pneumonia呼吸系统肺炎全英文实用教案

1、uRespiratory Systemnose（nas/o OR rhin/o）larynx (laryn/o)Lungs (pneumon/o OR pulmo )bronchus (bronch/o)diaphragm (diaphragm/o)mediastinum（一）pandect Organs 第1页/共61页第一页，共62页。2 Functions Breathing process Exchange of Oxygen and Carbon Dioxide Enable speech productionoxygencarbon dioxideAlveolarAlveolar/

2、 /0-0-HyperpneaCyanosis02co2uRespiratory System（一）pandect第2页/共61页第二页，共62页。3 The influencing factors of respiratory diseasesuRespiratory System（一）pandect Air pollution and smoking Inhaled allergens The variation of etiology and Drug resistance increases 第3页/共61页第三页，共62页。 Signs and symptoms Cough Lary

3、ngitis/ bronchitis/ bronchial asthma/ chronic obstructive pulmonary disease (COPD)/ lung cancer Expectoration Lung abscess/ bronchiectasis/ pneumonia Hemoptysis pulmonary Tuberculosis Dyspnea Pneumothorax/ pleural effusion/ left heart failure Stethalgia hemothorax/ Pulmonary thromboembolismuRespirat

4、ory System（一）pandect第4页/共61页第四页，共62页。 Lab and other inspectionBlood testsantigen skin test phlegm examination pleural effusionthoracicopunctureradio examination uRespiratory System（一）pandectbronchoscopyThoracoscope lungobiopsysupersonic inspectionrespiratory function testPulmometry 第5页/共61页第五页，共62页。

5、x查）.伴随发热，局灶性胸部症状，胸片阴影。Respiratory System第6页/共61页第六页，共62页。2021-12-10Defense mechanism difens meknizmof the respiratory tract（呼吸道防御机制(fn y j zh)）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(fnsh)Mucociliarymju:kslr clearance

6、 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uRespiratory System（二）、Pneumonia in general第7页/共61页第七页，共62页。2021-12-10 鼻炎(b yn)咽炎(yn yn)耳炎扁桃体炎(bin to t yn)喉炎细支气管炎uRespiratory SystemSinus/-itis sansats 鼻

7、窦炎 Pharyng/-itis .frndats 咽炎Laryng/-itis lrndats 喉炎Bronch/-itis brkats 支气管炎第8页/共61页第八页，共62页。2021-12-10rootmeaningexamplePneum(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

8、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

9、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支气管狭窄第9页/共61页第九页，共62页。2021-12-10rootmeaningexampledys-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

10、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）hapard hypo-在下、次于、不足hypothermia（低体温）hap:mi 、hypoglottis（舌下部）hapglts 、hypoacidity （胃）酸过少 h

11、psdt 、hypocalcemia（低血钙）hapklsi:m 、hypoglycemia（低血糖）hapglasi:m uRespiratory System第10页/共61页第十页，共62页。2021-12-10Etiology病因(bngyn) There are two factors involved in the formation of pneumonia ,参与肺炎形成的两个因素(yn s)，including pathogens and host defenses.包括病原体和宿主防御 uRespiratory System第11页/共61页第十一页，共62页。2021-1

12、2-10Causative 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(zhnjn) Parasites寄生虫 Viruses病毒rootmeaningexamplegerm-病菌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 、gono

13、coccus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fungoid似真菌的，状的fgd 、fungicide杀真菌剂fngsad myc-霉菌mycoology霉菌学，真菌学 antimycotic抗真菌的第12页/共61页第十二页，共62页。2021-12-10Classification分类(fn li) Classification of anatomy按

14、解剖分类 Classification of pathogen按病原体分类 Classification of acquired environment按患病(hun bn)环境分类 uRespiratory System第13页/共61页第十三页，共62页。2021-12-10Classification by anatomy按解剖(jipu)分类 Lobar大叶性 : Involvement of an entire lobe 一个(y )完整的叶的参与 Lobular小叶性 : Involvement of parts of the lobe only, segmental or of

15、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； I n t e r s t i t i a l 间 质 性 n t s t l : Involvement of the interstitial tissue of the lungs肺间质组织参与 uRespiratory System第14页/共61页第十四页，共62页。2021-12-10Classification by pathogen按病原体分类(fn li)Pneumococcal pneumonia ,njumkkl肺

16、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uRespiratory System第15页/共61页第十五页

17、，共62页。2021-12-10Classifications by acquired environment按患病环境(hunjng)分类 Community-acquired pneumonia:社区(sh q)获得性肺炎：。 Occur in community within 48 hour.在社区(sh q)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。 Hosp

18、ital-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。 第16页/共61页第十六页，共62页。2021-1

19、2-10Symptoms Cough Dyspnea呼吸困难 dspni: Pleuritic肋膜炎的 plrtk chest pain胸痛 Fever or hypothermia发热(f r)或低体温 Myalgias肌痛 mald Chills/Sweats发冷(f ln)/出汗 Fatigue疲劳 fti: Headache Diarrhea腹泄 sinusitis鼻窦炎sansats expectoration咳痰 uRespiratory System第17页/共61页第十七页，共62页。2021-12-10全身(qun shn)怕冷湿冷发青(f qn)痰痰短气(dunq)胸膜炎的

20、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 关节痛第18页/共61页第十八页，共62页。Pneumococcal pneumonia肺炎(fiyn)链球菌肺炎(fiyn) 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(sh q)获得性肺炎. The disease onset is acute起病急and can be serious,a

21、ccompanied伴有 by high fever , chills寒战, cough, bloody sputum痰中带血 and chest pain. uRespiratory System第19页/共61页第十九页，共62页。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(xiosn)期. 1 2 1,dilatation扩张dalt

22、en 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第20页/共61页第二十页，共62页。 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 th

23、e 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 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(fnji)和吸收，肺泡重新充气。uRespiratory System第21页/共61页第二十一页，共62页。In fact, early t

24、reatment 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，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(dinxng)的临床病理分期。uRespiratory System第22页/共61页第二十二页，共62页。2021-12-10Etiology and patho

25、genesis organismDynamic balance 第23页/共61页第二十三页，共62页。2021-12-10 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 min can be

26、 killed.uRespiratory System第24页/共61页第二十四页，共62页。2021-12-10Etiology 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 hunman oral cavity and nasopharynx,they are

27、called “ normal flora”. uRespiratory System第25页/共61页第二十五页，共62页。2021-12-10Etiology 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 and pulmonary lobe.uResp

28、iratory System第26页/共61页第二十六页，共62页。2021-12-10Etiology 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 and

29、lead to the occurance of disease .uRespiratory System第27页/共61页第二十七页，共62页。2021-12-10Streptococcus pneumoniae high-risk groups ： Smokers, dementia, Chronic Bronchitis , bronchiectasis, cardiac failure,chronic disease,immunosuppressants users, the elderly, infants and young children 第28页/共61页第二十八页，共62页

30、。2021-12-10Laboratory Examinations实验室检查(jinch) WBC(white blood cell)白细胞 PaO2 (动脉(dngmi)血氧分压Arterial动脉(dngmi)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)第29页/共61页第二十九页，共62页。2021-12-10 1.The WBC:( 10 30) x 109 / L, neutrophils中性(zhngxng)粒细胞 80%;

31、 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 culture with blood or pleural effusion 血液或胸腔积液培养.第30页/共61页第三十页，共62页。2021-12-103. Blood gas analysis血气(xuq)分析: PaO2 can be decreased, PaCO2 can be normal or de

32、creased, metabolic acidosis代谢性酸中毒metblik sidusis .第31页/共61页第三十一页，共62页。What are pneumonia 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,

33、 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 purplish（a condition known as “cyanosis ”）due to their blood.第32页/共61页第三十二页，共62页。Symptoms This pain is usually sharp and worsen wh

34、en 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 any specific signs of a chest infection but develop a fever ,appear quite ill,and can become lethar

35、gic.第33页/共61页第三十三页，共62页。Complications Serious and potentially lethal Pleural effusion and empyema Infective shock Toxic myocarditis ARDS （Acute Respiratory Distress Syndrome ) Organized pneumonia Pleuritis Meningocephalitis 第34页/共61页第三十四页，共62页。How is pneumonia diagnosed？ Coarse breathing or cracking

36、 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 right.When the pneumonia affects one of these lobes，it

37、 is often referred to as lobar pneumonia.第35页/共61页第三十五页，共62页。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 fashion, more organisms are

38、becoming resistant to the commonly used antibiotics. These types of cultures can help in directing more appropriate therapy.第36页/共61页第三十六页，共62页。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 whethe

39、r 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.第37页/共61页第三十七页，共62页。Hematology labo

40、ratory Complete blood 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 glucose第38页/共61页第三十八页，共62页。Bronchoscopy Bronchoscopy is a procedure in which a

41、 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（trachea and bronchi）.Simultaneously, samples of sputum or tissue from the infected part of the lung can be obta

42、ined.第39页/共61页第三十九页，共62页。Fluid collects Sometimes, fluid collects in the pleural 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

43、 needle is inserted into the chest cavity and fluid can be withdrawn and examined under the microscope. This procedure is called a thoracentesis. 第40页/共61页第四十页，共62页。Diagnosis1Preceding history of common cold or other URI；2. Symptoms：abrupt onset, high fever,cough with a rusty sputum,chest pain,dyspn

44、ea and cough etc；igns: remarkable moist rale； 4. Blood test：leukocytosis；5. Radiologic study: Lobar consolidation ；6.A definitive diagnosis requires demonstration of pneumonia in sputum culture ,blood ,lung tissue. Upper respiratory infection第41页/共61页第四十一页，共62页。Diffuse interstitial pneumoniaLobar pn

45、eumonia第42页/共61页第四十二页，共62页。Criteria of severe pneumonia1. 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 Failure第43页/共61页第四十三页，共62页。 Caseous pneumonia(lung tuberculosis）Differential d

46、iagnosisApicallocationInsidious onset with lower fever，night sweats，Fatigue and weight lossNot respond to antibioticsSputum smear for tubercle bacilli(+)第44页/共61页第四十四页，共62页。Differential diagnosis Lung abscessCopious purulent foul-smelling sputum第45页/共61页第四十五页，共62页。Differential diagnosis Obstructive

47、pneumoniasuperimposed hilar shadowrecurrent pneumonia at the same site happended in patients over 40, which does not respond well to the antibiotic treatmentfiberoptic bronchoscopy第46页/共61页第四十六页，共62页。2021-12-10Treatment Antiinfectious therapy Supportive therapy Therapy of complications第47页/共61页第四十七页

48、，共62页。2021-12-10 Treatment The more serious pneumonia, requires antibiotics such as penicillin. 第48页/共61页第四十八页，共62页。2021-12-10Treatment All 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

49、basis of patients status /adverse rea- ction or complication that occur 第49页/共61页第四十九页，共62页。2021-12-10Treatment For patients who are believed to be allergic to penicillin(青霉素), one may select the first or second generation cephalosporin(头孢菌素(tu bo jn s) or advanced macrolide(大环内酯物)+ -lactam(-内酰胺) or

50、 respiratory fluoroquinolone(氟喹诺酮) alone.第50页/共61页第五十页，共62页。2021-12-10Treatment 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 days第51页/共61页第五十一页，共62页。2021-12-10Supportive measure Supp

51、ortive 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) to relieve pleuritic (胸膜炎的)pain -Replacing fluids, if the patient is dehydrated(脱水(tu shu)的) 第52页/共61页第五十二页，共62页。2021-12-10Supportive measure Correcting electrolytes(电解质) Oxygen therapy 第53页/共61页第五十三页，共62页。2021-12-10Treatment of complications Empyema(脓胸(nn xin) develops in appoximately 5% of patients with pneumococcal pne