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1、Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 气管和支气管疾病 一 支气管扩张 是常见的慢性支气管疾病 多见于 儿童及青壮年 常继发于肺及支气管的 化脓性炎症 肺不张及肺纤维化 少数 患者为先天性支气管内径 的不同程度的 异常扩张 故分先天性和后天性 两种 以后者常见 Our greatest weakness lies in giving up The most certain way to succeed is alway
2、s to try just one more time 临床 以咳嗽 咳血和咳大量脓痰为主 X线表现 肺纹理改变 増多 増粗 紊乱而呈网状 可见条状或柱状透亮区 亦可表现为多个 薄壁空腔 形似蜂窝状 肺内炎症 在增多 紊乱的肺纹理中伴有 小斑片状模糊影 肺不张 常为密度不均匀的三角形致密影 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time Our greatest weakness lies in giving up The mo
3、st certain way to succeed is always to try just one more time 支气管造影 1 柱状扩张 支气管腔粗细不等 呈 柱状或杵状 2 囊状扩张 支气管末端呈大小不等 的圆形阴影 如蜂窝状或葡萄串样 3 混合型扩张 表现为柱状和囊状扩 张同时存在 病变多较广泛 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time Our greatest weakness lies in givin
4、g up The most certain way to succeed is always to try just one more time 二 慢性支气管炎 1 概念 2 临床与病理 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 3 X线表现 Our greatest weakness lies in giving up The most certain way to succeed is always to try j
5、ust one more time Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 肺部炎症 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 大叶性肺炎 lobar pneumonia 是急性肺部炎症 致病菌 多为肺炎双球菌 冬春季发病较多 多见于青壮年 Our
6、greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 病理 分为四期 一 充血期 肺泡壁毛细血管扩张 充血 肺泡内浆液性渗出 二 红色肝变期 肺泡内有大量纤维 蛋白及红细胞等物渗出 肺组织实 变 切面呈红色肝样 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 三 灰色肝变期 肺
7、泡渗出物中红细 胞减少 大量白细胞代之 切面呈 灰色 四 消散期 肺泡内渗出物逐渐吸收 肺泡重新充气 由于抗菌素广泛应用 典型的病理 分期已不多见 以轻症或不典型病 例多见 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 临床表现 临床以寒战 高热 胸 痛 咳嗽 铁色痰为特征 血白细胞总数和中性白 细胞明显增高 影像表现晚于临床症状 Our greatest weakness lies in giving up The most
8、 certain way to succeed is always to try just one more time X线表现 一 充血期 常无明显X线征象 1 仅有肺纹理增粗 2 病变区肺透过度略低 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 二 实变期 1 呈肺叶或肺段性实变阴影 2 密度均匀 肺纹不能显示 内可见支 气管气象 3 靠叶间胸膜面边缘清晰 其余边缘模 糊 4 实变部位肺体积略大或正常 无明显 缩小 5 下
9、肺病变可有膈肌动度减弱或轻微升 高 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time Our greatest weakness lies in giving up The most certain way to su
10、cceed is always to try just one more time Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 三 消散期 病变阴影密度减低 不均匀 呈散在斑片状 肺纹理增粗 模糊 吸收不全者可残
11、留纤维索条瘢痕或形成机化 性肺炎 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time Our greatest weakness lies in giving up The most certain way to suc
12、ceed is always to try just one more time 支气管肺炎 bronchopneumonia 又称小叶性肺炎 致病菌 肺炎双球菌 链球菌 葡萄球菌 好发年龄 幼儿 老年人 慢性病长期卧床者 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 临床表现 发热 咳嗽 泡沫粘痰 重者有呼吸困难或紫绀 Our greatest weakness lies in giving up The most cert
13、ain way to succeed is always to try just one more time 病理 以细支气管为中心的化脓性炎症 1 细支气管壁充血 水肿 2 肺间质内炎性浸润 3 肺小叶渗出和实变的混杂病变 可融合成大片 4 可有细支气管阻塞性气肿或肺不 张 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time X线表现 一 两肺纹理增粗 模糊 二 颗粒状 小斑片或斑点状阴影 两下肺内 中带沿肺纹理分布 可融合成大片
14、状 病变密度不甚均匀 边缘模糊不清 单个病灶中央部密度较高 可有小空洞 少见 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 三 可有小叶性肺不张 但影像上与小叶性炎变难以区别 四 可有小叶性肺气肿 五 可有肺门模糊 淋巴结肿大或少量 胸腔积液 Our greatest weakness lies in giving up The most certain way to succeed is always to try just
15、 one more time Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 支气管肺炎 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 支原体肺炎 mycoplasmal pneumonia 由肺炎支原体引起 散发或小流行 占各种原因引起的肺炎的10 占非细 菌
16、性肺炎的1 3以上 常于秋季发病 儿童和青年人居多 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 病理 1 以间质性炎症为主 支气管 细支气管粘膜及其周围肺泡间 隔充血 水肿 多核炎细胞浸润 2 侵及肺泡时引起浆液性渗出 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 临床表现 1 临床症状多较轻 可有低热 疲乏 胸闷 头痛 2 病后2 3周血冷凝集试验比值高 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time X线表现 一 肺纹理增粗 模糊 与网状阴影并 二 单灶 多灶性密度较淡斑片状阴影
