pneumonia呼吸系统肺炎英文带教课件

1、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582022/10/3Respiratory Systempneumonia呼吸系统肺炎英文带教Contents（一）、pandect总论Respiratory Systemnose（nas/o OR rhin/o）larynx (laryn/o)Lungs (pneumon/o OR pulmo )bronchus (bronch/o)diaphragm (diaphragm

2、/o)mediastinum（一）pandect Organs pneumonia呼吸系统肺炎英文带教Respiratory Systemnose（nas/o O3 Functions Breathing process Exchange of Oxygen and Carbon DioxideEnable speech productionoxygencarbondioxideAlveolar/0-HyperpneaCyanosis02co2Respiratory System（一）pandectpneumonia呼吸系统肺炎英文带教3 Functions Breathing process

3、 4 The influencing factors of respiratory diseasesRespiratory System（一）pandect Air pollution and smoking Inhaled allergens The variation of etiology and Drug resistance increases pneumonia呼吸系统肺炎英文带教4 The influencing factors Resp Signs and symptomsCough Laryngitis/ bronchitis/ bronchial asthma/ chron

4、ic obstructive pulmonary disease (COPD)/ lung cancerExpectoration 吐痰 Lung abscess/ bronchiectasis/ pneumoniaHemoptysis 咯血 pulmonary TuberculosisDyspnea Pneumothorax 气胸/ pleural effusion/ left heart failureStethalgia 胸痛 hemothorax/ Pulmonary thromboembolismRespiratory System（一）pandectpneumonia呼吸系统肺炎英

5、文带教 Signs and symptomsCoughRespir Lab and other inspectionBlood testsantigen skin testphlegmexamination pleural effusionthoracicopunctureradio examination Respiratory System（一）pandectbronchoscopyThoracoscope lungobiopsysupersonic inspectionrespiratory function testPulmometry pneumonia呼吸系统肺炎英文带教 Lab

6、and other inspectionBloodDefinitionPneumonia 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-ray胸部x线检查）.伴随发热，局灶性胸部症状，胸片阴影。Respiratory System

7、pneumonia呼吸系统肺炎英文带教DefinitionRespiratory Systempn2022/10/3Defense 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macrophagesmkrfed 巨

8、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 generalpneumonia呼吸系统肺炎英文带教2022/10/2Defense mechanism di2022/10/3 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 .frndat

9、s 咽炎Laryng/-itis lrndats 喉炎Bronch/-itis brkats 支气管炎pneumonia呼吸系统肺炎英文带教2022/10/2 2022/10/3rootmeaningexamplePneum(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 pneumocyte

10、nju: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myxiod粘液样的Bro

11、nch(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pneumonia呼吸系统肺炎英文带教2022/10/2rootmeaningexamplePne2022/10/3rootmeaningexampledys-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）ds

12、ntr 、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 、hy

13、poacidity （胃）酸过少 hpsdt 、hypocalcemia（低血钙）hapklsi:m 、hypoglycemia（低血糖）hapglasi:m Respiratory Systempneumonia呼吸系统肺炎英文带教2022/10/2rootmeaningexampledys2022/10/3Etiology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 Respirator

14、y Systempneumonia呼吸系统肺炎英文带教2022/10/2Etiology病因 There ar2022/10/3Causative 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bacillemi

15、a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pneumonia呼吸系统肺炎英文带教2022/10/2Caus

16、ative organisms致病2022/10/3Classification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 Systempneumonia呼吸系统肺炎英文带教2022/10/2Classification分类Class2022/10/3Classification by anatomy按解剖分类 Lobar大叶性 : Involvement of an entire lobe 一个

17、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 Systempneumonia呼吸系统肺炎英文带教2022/10/2Classification b

18、y ana2022/10/3Classification 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 pneumoniakl

19、ebziel 克雷伯杆菌肺炎legionaires disease li:dne 军团菌肺炎Respiratory Systempneumonia呼吸系统肺炎英文带教2022/10/2Classification by pa2022/10/3Classifications 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 old

20、er 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 intu

21、bation 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。 pneumonia呼吸系统肺炎英文带教2022/10/2Classifications by ac2022/10/3SymptomsCoughDyspnea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 exp

22、ectoration咳痰 Respiratory Systempneumonia呼吸系统肺炎英文带教2022/10/2SymptomsCoughChills/2022/10/3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pneumonia呼吸系统肺炎英文带教2022/10/2全身怕冷湿冷发青痰痰短气胸膜炎的plPneumococcal pneumonia肺炎链球菌肺炎The pneumonia that is caused by Streptococcus pneumoniae nearly ha

23、lf 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 Systempneumonia呼吸系统肺炎英文带教Pneumococcal pneumonia肺炎链球菌肺炎The pathological change病理变化is divided into

24、 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 Systempneumonia呼吸系统肺炎英文带教The pathological change病理变化is T

25、his 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白细胞吞噬作用.At last, the fibrous protein纤维蛋白is broken down and absorbed,the alve

26、olar 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 Systempneumonia呼吸系统肺炎英文带教This is noted clinically as oeIn 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

27、 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 Systempneumonia呼吸系统肺炎英文带教In fact, early treatment by us2022/10/3Etiology and pathogenesis organismS.pneumoniaeDynamic balance pneumonia呼吸系统肺炎英文带教2022/10/2Etiology and pathogen2022/10

28、/3 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 killed.Respiratory Systempneumonia呼吸系统肺炎英文带教2022/10/2 S.pne

29、umoniae as the2022/10/3Etiology 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 called “ normal flora”. Respirator

30、y Systempneumonia呼吸系统肺炎英文带教2022/10/2Etiology and pathogen2022/10/3Etiology 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.Respiratory

31、Systempneumonia呼吸系统肺炎英文带教2022/10/2Etiology and pathogen2022/10/3Etiology 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 pa

32、thogenic factor and lead to the occurance of disease .Respiratory Systempneumonia呼吸系统肺炎英文带教2022/10/2Etiology and pathogen2022/10/3Streptococcus pneumoniae high-risk groups ： Smokers, dementia, Chronic Bronchitis , bronchiectasis, cardiac failure,chronic disease,immunosuppressants users, the elderly,

33、 infants and young children pneumonia呼吸系统肺炎英文带教2022/10/2Streptococcus pneumon2022/10/3Laboratory 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 Carbon Dioxide)pneumonia呼吸系统肺炎英文带教2022/10/2Laboratory E

34、xaminatio2022/10/31.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.pneumonia呼吸系统肺炎英文带教2022/10/21.The WBC:( 1

35、0 30) 2022/10/33. 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 .pneumonia呼吸系统肺炎英文带教2022/10/23. Blood gas analysisWhat are pneumonia symptoms and signs?Initially have symptoms of a cold（upper respiratory infection, for exampl

36、e, 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 purplish（a c

37、ondition known as “cyanosis ”）due to their blood.pneumonia呼吸系统肺炎英文带教What are pneumonia symptoms anSymptomsThis 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 b

38、abies who develop pneumonia often do not have any specific signs of a chest infection but develop a fever ,appear quite ill,and can become lethargic.pneumonia呼吸系统肺炎英文带教SymptomsThis pain is usually sComplications Serious and potentially lethal Pleural effusion and empyema Infective shock Toxic myocar

39、ditis ARDS （Acute Respiratory Distress Syndrome ) Organized pneumonia Pleuritis Meningocephalitis pneumonia呼吸系统肺炎英文带教Complications Serious How 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 c

40、hest.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 is often referred to as lobar pneumonia.pneumonia呼吸系统肺炎英文带教How is pneumonia diagnosed？CoaSputum SamplesSpu

41、tum 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 becoming resistant to the commonly used antibiotics. These types of cultures ca

42、n help in directing more appropriate therapy.pneumonia呼吸系统肺炎英文带教Sputum SamplesSputum Samples cA 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 whether it is caused by bacteria or a virus. An increased

43、 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.pneumonia呼吸系统肺炎英文带教A blood testThat measures whitHematology laboratoryComplete blood c

44、ount（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 glucosepneumonia呼吸系统肺炎英文带教Hematology laboratoryComplete BronchoscopyBronchoscopy is a procedure in which a

45、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 obtai

46、ned.pneumonia呼吸系统肺炎英文带教BronchoscopyBronchoscopy is a Fluid collectsSometimes, 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 s

47、kin with local anesthetic a needle is inserted into the chest cavity and fluid can be withdrawn and examined under the microscope. This procedure is called a thoracentesis. pneumonia呼吸系统肺炎英文带教Fluid collectsSometimes, fluidDiagnosis1Preceding history of common cold or other URI；2. Symptoms：abrupt ons

48、et, 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 consolidation ；6.A definitive diagnosis requires demonstration of pneumonia in sputum culture ,blood ,lung tissue. Upper respiratory infecti

49、onpneumonia呼吸系统肺炎英文带教DiagnosisUpper respiratory infDiffuse interstitial pneumoniaLobar pneumoniapneumonia呼吸系统肺炎英文带教Diffuse interstitial pneumoniaCriteria 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

50、are involved；Need for vasopressorsRenal Failurepneumonia呼吸系统肺炎英文带教Criteria of severe pneumonia1Caseous pneumonia(lung tuberculosis）Differential diagnosisApicallocationInsidious onset with lower fever，night sweats，Fatigue and weight lossNot respond to antibioticsSputum smear for tubercle bacilli(+)pn

51、eumonia呼吸系统肺炎英文带教Caseous pneumonia(lung tubercuDifferential diagnosisLung abscessCopious purulent foul-smelling sputumpneumonia呼吸系统肺炎英文带教Differential diagnosisLung abDifferential diagnosisObstructive pneumoniasuperimposed hilar shadowrecurrent pneumonia at the same site happended in patients over 40

52、, which does not respond well to the antibiotic treatmentfiberoptic bronchoscopypneumonia呼吸系统肺炎英文带教Differential diagnosisObstruct2022/10/3TreatmentAntiinfectious therapySupportive therapyTherapy of complicationspneumonia呼吸系统肺炎英文带教2022/10/2Treatmentpneumonia呼吸系2022/10/3 TreatmentThe more serious pneu

53、monia, requires antibiotics such as penicillin. pneumonia呼吸系统肺炎英文带教2022/10/2 TreatmentThe more se2022/10/3TreatmentAll 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 sta

54、tus /adverse rea- ction or complication that occur pneumonia呼吸系统肺炎英文带教2022/10/2TreatmentAll patient2022/10/3TreatmentFor 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) or advanced macrolide(大环内酯物)+ -lactam(-内酰胺)or respir

55、atory fluoroquinolone(氟喹诺酮) alone.pneumonia呼吸系统肺炎英文带教2022/10/2Treatmentpneumonia呼吸系2022/10/3TreatmentIn 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 dayspneumonia呼吸系统肺炎英文带教2022/10/2Treat

56、mentpneumonia呼吸系2022/10/3Supportive 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) pneumonia呼吸系统肺炎英文带教2022/10/2Supportive measurepn2022/10/3Supportive measureCorrecting electrolytes(电解质)Oxygen therapy pneumonia呼吸系统肺炎英文带教2022/10/2Supporti