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58,2019/4/29,Respiratory System,Respiratory System,nose（nas/o OR rhin/o）,larynx (laryn/o),Lungs (pneumon/o OR pulmo ),bronchus (bronch/o),diaphragm (diaphragm/o),mediastinum,（一）pandect,Organs,3,Functions,Breathing process Exchange of Oxygen and Carbon Dioxide Enable speech production,oxygen carbon dioxide,Alveolar/0-,Hyperpnea,Cyanosis,02,co2,Respiratory System,（一）pandect,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,Signs and symptoms,Cough Laryngitis/ bronchitis/ bronchial asthma/ chronic obstructive pulmonary disease (COPD)/ lung cancer Expectoration 吐痰 Lung abscess/ bronchiectasis/ pneumonia Hemoptysis 咯血 pulmonary Tuberculosis Dyspnea Pneumothorax 气胸/ pleural effusion/ left heart failure Stethalgia 胸痛 hemothorax/ Pulmonary thromboembolism,Respiratory System,（一）pandect,Lab and other inspection,Blood tests antigen skin test phlegm examination pleural effusion thoracicopuncture radio examination,Respiratory System,（一）pandect,bronchoscopy Thoracoscope lungobiopsy supersonic inspection respiratory function test Pulmometry,Definition Pneumonia is an acute infection of 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，局灶性胸部症状，胸片阴影。,Respiratory System,2019/4/29,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 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,2019/4/29,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,2019/4/29,2019/4/29,Respiratory System,2019/4/29,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,2019/4/29,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,2019/4/29,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,2019/4/29,Classification 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,Respiratory System,2019/4/29,Classification by pathogen按病原体分类,Respiratory System,2019/4/29,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 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;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。,2019/4/29,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,Respiratory System,2019/4/29,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,Pneumococcal 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.,Respiratory System,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,Respiratory System,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,leukoc