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1、,重庆医科大学附一院肺科陈 虹,Pneumococcal pneumonia,Definition,肺炎球菌Pneumococcus肺大叶性炎变 肺炎链球菌 streptococcus pneumoniae院外感染最常见的肺炎多见于青壮年,Inflammation,vessel congestion,serumRBC /WBCfibrin,exudation,absorption,(血管充血),(渗出 实变),(吸收),（荚膜致病）,Cohn,支气管充气征,Pathology,Congestion(充血),Red Hepatization(红色肝样变),Gray Hepatization(灰色
2、肝样变),Resolution (消散),acute onset of,II. X-ray findings,complications,Pluaritis（胸膜炎） Shock : BP, cold extremities, sweat, cyanosis (紫绀), tachycardia(心动过速) Toxic myocarditis（中毒性心肌炎）,II. X-ray findings,Left lower lobe pneumonia,Diagnosis,Typical features Consolidation signs or rales WBC X-ray findings
3、Sputum and blood culture(+),Differential diagnosis,Caseous pneumonia(干酪性肺炎)Obstructive pneumonia（阻塞性肺炎） III. Pneumonia caused by other micro-organisms,Caseous pneumonia(干酪性肺炎)(Tuberculosis),Low fever Night sweat(盗汗) Lack of chill Insensitive to antibiotics Tubercle bacilli 结核菌素试验（+）,II. Obstructive
4、pneumonia,Foreign body / Neoplasm, slow absorption recurrent (复发) fibrobrochoscopy(纤维支气管镜检查),III. Pneumonia caused by other microorganisms,staphylococcus staphylococcus pneumonia( 葡萄球菌肺炎)klebsiella klebsiella pneumonia( 克雷伯杆菌肺炎) legionella legionaires disease（军团菌肺炎）mycoplasma mycoplasmal pneumonia（支
5、原体肺炎）,Treatment, Pinicillin(青霉素) Allergic or resistant to Pinicillin：Erythromycin(红霉素) or Vancomycin(万古霉素) Qinolones（喹诺酮类）or Cephalothins(头孢菌素),I. Antibiotics,Duration: 57 days or 3 days after defeverness(退热),Treatment,Duration: 57 days or 3 days after defeverness(退热),Treatment,II. Support therapyRe
6、st , water and nutrition food Alleviation(pain/fever/cough/sputum) Oxygen,Anti-shock therapyOther complications,adequate infusionvasoactive agonist(血管活性药物)antibioticscorticosteroid (糖皮质激素):抗过敏，抗休克，抗毒纠正水、电解质及酸碱平衡紊乱,red lips, warm extremty systaltic pressure 90mmHg pulse rate 30 milliliter/ hour CVP 10cmH2O,III. Therapy to complications,
