呼吸系统疾病基础知识概述培训课件

1、呼吸系统疾病基础知识概述呼吸系统疾病基础知识概述呼吸系统疾病 Respiratory System Disease湘雅医院儿科 郑湘榕 2呼吸系统疾病基础知识概述呼吸系统疾病湘雅医院儿科 郑湘榕 2呼吸系统疾病基础知 婴幼儿上感、2种特殊类型上感的特点 支气管肺炎临床表现、重症肺炎特点 支气管肺炎的诊断、治疗 支气管哮喘的临床表现、诊断和治疗 重点3呼吸系统疾病基础知识概述 婴幼儿上感、2种特殊类型上感的特点重点3呼吸系统疾病基础IntroduceIn pediatric outpatient, 6o% patients are acute respiratory infections. In

2、 pediatric ward, 25% patients are Pneumonia. The first cause of childrens death in China is Pneumonia. Pneumonia is the worlds leading cause of death among children. It kills nearly two million children under age five every year. 4呼吸系统疾病基础知识概述IntroduceIn pediatric outpatieWhy children are so suscept

3、ible to acute respiratory infections?5呼吸系统疾病基础知识概述Why children are so susceptibl6呼吸系统疾病基础知识概述6呼吸系统疾病基础知识概述anatomic physiological features The childrens respiratory lumens are narrow, blood flow is abundant.The childrens repertory ability is low.The childrens local immunity is low.7呼吸系统疾病基础知识概述anatom

4、ic physiological featuChildren Respiratory System Physiologic Feature Respiratory rateNeonate 40-44/min1year 30/min2-3years 24/min4-7years 22/min8-14years 20/min8呼吸系统疾病基础知识概述Children Respiratory System PhChildren Respiratory System Physiologic Feature Respiratory type Respiratory type of abdomen Res

5、piratory type of chest abdomen 9呼吸系统疾病基础知识概述Children Respiratory System Ph hysical examination inspection Change of respiratory rate Cyanopathy Three concave sign uscultationExamine Method 10呼吸系统疾病基础知识概述 hysical examinationExamine急性上呼吸道感染（AURI） Acute Upper Respiratory Infection11呼吸系统疾病基础知识概述急性上呼吸道感染

6、（AURI）11呼吸系统疾病基础知识概述Etiologyirus： ccupy 90% acteria： econdary Streptococus pyogens Pneumococcu aemophilus influenzae12呼吸系统疾病基础知识概述Etiology12呼吸系统疾病基础知识概述CommonAURI Local symptom is mild In infant and toddlerSystemic symptom is severeComplications are commonClinical Manifestations13呼吸系统疾病基础知识概述Common

7、Local symptom is mild ICommonAURIhysical examination Congestion of pharyngeal portion, antiadoncus (咽部充血，扁桃体肿大)Lymphadenectasis in submaxilla (有时下颌、淋巴结肿大)Rash when enterovirus infection (肠道病毒感染时可出现皮疹)Clinical Manifestations14呼吸系统疾病基础知识概述Commonhysical examination ConSpecialAURI 柯萨奇病毒A组感染 夏秋好发 高热、咽痛、流

8、涎 咽腭弓、软腭处有疱疹 疱疹破溃后可形成溃疡 病程 1 周左右Clinical ManifestationsHerpangina疱疹性咽峡炎15呼吸系统疾病基础知识概述Special 柯萨奇病毒A组感染Clinical ManPharyngo-conjunctival fever咽结合膜热 腺病毒 3，7 型所致 春夏发病，可小流行 发热、咽炎、结合膜炎 咽部充血、结合膜充血，颈部、 耳后淋巴结肿大 病程 12 周Clinical ManifestationsSpecialAURI16呼吸系统疾病基础知识概述Pharyngo- 腺病毒 3，7 型所致ClinicSchool ageTympa

9、nitis, sinusitisAbscess of pharynx posterior-wall Laryngitis, bronchitisInfant , toddlerPneumoniaGlomerulonephritisRheumatic feverComplications17呼吸系统疾病基础知识概述School ageTympanitis, sinusitAntivirus drugs Oseltamivir Ribovirin3-5 daysAntibioticsPenicillinSMZ3-5 daysSever symptomatic;Secondary bacteria

10、affectionTreatment18呼吸系统疾病基础知识概述Antivirus drugs Oseltamivir DefervesceDrugsPhysics methodsFebril convulsionCalmStop convulsionDefervesceTreatment19呼吸系统疾病基础知识概述DefervesceDrugsPhysics methodsPneumonia肺 炎 20呼吸系统疾病基础知识概述Pneumonia肺 炎 20呼吸系统疾病基础知识概述Childrenfamiliar diseaseIn world,Occupy 1/3-1/4 in the de

11、ath of children under 5 years of ageIn china, Occupy more than 1/4 in paediatric ward The hospitalization number of infant and toddler is 39.5 timesof school age Pneumonia21呼吸系统疾病基础知识概述In world,Occupy 1/3-1/4 in In Pneumonia is an inflammation of the parenchyma of the lungs It is caused by microorga

12、nisms or noninfectious causes Manifested by fever,cough, tachypnea , respiratory distress and ralesDefinition22呼吸系统疾病基础知识概述Pneumonia is an inflammation On course of illness On anatomic basisBronchopneumoniaLobar pneumonia Interstitial pneumonia Acute： 3 months Deferred：13 monthsClassification 123呼吸系

13、统疾病基础知识概述On courseOn anatomicBronchopneOn the etiologyVirus RSV(respiratory syncytial virus)AdenovirusInfluenza ParainfluenzaBacteriaStreptococus pneumoniaeStaphylococus aureusHaemophilus influenzae type Classification 224呼吸系统疾病基础知识概述On the Virus BacteriaClassifiOn the etiologyMycoplasmaChlamydia, p

14、arasites ,fungiNoninfections causesClassification 325呼吸系统疾病基础知识概述On theMycoplasmaChlamydia, parOn theseverity of illnessMild symptomaticSevere symptomaticBesides symptoms of respiratory system, concomitant manifestations of other organ systems are presentClassification 426呼吸系统疾病基础知识概述On theMild symp

15、tomaticSevere on typical of clinical manifestationTypical pneumoniauntypical pneumoniaSevere acute respiratory syndrome,(SARS)coronavirusClassification 527呼吸系统疾病基础知识概述on typicalTypical pneumoniauntOn Occurrence RegionCommunity Acquired PneumoniaCAPHospital Acquired PneumoniaHAPClassification 628呼吸系统

16、疾病基础知识概述On Community Acquired Pneumoni支气管肺炎 Bronchopneumonia29呼吸系统疾病基础知识概述支气管肺炎 Bronchopneumonia29呼吸系统疾病EtiologyvirusMain cause of pneumonia in developed countryRSVbacteriaMain cause of pneumonia in developing countryS. pneumoniae 30呼吸系统疾病基础知识概述EtiologyvirusMain cause of pnePathologyCommonBroncho-pn

17、eumoniahyperaemia、edema、inflammatory effution of alveolusInterstitial pneumoniahyperaemia、edema、inflammatory effution of bronchia wall、bronchiole wall、 alveolus wall31呼吸系统疾病基础知识概述PathologyCommonhyperaemia、edem32呼吸系统疾病基础知识概述32呼吸系统疾病基础知识概述33呼吸系统疾病基础知识概述33呼吸系统疾病基础知识概述Pathologic physiology气道炎症循环系统神经系统水电

18、解质消化系统肺A压增高中毒性心肌炎心衰代酸中毒性肠麻痹胃肠粘膜屏障功能脑水肿颅压呼酸K+水钠储留毒血症通气不足 PaO2,PaCO2换气障碍 PaO234呼吸系统疾病基础知识概述Pathologic physiology气道炎症循环系统Clinical manifestationMild symptomaticrespiratory systemfeverrespiratory distressnasal flaring, retractions,cyonosistachypnea cough rales5 years RR30次/分35呼吸系统疾病基础知识概述Clinical manifes

19、tationMild resClinical manifestationSevere symptomaticcircular systemsymptomCardiac muscleinflammationHeart failure36呼吸系统疾病基础知识概述Clinical manifestationSevereciClinical manifestSevere symptomaticHeart failure呼吸突然加快，60次/分心率突然增快 婴儿180次/分幼儿160次/分突然烦躁不安、面色发灰心音明显低钝，奔马率，颈静脉怒张肝大肋下3cm以上尿少、下肢浮肿37呼吸系统疾病基础知识概述C

20、linical manifestSevereHeart呼吸Clinical manifestnerval systemLight hypoxia：irritability，lethargySever hypoxia：hydrocephalusdigestive systemalimentary canal bleedingPoisoning intestine palsySevere symptomatic38呼吸系统疾病基础知识概述Clinical manifestnerval Light Clinical manifest DICBp四肢凉，脉速弱，出血SLADHNa + 130mmol/

21、L渗透压 270mOsm/LEdemaSevere symptomatic39呼吸系统疾病基础知识概述Clinical manifest DICBp四肢凉，脉速弱ComplicationsComplicationpneumatocelepyopneumothoraxempyema40呼吸系统疾病基础知识概述ComplicationsComplicationpneumLaboratory dataBloodblood routinebacteria infect：WBC、N left shift of nucleus virus infect：WBC、Labnormal lymph cellba

22、cteria infect ： CRP virus infect ：CRP normalCRPNBTbacteria infect ： 10%virus infect ： 10%Pathogenyvirus separateGermiculturesputum for Gram stain and culture41呼吸系统疾病基础知识概述Laboratory dataBloodbloodbacteLaboratory dataX-rayshadow of dot and spoteemphysema atelectasis42呼吸系统疾病基础知识概述Laboratory dataX-rays

23、hadow of 支气管肺炎正常胸片43呼吸系统疾病基础知识概述支气管肺炎正常胸片43呼吸系统疾病基础知识概述大叶性肺炎正常胸片44呼吸系统疾病基础知识概述大叶性肺炎正常胸片44呼吸系统疾病基础知识概述fever,cough, tachypnea , respiratory distress and ralesX-raydiagnosis45呼吸系统疾病基础知识概述fever,cough, tachypnea , X-rayDifferentiationacute bronchitisrales、tachypneaforeign bodies in bronchihistory of fore

24、ign bodies、sudden cough、respiratory distress、lower of breath tone or wheezingtuberculosishistory of TB contact、PPD test、PPD-IgGIgM、X-ray、rales46呼吸系统疾病基础知识概述Differentiationacute rales、tacTreatmentgeneral treatmentBalance of water and electrolyte3%Nacl 12ml/LNa+10mmol/L Temperature 18-20 Humidity 60%F

25、ood nutritive47呼吸系统疾病基础知识概述Treatmentgeneral Balance of waTreatmentControl infectionvirus：no ideal drug like virozolmycoplasma、chlamydia select erythromycinbactrria：the principle of sensitivityefficiency、full period of treatment,first select Peniccilin48呼吸系统疾病基础知识概述TreatmentControl virus：no ideaTreat

26、ment抗生素使用原则 根据药敏选药adopt sensitive drugs on the basis of pathogenic bacterium 用下呼吸道浓度高的药物adopt drugs which can finally infiltratelung tissue 足量足疗程重症静脉给药in severe case,drugs should be administedby vein , full dose, full period 49呼吸系统疾病基础知识概述Treatment抗生素根据药敏选药49呼吸系统疾病基础知识Treatment抗生素选择 肺炎链球菌：PNC,阿莫西林，红

27、霉素金黄色葡萄球菌：苯唑西林、氯唑西林、万古、利福平 流感嗜血杆菌：阿莫西林+克拉维酸钾或舒巴坦大肠杆菌和肺炎杆菌：头孢曲松或头孢噻肟绿脓杆菌：替卡西林钠克拉维酸钾或头孢哌酮肺炎支原体或衣原体：大环内酯 50呼吸系统疾病基础知识概述Treatment抗生素肺炎链球菌：PNC,阿莫西林，红霉素Treatmentfull periodof treatmentafter temperature normal 5 7days or clinical symptom disappearing 3 daysMycoplasma pneumonia： 23 weeksStaphylococus aureus

28、 ： after temperature normal 2 weeks ， full period is 6 weeks51呼吸系统疾病基础知识概述Treatmentfull periodafter temptreat against symptomsTreatmentoxygentreatPaO2：dyspnea、 cyanosis、asthma suppress、toxic appearance, methods: by nose canal 0.5 1 L /min，40%；by veil 24 L/min,50%60%mechanism ventilate（ respire failt

29、ure）holding respiratory tract unobstructed remove sputum、pulverization 、relieve spasmensure liquid absorb52呼吸系统疾病基础知识概述treat TreatmentoxygenPaO2：dysTreatmenttreat ofother sympdefervesce calmtreat ofwindysupply KaliumPoisoning intestine palsy：fasting、decompress of stomach and intestine 酚妥拉明 0.5 mg/kg

30、 ivgtt 10%GS 20 ml treat against symptoms53呼吸系统疾病基础知识概述Treatmenttreat ofdefervescetreTreatmenttreat ofHeart failure镇静给氧强心：西地兰减轻心脏负荷 treat against symptoms54呼吸系统疾病基础知识概述Treatmenttreat of镇静treat 54呼吸系Treatment合并中毒性脑病的治疗脱水：甘露醇改善通气改善脑微循环止痉：地西泮地塞米松营养神经treat against symptoms55呼吸系统疾病基础知识概述Treatment合并中毒性脑病脱

31、水：甘露醇treat 55Treatment糖皮质激素应用适应症：喘憋重,呼吸衰竭全身中毒症状重感染性休克 脑水肿琥珀酸氢化可的松5 10 mg/kg.d地塞米松0.1 0.3 mg/kg.d ivgtt23 次/日35 天甲基强的松龙 2 4 mg/kg.次56呼吸系统疾病基础知识概述Treatment糖皮质激素适应症：琥珀酸氢化可的松5 Response to treatment in otherwise uncomplicated CAP?Fever- falls in 2 daysLeucocytosis- decreases in 4 days Physical findings p

32、ersist slightly longerChest radiographic abnormalities may take4-12 weeks to resolve57呼吸系统疾病基础知识概述Response to treatment in otherWhat if patients fails to recover?You should consider-Noninfectious conditionResistance to drugNew nosocomial pathogen58呼吸系统疾病基础知识概述What if patients fails to reco病毒性肺炎呼吸道合胞

33、病毒肺炎腺病毒肺炎2岁，2 6月多见喘憋、呼吸困难，可合并呼衰、心衰哮鸣音，细湿罗音小点片状影，肺气肿肺不张间质性肺炎6月 2岁中毒症状重，稽留热，咳剧，喘憋，呼吸困难出现晚，湿罗音或肺实变 胸片改变出现早，肺气肿，片状影或融合年龄症状胸片体征59呼吸系统疾病基础知识概述病毒性呼吸道合胞病毒肺炎腺病毒肺炎2岁，2 6月多见6月细菌性肺炎葡萄球菌肺炎新生儿，婴幼儿急、重、快，弛张热或稽留热，咳嗽，呼吸困难，呻吟，易致迁徒化脓病灶，并发脓胸，脓气胸，肺大疱中细湿罗音，出现早，皮疹浸润影，持续时间较长，易变，可见多发性肺脓肿，脓胸，脓气胸等 4岁慢，重，发热，痉挛性咳嗽，呼吸困难，发绀。易致迁徒化脓

34、病灶，易并发脓胸湿罗音或实变大叶性肺炎、支气管肺炎、肺实变 年龄症状体征胸片革兰阴性杆菌肺炎60呼吸系统疾病基础知识概述细菌性葡萄球菌肺炎新生儿，婴幼儿4岁年龄症状体征胸片革兰阴肺炎支原体肺炎年长儿，婴幼儿发热、刺激性咳嗽，多系统病变不明显，婴幼儿可有呼吸困难，喘憋，哮鸣音，湿罗音肺门影增浓；支气管肺炎改变；间质性肺炎；均一实变影6月起病慢，无发热，先URI症状后咳、喘、气促，部分伴结膜炎湿罗音，持续时间长间质性炎症，过度充气、片状影，持续时间长年龄症状体征胸片沙眼衣原体肺炎支衣原体肺炎61呼吸系统疾病基础知识概述肺炎支原体肺炎年长儿，婴幼儿20%,使用支扩剂后增加20% 可诊断哮喘）71呼吸

35、系统疾病基础知识概述auxiliary examinationX-raylungDiagnose of childfood asthmagasp recurrent attacks lung wheezing ralesbronchodilators is validexclude other disease that can cause gasp72呼吸系统疾病基础知识概述Diagnose of childfood asthmagacough1month,antibiotics treat is invalidbronchodilators can relieve coughhypersensitive history or allergia family historyairway is hyperreactivityexclude other cough disease Diagnose of cough variant asthma73呼吸系统疾病基础知识概述cough1month,antibiotics treattherapyPrinciple: long-term 、 persistence、standard、individuationPeriod of onset:antiinflammatory、calm