Contents（一）、pandect3（二）、Pneumoniaingeneral8（三）、Etiology13（四）、Signs34（五）、Treatment49（六）、Prevention582024/8/22uRespiratorySystemuRespiratorySystemnose（nas/oORrhin/o）larynx(laryn/o)Lungs(pneumon/oORpulmo)bronchus(bronch/o)diaphragm(diaphragm/o)mediastinum（一）（一）pandectOrgans3Functions BreathingprocessExchangeofOxygenandCarbonDioxideEnablespeechproductionoxygencarbondioxideAlveolar/0-Hyperpnea Cyanosis02co2uRespiratorySystem（一）（一）pandect4The influencing factors of respiratory diseasesuRespiratorySystem（一）（一）pandectAirpollutionandsmokingInhaledallergensThevariationofetiologyandDrugresistanceincreasesSigns and symptomsCough Laryngitis/bronchitis/bronchialasthma/chronicobstructivepulmonarydisease(COPD)/lungcancerExpectorationLungabscess/bronchiectasis/pneumoniaHemoptysispulmonaryTuberculosisDyspneaPneumothorax/pleuraleffusion/leftheartfailureStethalgia hemothorax/PulmonarythromboembolismuRespiratorySystem（一）（一）pandectLab and other inspectionBloodtestsantigenskintestphlegmexaminationpleuraleffusionthoracicopunctureradioexaminationuRespiratorySystem（一）（一）pandectbronchoscopyThoracoscopelungobiopsysupersonicinspectionrespiratoryfunctiontestPulmometryDefinitionPneumoniaPneumoniaisanacuteinfectionisanacuteinfectionoftheoftheparenchymaprekmparenchymaprekmofofthelung,thelung,肺炎是肺肺炎是肺实质实质的急性感染的急性感染 ，(lower-(lower-respiratorytract)respiratorytract)下呼吸道下呼吸道causedbycausedbymicroorganismmicroorganismmakr:gnzmmakr:gnzm 由微生物引起由微生物引起, ,comeswithfever,focalchestcomeswithfever,focalchestsymptoms,shadowingonsymptoms,shadowingonCXRCXR（chestX-raychestX-ray胸部胸部x x线检查）线检查）. .伴随发热，局灶性胸部症状，胸片阴伴随发热，局灶性胸部症状，胸片阴影。影。RespiratorySystem2024/8/22Defense mechanism difens meknizmof the respiratory tract（呼吸道防御机制）（呼吸道防御机制）Filtrationfiltreinanddepositiondepzn滤除及沉积（nasalfunction鼻功能）pathogenspdnsintheupperairways上呼吸道病原体Coughreflex咳嗽反射Mucociliarymju:kslrclearance黏液纤毛清除macrophagesmkrfed巨噬细胞Humoralhju:mrlandcellularseljl(r)immunity体液及细胞的免疫Oxidativeksdetvmetabolismmtblzmoftheneutrophils中性粒细胞的氧化代谢uRespiratorySystem（二）、Pneumoniaingeneral2024/8/22 鼻炎咽炎耳炎扁桃体炎喉炎细支气管炎uRespiratorySystemSinus/-itis sansats 鼻窦炎鼻窦炎 Pharyng/-itis .frndats 咽炎咽炎Laryng/-itis lrndats 喉炎喉炎Bronch/-itis brkats 支气管炎支气管炎2024/8/22rootmeaningexamplePneum(o)-Lung,airpneumothoraxnju:m:rks气胸pneumonia肺炎pneumaticnu:mtk充气的pneumocystisnjumssts肺囊虫pneumonectomynju:mnektm肺切除术pneumonrrhagianju:mrei:d肺出血pneumographnju:mgr:f呼吸描计议pneumocytenju:mst肺细胞pneumatocelenju:mtsi:l肺膨出Pulmo(o)-Pulmonaryplmnri肺的,肺病的Path(o)-pathologyPathobiologypbald病理学Pathogenpdn病原体Pathogenesispdenss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2024/8/22rootmeaningexampledys-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）dsplepnea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hyperadenosis（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）hapardhypo-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:muRespiratorySystem2024/8/22Etiology病因Therearetwofactorsinvolvedintheformationofpneumonia,参与肺炎形成的两个因素，includingpathogensandhostdefenses.包括病原体和宿主防御uRespiratorySystem2024/8/22Causativeorganisms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-病菌germicide杀菌剂d:msadbacteri-细菌bacteriology细菌学bacteriemia菌血症bktrmjbactericide杀菌剂bktrsadbacill-杆菌bacillemia杆菌血症bsli:m-coccus球菌diplococcus双球菌dplkks、gonococcus淋球菌gnkksstrept-链streptococcus链球菌属streptkksstaphyl-葡萄staphylococcus葡萄球菌属stflkks、staphyloma葡萄肿stflmmonil-念珠菌moniliasis念珠菌病mnlassfung-真菌fungoid似真菌的，状的fgd、fungicide杀真菌剂fngsadmyc-霉菌mycoology霉菌学，真菌学antimycotic抗真菌的2024/8/22Classification分类Classificationofanatomy按解剖分类Classificationofpathogen按病原体分类Classificationofacquiredenvironment按患病环境分类uRespiratorySystem2024/8/22Classification by anatomy按解剖按解剖分类分类Lobar大叶性大叶性: Involvementofanentirelobe一个完整的叶的参与Lobular小小叶叶性性: Involvementofpartsofthelobeonly,segmentalorofalveolicontiguoustobronchi(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间间质质性性ntstl: Involvementoftheinterstitialtissueofthelungs肺间质组织参与uRespiratorySystem2024/8/22Classification by pathogen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 disease li:dne军团菌肺炎uRespiratorySystem2024/8/22Classifications by acquired environment按患病环境分类按患病环境分类Community-acquiredpneumonia: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-acquiredpneumonia:医院获得性肺炎医院获得性肺炎 CertainillnessmaypredisposeHAPbecauseof:Impaireddefensesorchronicillness;Coma昏迷,malnutrition营养不良,prolonghospitalization住院时间延长;Numerousintervention介入asendotrachealintubation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。2024/8/22SymptomsCoughDyspnea呼吸困难dspni:Pleuritic肋膜炎的plrtkchestpain胸痛Feverorhypothermia发热或低体温Myalgias肌痛maldChills/Sweats发冷/出汗Fatigue疲劳fti:HeadacheDiarrhea腹泄sinusitis鼻窦炎sansatsexpectoration咳痰uRespiratorySystem2024/8/22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Pneumococcalpneumonia肺炎链球菌肺炎ThepneumoniathatiscausedbyStreptococcuspneumoniaenearlyhalfofcommunity-acquiredpneumonia(CAP）由肺炎链球菌引起的肺炎近一半是社区获得性肺炎. Thediseaseonsetisacute起病急andcanbeserious,accompanied伴有byhighfever,chills寒战,cough,bloodysputum痰中带血andchestpain.uRespiratorySystemThepathologicalchange病理变化isdividedintofourperiods,分为四个时期，i.e.congestivestage充血期,redhepatization红色肝样变,grayhepatization灰色肝样变andresolution消散期.121,dilatation扩张daltenandcongestion充血kndestnofthecapillaries毛细血管kplrz2,thefibrinous纤维蛋白fabrnsexudate渗出物eksdetuRespiratorySystemThisisnotedclinicallyasoedema水肿di:mandcongestion充血inlung, alveolarexudate肺泡渗出,hematidhemtdinfiltration红细胞浸润,leukocytelu:ksatinfiltration白细胞浸润.Thenthebacterium细菌willbeeliminated消除throughleukocyticphagocytosis白细胞吞噬作用.Atlast,thefibrousprotein纤维蛋白isbrokendownandabsorbed,thealveolarinflatesagain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。uRespiratorySystemInfact,earlytreatmentbyusingantibacterial抗菌的drugcausehepatization肝样变inpathologicalstagedoesnothavepreciselimits.Wehadrarelyseenthistypicalpathologicalstageinclinical.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。uRespiratorySystem2024/8/22EtiologyandpathogenesisorganismS.pneumoniaeDynamic balance 2024/8/22S.pneumoniaeasthegram-positivebacillus,capsule,itsvirulencesizerelatedtothestructureandcontentofcapsularpolysaccharide,indryphlegmcansurviveformonths,butdirectsunlightfor1hour,heat52degrees10mincanbekilled.uRespiratorySystem2024/8/22EtiologyandpathogenesisThebodykeepsadynamicequilbriumbetweentheorganismandS.pneumoniaeaswellastheinternalandexternalenvairoment,undernormalconditions,S.pneumoniaesentinthehunmanoralcavityandnasopharynx,theyarecalled“normalflora”.uRespiratorySystem2024/8/22EtiologyandpathogenesisthepathogenicityofS.pneumoniaeisduetothecapsuleinvadetheorganization,firstofall,causetohydropsofalveolarwalls,leukopedesis,overspreadingthelungsegmentandpulmonarylobe.uRespiratorySystem2024/8/22Etiologyandpathogenesiswhenthebodyresistanceistooweakforthebodytoadapttoclimaticchange,whenS.pneumoniaeareexcessive,Whenthedynamicequilbriumisdamagedandcannotrestoredimmediately,S.pneumoniaewillbecomepathogenicfactorandleadtotheoccuranceofdisease.uRespiratorySystem2024/8/22Streptococcuspneumoniaehigh-riskgroups：Smokers,dementia,ChronicBronchitis,bronchiectasis,cardiacfailure,chronicdisease,immunosuppressantsusers,theelderly,infantsandyoungchildren2024/8/22LaboratoryExaminations实验室检查WBC(whitebloodcell)白细胞PaO2(动脉血氧分压Arterial动脉的:trlPartial部分的PressureofOxygen)PaCO2(肺泡二氧化碳分压Alveolar肺泡的PartialPressureofCarbonDioxide)2024/8/221.TheWBC:(1030)x109/L,neutrophils中性粒细胞80%;TheWBCcanbenormal,butneutrophilsmustbeincreased.2.TheBacteriologicalexamination细菌学检查:directsmear直接涂片，usesputumculture,痰涂片culturewithbloodorpleuraleffusion血液或胸腔积液培养.2024/8/223.Bloodgasanalysis血气分析:PaO2canbedecreased,PaCO2canbenormalordecreased,metabolicacidosis代谢性酸中毒metblik sidusis.Whatarepneumoniasymptomsandsigns?Initiallyhavesymptomsofacold（upperrespiratoryinfection,forexample,sneezing,sorethroat,cough）,whicharethenfollowedbyahighfever（sometimesashighas104F）,shakingchills,andacoughwithsputumproduction.Thesputumisusuallydiscoloredandsometimesbloody,shortnessofbreath.Theindividualsskincolormaychangeandbecomedustyorpurplish（aconditionknownas“cyanosis”）duetotheirblood.SymptomsThispainisusuallysharpandworsenwhentakingadeepbreathandisknownaspleuriticpainorpleurisy.Aworseningcough,headaches,andmuscleachesmaybetheonlysymptoms.Childrenandbabieswhodeveloppneumoniaoftendonothaveanyspecificsignsofachestinfectionbutdevelopafever,appearquiteill,andcanbecomelethargic.ComplicationsSeriousandpotentiallylethalPleuraleffusionandempyemaInfectiveshockToxicmyocarditisARDS（AcuteRespiratoryDistressSyndrome)OrganizedpneumoniaPleuritisMeningocephalitisHowispneumoniadiagnosed？Coarsebreathingorcrackingsoundswithastethoscope.Wheezingorthesoundsofbreathingmaybefaintinaparticularareaofthechest.AchestX-rayisusuallyorderedtoconfirmthediagnosisofpneumonia.Thelungshavelobes，usuallytwoontheleftandthreeontheright.Whenthepneumoniaaffectsoneoftheselobes，itisoftenreferredtoaslobarpneumonia.SputumSamplesSputumSamplescanbecollectedandexaminedunderthemicroscope.Pneumoniacausedbybacteriaorfungicanbedetectedbythisexamination.Aswehaveusedantibioticsinabroaderuncontrolledfashion,moreorganismsarebecomingresistanttothecommonlyusedantibiotics.Thesetypesofculturescanhelpindirectingmoreappropriatetherapy.AbloodtestThatmeasureswhitebloodcellcount.Anindividualswhitebloodcellcountcanoftengiveahintastotheseverityofthepneumoniaandwhetheritiscausedbybacteriaoravirus.Anincreasednumberofneutrophils,onetypeofWBC,isseeninmostbacterialinfections.Whereasanincreaseinlymphocytes,anothertypeofWBC,isseeninviralinfections,fungalinfections,andsomebacterialinfections.HematologylaboratoryCompletebloodcount（CBC）Redbloodcellcount（RBC）Hemoglobin（Hgb）Hematocrit（Hct）Whitebloodcellcount（WBC）NeutrophilslymphocytesMonocytesPlateletcount,prothrombintimePartialthromboplastintimebloodglucoseBronchoscopyBronchoscopyisaprocedureinwhichathin,flexible,lightedviewingtubeisinsertedintothenoseormouthafteralocalanestheticisadministered.Usingthisdevice,thedoctorcandirectlyexaminethebreathingpassages（tracheaandbronchi）.Simultaneously,samplesofsputumortissuefromtheinfectedpartofthelungcanbeobtained.FluidcollectsSometimes,fluidcollectsinthepleuralspacearoundthelungasaresultoftheinflammationfrompneumonia.Thisfluidiscalledapleuraleffusion.Ifasignificantamountoffluiddevelops,itcanberemoved.Afternumbingtheskinwithlocalanestheticaneedleisinsertedintothechestcavityandfluidcanbewithdrawnandexaminedunderthemicroscope.Thisprocedureiscalledathoracentesis.Diagnosis1PrecedinghistoryofcommoncoldorotherURI；2.Symptoms：abruptonset,highfever,coughwitharustysputum,chestpain,dyspneaandcoughetc；3.Signs:remarkablemoistrale；4.Bloodtest：leukocytosis；5.Radiologicstudy:Lobarconsolidation；6.Adefinitivediagnosisrequiresdemonstrationofpneumoniainsputumculture,blood,lungtissue.Upper respiratory infectionDiffuse interstitial pneumoniaLobar pneumoniaCriteriaofseverepneumonia1. Respiratory rate30/min；2. Blood pressure90/60mmHg；3. Blood gas :PaO260mmHg， PaO2/FiO2 7.1mmol/L(30mg/DL)；5. X-ray:two lobes are involved；Need for vasopressorsRenal FailureCaseouspneumonia(lungtuberculosis）Differential diagnosisApicallocationInsidious onset with lower fever，night sweats，Fatigue and weight lossNot respond to antibioticsSputum smear for tubercle bacilli(+)Differential diagnosisLung abscessCopious purulent foul-smelling sputumDifferential diagnosisObstructivepneumoniasuperimposed hilar shadowrecurrent pneumonia at the same site happended in patients over 40, which does not respond well to the antibiotic treatmentfiberoptic bronchoscopy2024/8/22TreatmentAntiinfectioustherapySupportivetherapyTherapyofcomplications2024/8/22TreatmentThemoreseriouspneumonia,requiresantibioticssuchaspenicillin.2024/8/22TreatmentAll patients with suspected pneumococcal pneumonia should be treated as promptly 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 2024/8/22TreatmentFor 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 respiratory fluoroquinolone(氟喹诺酮氟喹诺酮) alone.2024/8/22TreatmentIn 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 days2024/8/22Supportive measureSupportive 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) 2024/8/22Supportive measureCorrecting electrolytes(电解质电解质)Oxygen therapy 2024/8/22Treatment of complicationsEmpyema(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% patientsChest X-ray with lateral decubitus（侧卧位）（侧卧位） films are often useful in the early recognition of pleural effusion, pleural fluid that is removed should be subjected to routing examination2024/8/22Treatment of complicationsExtra pulmonary（胸部的）（胸部的） complications such as arthritis（关节炎）（关节炎）, endocarditis（心内膜炎）（心内膜炎） must be excluded, because the therapy requires higher dosages（剂量）（剂量） Treatment of infections shock2024/8/22PreventionThe 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（脾切除术）切除术）, diabetes mellitus（糖尿病患者）（糖尿病患者） and aged2024/8/22PreventionThegerms（微生物）thatcausemanyofthedifferenttypesofpneumoniacanbecontagious（有传染性的）andarespreadthroughcoughingandsneezing.Youcanpreventpneumoniabyfollowinggoodhygienehabits,suchas:-Coughorsneezeintoatissue.-Useseparatedrinkingglassesandeatingutensils.-Washyourhandsfrequentlywithwarmsoapywater.2024/8/22PreventionDonotvisitsickpatientswithpneumonia.Ifyouhavepneumonia,donotvisitolderpeople,visitolderpeople,babiesorsickpeople.2024/8/22PreventionImproveimmunity：followthesewell-knownmeasurestostayhealthyandkeeptheimmunesystemready:-Eathealthy-Sleepwell-Avoidsmoking-Exercise-Reducestress-Donotdrinkalcoholinexcess2024/8/22