pneumonia呼吸系统肺炎全英文教学课件

1、Contents（一）、pandect3（二）、Pneumonia in general8（三）、Etiology13（四）、Signs34（五）、Treatment49（六）、Prevention582022/8/3Respiratory System第1页，共61页。Respiratory 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2页，共61页。3

2、Functions Breathing process Exchange of Oxygen and Carbon DioxideEnable speech productionoxygencarbondioxideAlveolar/0-HyperpneaCyanosis02co2Respiratory System（一）pandect第3页，共61页。4 The influencing factors of respiratory diseasesRespiratory System（一）pandect Air pollution and smoking Inhaled allergens

3、The variation of etiology and Drug resistance increases 第4页，共61页。 Signs and symptomsCough Laryngitis/ bronchitis/ bronchial asthma/ chronic obstructive pulmonary disease (COPD)/ lung cancerExpectoration Lung abscess/ bronchiectasis/ pneumoniaHemoptysis pulmonary TuberculosisDyspnea Pneumothorax/ ple

4、ural effusion/ left heart failureStethalgia hemothorax/ Pulmonary thromboembolismRespiratory System（一）pandect第5页，共61页。 Lab and other inspectionBlood testsantigen skin testphlegmexamination pleural effusionthoracicopunctureradio examination Respiratory System（一）pandectbronchoscopyThoracoscope lungobi

5、opsysupersonic inspectionrespiratory function testPulmometry 第6页，共61页。DefinitionPneumonia is an acute infectionof 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-ra

6、y胸部x线检查）.伴随发热，局灶性胸部症状，胸片阴影。Respiratory System第7页，共61页。2022/8/3Defense 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macrophagesmkrf

7、ed 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第8页，共61页。2022/8/3 鼻炎咽炎耳炎扁桃体炎喉炎细支气管炎Respiratory SystemSinus/-itis sansats 鼻窦炎 Pharyng/-itis .frndats 咽炎Laryng/-itis lrndats 喉炎Bronch/-i

8、tis brkats 支气管炎第9页，共61页。2022/8/3rootmeaningexamplePneum(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Pulmo(o)-Pulmonarypl

9、mnri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 bronchoscopybrnt

10、skp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10页，共61页。2022/8/3rootmeaningexampledys-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hype

11、radenosis（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 Respiratory Syste

12、m第11页，共61页。2022/8/3Etiology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第12页，共61页。2022/8/3Causative 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rootme

13、aningexamplegerm-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 、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

14、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13页，共61页。2022/8/3Classification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第14页，共61页。2022/8/3Classification by anatomy按解剖分

15、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 Syste

16、m第15页，共61页。2022/8/3Classification by pathogen按病原体分类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 pneumo

17、niaklebziel 克雷伯杆菌肺炎legionaires disease li:dne 军团菌肺炎Respiratory System第16页，共61页。2022/8/3Classifications 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 win

18、ter 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

19、，营养不良住院时间延长；气管插管等较多的介入治疗。 第17页，共61页。2022/8/3SymptomsCoughDyspnea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: HeadacheDiarrhea腹泄 sinusitis鼻窦炎sansats expectoration咳痰 Respiratory System第18页，共61页。2022/8/3全身怕冷湿冷发青痰痰短气胸膜炎的plrtk 胸痛咳

20、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19页，共61页。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

21、, cough, bloody sputum痰中带血 and chest pain. Respiratory System第20页，共61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消散期. 1 2 1,dilatation扩张dalten and congestion充血kndestn of the capillaries毛细血管 kplr

22、z 2,the fibrinous纤维蛋白fabrns exudate渗出物eksdet Respiratory System第21页，共61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 the bacterium细菌will be eliminated消除through leukocytic phagocytosis白细

23、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，纤维蛋白分解和吸收，肺泡重新充气。Respiratory System第22页，共61页。In fact, early treatment by using antibacterial抗菌的drug cause hepatization肝样变 in pathological stage d

24、oes 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的临床病理分期。Respiratory System第23页，共61页。2022/8/3Etiology and pathogenesis organismS.pneumoniaeDynamic balance 第24页，共61页。2022/8/3 S.pneumoniae as the gram- positive bacillu

25、s, 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 killed.Respiratory System第25页，共61页。2022/8/3Etiology and pathogenesis The body keeps a dynamic equilbrium

26、 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 called “ normal flora”. Respiratory System第26页，共61页。2022/8/3Etiology and pathogenesis the pathogenicity of S. pneumoni

27、ae 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.Respiratory System第27页，共61页。2022/8/3Etiology and pathogenesis when the body resistance is too weak for the body to adapt to climatic cha

28、nge,when S.pneumoniae are excessive ,When the dynamic equilbrium is damaged and cannot restored immediately,S. pneumoniae will become pathogenic factor and lead to the occurance of disease .Respiratory System第28页，共61页。2022/8/3Streptococcus pneumoniae high-risk groups ： Smokers, dementia, Chronic Bro

29、nchitis , bronchiectasis, cardiac failure,chronic disease,immunosuppressants users, the elderly, infants and young children 第29页，共61页。2022/8/3Laboratory Examinations实验室检查WBC(white 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

30、 Carbon Dioxide)第30页，共61页。2022/8/31.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直接涂片， use sputum culture, 痰涂片 culture with blood or pleural effusion 血液或胸腔积液培养.第31页，共61页。2022/8/33. Bloo

31、d 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 .第32页，共61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

32、 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 purplish（a condition known as “cyanosis ”）due to their blood.第33页，共61页。Sy

33、mptomsThis 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 any specific signs of a chest infection but develop a

34、fever ,appear quite ill,and can become lethargic.第34页，共61页。Complications Serious and potentially lethal Pleural effusion and empyema Infective shock Toxic myocarditis ARDS （Acute Respiratory Distress Syndrome ) Organized pneumonia Pleuritis Meningocephalitis 第35页，共61页。How is pneumonia diagnosed？Coar

35、se 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 right.When the pneumonia affect

36、s one of these lobes，it is often referred to as lobar pneumonia.第36页，共61页。Sputum SamplesSputum 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 or

37、ganisms are becoming resistant to the commonly used antibiotics. These types of cultures can help in directing more appropriate therapy.第37页，共61页。A blood testThat measures white blood cell count.An individuals white blood cell count can often give a hint as to the severity of the pneumonia and wheth

38、er 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38页，共61页。Hematology laboratoryCom

39、plete blood count（CBC）Red blood cell count（RBC）Hemoglobin （Hgb）Hematocrit（Hct）White blood cell count （WBC）Neutrophils lymphocytes MonocytesPlatelet count, prothrombin time Partial thromboplastin time blood glucose第39页，共61页。BronchoscopyBronchoscopy is a procedure in which a thin, flexible, lighted vi

40、ewing 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 obtained.第40页，共61页。Fluid collec

41、tsSometimes, 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 needle is inserted into the chest cav

42、ity and fluid can be withdrawn and examined under the microscope. This procedure is called a thoracentesis. 第41页，共61页。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

43、； 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42页，共61页。Diffuse interstitial pneumoniaLobar pneumonia第43页，共61页。Criteria of severe pneumonia1. Respir

44、atory 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44页，共61页。Caseous pneumonia(lung tuberculosis）Differential diagnosisApicallocationInsidious onset with lower fever，night sweats，Fatigue

45、 and weight lossNot respond to antibioticsSputum smear for tubercle bacilli(+)第45页，共61页。Differential diagnosisLung abscessCopious purulent foul-smelling sputum第46页，共61页。Differential diagnosisObstructive pneumoniasuperimposed hilar shadowrecurrent pneumonia at the same site happended in patients over

46、 40, which does not respond well to the antibiotic treatmentfiberoptic bronchoscopy第47页，共61页。2022/8/3TreatmentAntiinfectious therapySupportive therapyTherapy of complications第48页，共61页。2022/8/3 TreatmentThe more serious pneumonia, requires antibiotics such as penicillin. 第49页，共61页。2022/8/3TreatmentAl

47、l 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 第50页，共61页。2022/8/3TreatmentFor patients who are believed to be all

48、ergic to penicillin(青霉素), one may select the first or second generation cephalosporin(头孢菌素) or advanced macrolide(大环内酯物)+ -lactam(-内酰胺)or respiratory fluoroquinolone(氟喹诺酮) alone.第51页，共61页。2022/8/3TreatmentIn some cases, vancomycin may be used.Treatment with any effective agent should be given for at

49、 least 5 to 7 day or after the patients have been afebrile for 2-3 days第52页，共61页。2022/8/3Supportive 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) to relieve pleuritic (胸膜炎的)pain -Replacing fluids, if the patient is dehydrated(脱水的) 第53页，共61页。2022/8/3Supportive measur