the interstitial tissue of the lungs肺间质组织参与 uRespiratory System2022-7-30Classification by pat
15、hogen按病原体分按病原体分类类Pneumococcal pneumonia ,njumkkl肺炎球菌肺炎Staphylococcal pneumonia stflkkl 葡萄球菌肺炎Mycoplasmal pneumonia肺炎支原体肺炎Chlamydia pneumonia klmidi 肺炎衣原体肺炎 Viral pneumonia病毒性肺炎Pulmonary candidiasis knddass 肺念珠菌病Pulmonary aspergillosisspdilusis 肺曲霉菌病klebsiella pneumoniaklebziel 克雷伯杆菌肺炎legionaires dis
16、ease li:dne 军团菌肺炎uRespiratory System2022-7-30Classifications by acquired environment按患病环境分类按患病环境分类 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 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
17、生在冬季和春季。Hospital-acquired pneumonia:医院获得性肺炎医院获得性肺炎 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 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。2022-7-30
18、Symptoms Cough Dyspnea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:Headache Diarrhea腹泄 sinusitis鼻窦炎sansats expectoration咳痰 uRespiratory System2022-7-30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呕吐呕吐 关节痛Pne
19、umococcal pneumonia肺炎链球菌肺炎 The pneumonia 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.uRespiratory System T
20、he 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 uRespiratory System This is not
21、ed 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,the fibrous protein纤维蛋白is broken down and absorbed,the alveolar inflate
22、s 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。uRespiratory System 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.事实上，
23、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。uRespiratory System2022-7-30Etiology and pathogenesis organismS.pneumoniaeDynamic balance 2022-7-30 S.pneumoniae as the gram-positive bacillus,capsule,its virulence size related to the structure and content of capsular polysaccharide,in dry phlegm can sur
24、vive for months,but direct sunlight for 1 hour,heat 52 degrees 10 min can be killed.uRespiratory System2022-7-30Etiology 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 se
25、nt in the hunman oral cavity and nasopharynx,they are called“normal flora”.uRespiratory System2022-7-30Etiology and pathogenesis the pathogenicity of S.pneumoniae is due to the capsule invade the organization,first of all,cause to hydrops of alveolar walls,leukopedesis,overspreading the lung segment
26、 and pulmonary lobe.uRespiratory System2022-7-30Etiology 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 equilbrium is damaged and cannot restored immediately,S.pneumoniae will become pathogenic factor an
27、d lead to the occurance of disease.uRespiratory System2022-7-30Streptococcus pneumoniae high-risk groups：Smokers,dementia,Chronic Bronchitis,bronchiectasis,cardiac failure,chronic disease,immunosuppressants users,the elderly,infants and young children 2022-7-30Laboratory Examinations实验室检查 WBC(white
28、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Alveolar肺泡的 Partial Pressure of Carbon Dioxide)2022-7-30 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
29、片，use sputum culture,痰涂片 culture with blood or pleural effusion 血液或胸腔积液培养.2022-7-30 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 .What are pneumonia symptoms and signs?Initially have symptoms of a cold（upper respiratory infec
30、tion,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,shortness of breath.The individuals skin color may change and become dusty or purpl
31、ish（a condition known as“cyanosis”）due to their blood.Symptoms This pain is usually sharp and worsen when taking a deep breath and is known as pleuritic pain or pleurisy.A worsening cough,headaches,and muscle aches may be the only symptoms.Children and babies who develop pneumonia often do not have
32、any specific signs of a chest infection but develop a fever,appear quite ill,and can become lethargic.Complications Serious and potentially lethal Pleural effusion and empyema Infective shock Toxic myocarditis ARDS（Acute Respiratory Distress Syndrome)Organized pneumonia Pleuritis Meningocephalitis H
33、ow is pneumonia diagnosed？Coarse breathing or cracking sounds 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 rig
34、ht.When the pneumonia affects one of these lobes，it is often referred to as lobar pneumonia.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
35、 fashion,more organisms are becoming resistant to the commonly used antibiotics.These types of cultures can help in directing more appropriate therapy.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
36、 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 bacterial infections.Hematology laboratory Complete blood
37、 count（CBC）Red blood cell count（RBC）Hemoglobin（Hgb）Hematocrit（Hct）White blood cell count（WBC）Neutrophils lymphocytes Monocytes Platelet count,prothrombin time Partial thromboplastin time blood glucoseBronchoscopy Bronchoscopy is a procedure in which a thin,flexible,lighted viewing tube is inserted i
38、nto 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.Fluid collects Sometimes,fluid collects in the pl
39、eural 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 into the chest cavity and fluid can be withdrawn and examin
40、ed under the microscope.This procedure is called a thoracentesis.Diagnosis1Preceding 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 cons
41、olidation；6.A definitive diagnosis requires demonstration of pneumonia in sputum culture,blood,lung tissue.Upper respiratory infectionDiffuse interstitial pneumoniaLobar pneumoniaCriteria of severe pneumonia1.Respiratory rate30/min；2.Blood pressure90/60mmHg；3.Blood gas:PaO260mmHg，PaO2/FiO2 7.1mmol/L
42、(30mg/DL)；5.X-ray:two lobes are involved；Need for vasopressorsRenal Failure Caseous pneumonia(lung tuberculosis）Differential diagnosisApicallocationInsidious onset with lower fever，night sweats，Fatigue and weight lossNot respond to antibioticsSputum smear for tubercle bacilli(+)Differential diagnosi
43、s Lung abscessCopious purulent foul-smelling sputumDifferential diagnosis Obstructive pneumoniasuperimposed hilar shadowrecurrent pneumonia at the same site happended in patients over 40,which does not respond well to the antibiotic treatmentfiberoptic bronchoscopy2022-7-30Treatment Antiinfectious t
44、herapy Supportive therapy Therapy of complications2022-7-30 Treatment The more serious pneumonia,requires antibiotics such as penicillin.2022-7-30Treatment All patients with suspected pneumococcal pneumonia should be treated as promptly as possible with penicillin G The dose and route of delivery ma
45、y have to be on the basis of patients status/adverse rea-ction or complication that occur 2022-7-30Treatment For patients who are believed to be allergic to penicillin(青霉素青霉素),one may select the first or second generation cephalosporin(头孢菌素头孢菌素)or advanced macrolide(大环内酯物大环内酯物)+-lactam(-内酰胺内酰胺)or re
46、spiratory fluoroquinolone(氟喹诺酮氟喹诺酮)alone.2022-7-30Treatment 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 days2022-7-30Supportive measure Supportive measure are generally used in the in
47、itial management of acute pneumo-coccal pneumonia,such measures include-Bed rest-Monitoring vital signs and urine output-Administering an occasional analgesic(止痛剂止痛剂)to relieve pleuritic(胸膜炎的胸膜炎的)pain-Replacing fluids,if the patient is dehydrated(脱水的脱水的)2022-7-30Supportive measure Correcting electro
48、lytes(电解质电解质)Oxygen therapy 2022-7-30Treatment of complications Empyema(脓胸脓胸)develops in appoximately 5%of patients with pneumococcal pneumonia,although pleural effusion(胸膜渗出物胸膜渗出物)commonly develop in 10%-20%patients Chest X-ray with lateral decubitus（侧卧位）（侧卧位）films are often useful in the early rec
49、ognition of pleural effusion,pleural fluid that is removed should be subjected to routing examination2022-7-30Treatment of complications Extra pulmonary（胸部的）（胸部的）complications such as arthritis（关节（关节炎）炎）,endocarditis（心内膜炎）（心内膜炎）must be excluded,because the therapy requires higher dosages（剂量）（剂量）Trea
50、tment of infections shock2022-7-30Prevention The most important preventive tool available is using a pneumococcal vaccine（疫苗）（疫苗）in those with chronic lung diseases,chronic liver diseases,splenectomy（脾切除术）（脾切除术）,diabetes mellitus（糖尿病患（糖尿病患者）者）and aged2022-7-30Prevention The germs（微生物）that cause many
