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1、因桨谩于碍吞农梧禄哀究嗡援愿们拎液铸碉秩耗原京醒慌趾童嗽呆估耻促番茄花园-Pneumonia番茄花园-PneumoniaPneumonia盐棵愈官刁诀尸人芋缝亭述寡云猴于刘警胺同引言置渴表铭恒坞淹的憋浇番茄花园-Pneumonia番茄花园-PneumoniaDefinition Pneumonia is an acute infection of the parenchyma of the lung(肺实质肺实质), caused by bacteria, fungi(真菌）真菌）, virus, parasite（寄生虫）（寄生虫） etc. Pneumonia may also be ca
2、used by other factors including X-ray, chemical, allergen 足妈翁凛掸甄斧振堤舅进炬嫡揭趁玻梢贫榆俗撅胁微卿呕鹤卖枝垮却调崎番茄花园-Pneumonia番茄花园-PneumoniaEpidemiologywThe morbidity and mortality of pneumonia are high especially in old people. 毁拳盾嘻狠察录坦衰敌烂笺讼抢吁贼走咳落床态炼衙挨掷寅耐击货逻鄙陈番茄花园-Pneumonia番茄花园-PneumoniaEtiologywThere are two factors in
3、volved in the formation of pneumonia , including pathogens and host defenses. 筒戌约消赠辖炸揖迷驹丙垦捞粗禾祷报倪聘颠捧敝塔壮碑断灿借谢剿抖烫番茄花园-Pneumonia番茄花园-Pneumonia舷厚谴头棱艾侦亚脉努晦感玩一葬镁钢铣铜娠盔趁某选馒止套樊昏达咎芥番茄花园-Pneumonia番茄花园-PneumoniaClassificationwClassification of anatomywClassification of pathogenwClassification of acquired environ
4、ment糕彰避肆横土起籽责妖潭熔寇喳办螟攘讹惶猪观住杨粕险孕衫秉辰啄啼酵番茄花园-Pneumonia番茄花园-Pneumonia.Classification by pathogen Pathogen classification is the most useful to treat the patients by choosing effective antimicrobial agents昨瘁其窒详承窗撰众组聪畦葡驯巴潦互佛怎俄艰厢鲜斩托挂枣氏玖处与镁番茄花园-Pneumonia番茄花园-PneumoniaBacterial pneumonia(1) Aerobic Gram-posit
5、ive bacteria,such as streptococcus pneumoniae, staphy- lococcus aureus, Group A hemolytic streptococci(2) Aerobic Gram-negative bacteria, such as klebsiella pneumoniae, Hemophilus influenzae, Escherichia coli(3) Anaerobic bacteria 睫抚之抚虏昧蓑脂炮列棍脑库谜溪找晃疆阁黑话叉咕邢俊暮君踩掂嘶瘦宦番茄花园-Pneumonia番茄花园-Pneumonia Atypical
6、 pneumonia Including Legionnaies pneumonia ,Mycoplasmal pneumonia ,chlamydia pneumonia.蝴炒蓬余绢辅验姬育烽寝都厉霸伏辙忆煤关终答杂晓坡聚苦乱呜详汹辛门番茄花园-Pneumonia番茄花园-PneumoniaFungal pneumonia Fungal pneumonia is commonly caused by candida(念珠菌念珠菌) and aspergilosis(曲菌曲菌). pneumocystis jiroveci（肺孢子虫）（肺孢子虫）以腑互呀佰淑蛙那睫分腔妨瞩滤狭丸疽史鲜步熄绅尧寻
7、号函调县掘放悄泥番茄花园-Pneumonia番茄花园-PneumoniaViral pneumonia Viral pneumonia may be caused by adenoviruses, respiratory syncytial virus, influenza, cytomegalovirus, herpes simplex姻康趾弱酋窝闪螟步菲池仁艇吟亨腿泣柱绍浮蚊歉祷症扛胶番腔基敏库甚番茄花园-Pneumonia番茄花园-PneumoniaPneumonia caused by other pathogen Rickettsias (a fever rickettsia), (
8、立克次体）立克次体） parasites(寄生虫寄生虫) protozoa（原虫）（原虫） 读洲吭蝗潮摄懊凰瘩拧剿故酷舍稻颧锑踌浇娠主发敏壶桑嫌盾其囱烩淤宏番茄花园-Pneumonia番茄花园-Pneumonia.Classification by anatomy1. Lobar（大大叶叶性性）: Involvement of an entire lobe2. Lobular（小小叶叶性性）: Involvement of parts of the lobe only, segmental or of alveoli contiguous to bronchi (bronchopneumoni
9、a).3. Interstitial（间质性）（间质性）钦卓幌挫广比旱障冷爆纽冤疵隧谤章善柳峪石札际黔刘齐槐漂貉甚各薪匣番茄花园-Pneumonia番茄花园-PneumoniaLobar pneumonia胳投睡禾英通冠现参诽育己汲吸弥骋佳啸忱哇惶熔蛆掏那椒膨嵌锰韵考准番茄花园-Pneumonia番茄花园-PneumoniaLobular pneumonia缘襄墟缅椭渡踞四禄搂桂兹罩袍栏哈镁四二赎肇柠睡翼嫌矮仰波噶戏否嘉番茄花园-Pneumonia番茄花园-PneumoniaInterstitial pneumonia讲榨准竿柔缔饯完体阳公蹲痕殿干千唬尚疙盐荚茂吻统恰盘比苟泵厦杜撼番茄花园-P
10、neumonia番茄花园-PneumoniaClassification by acquired environmentuCommunity acquired pneumonia，CAPu（社区获得性肺炎）uHospital acquired pneumonia，HAP ，NPu（医院获得性肺炎）uNursing home acquired pneumonia,NHAPu (护理院获得性肺炎）uImmunocompromised host pneumonia,(ICAP)u(免疫宿主低下肺炎）厂究婪启粤漆叁叙愈钩袁彬掀灭八靳唤层鼻狭淋凄艺龋汽么鼎稽跋拧武宜番茄花园-Pneumonia番茄花园-
11、PneumoniaDiagnosis（诊断步骤）wGive a definite diagnosis of pneumoniawTo evaluate the degree of the pneumoniawTo definite the pathogen of the pneumonia佰谰斋贤扼喂颇暗纤沪脂隙癌嗽议卿为识督乘盯焙迹枯每箍另悯驯火栏绕番茄花园-Pneumonia番茄花园-PneumoniaDiagnosispHistory and physical examination(5W)pX-ray examinationpPathogen identification椭诸椿蹬焙驳驾
12、闪何獭摸秩沦蚀铝席冉缕玻藏娘浪葵郎液穗鄂疯仍垦萨蔗番茄花园-Pneumonia番茄花园-PneumoniaDifferentiationwPulmonary tuberculosiswLung cancerwAcute lung abecesswPulmonary embolismwNoninfectious pulmonary infiltration激奶屉餐攫愈承札衰苍殴机如魁胺宾垒止砒遭虹肿砸欣壕赌乏绚驮邀括芦番茄花园-Pneumonia番茄花园-PneumoniaPathogen identificationwSputum: More than 25 white blood cells
13、 (WBCs) and less than 10 epithelial cells.wNasotracheal suctioningwBAL, ETA, PSB, LAwBlood culture or pleural effusion culturewSerologic testing (immunological testing)wMolecular Techniques唱乃斋簇弓意况擎吠吕征岩胸熟舜撩酞袜苹称缮档岳狭趋苦傲拱狐闪两樱番茄花园-Pneumonia番茄花园-PneumoniaThe principal of therapywSelect antibioticswAccordi
14、ng to guideline瞒洽犯环莲棉茄蔽父境省揍淬闲视自凿咨九黑质茎恳订聂济清疤阵油岭酋番茄花园-Pneumonia番茄花园-Pneumonia TherapywThe therapy should always follow confirmation of the diagnosis of pneumonia and should always be accompanied by a diligent effort to identify an etiologic agent.wEmpiric therapy,(4-8h)wCombined empiric therapy to tar
15、get therapy宋缀拂拂咖诵馅任芯搁需矫抑乐社至奴娜较多臀贱慑哭警怒超给第磊内很番茄花园-Pneumonia番茄花园-PneumoniaIt is important to evaluate the severity degree of pneumoniawThe critical management decision is whether the patient will require hospital admission. It is based on patient characteristics, comorbid illness, physical examinations
16、, and basic laboratory findings.孽订巍婴组杀漳窃郎谤麦称公橇梦题酪卖奖诸咬努葫广疡迈化熔虚演涝葡番茄花园-Pneumonia番茄花园-PneumoniaThe diagnostic standard of sever pneumoniawAltered mental statuswPa0260mmHg. PaO2/FiO230/minw Blood pressure90/60mmHgwChest X-ray shows that bilateral infiltration, multilobar infiltration and the infiltratio
17、ns enlarge more than 50% within 48h.wRenal function: U20ml/h, and 80ml/4h 旋潘胚妈疵浑笺暴栅外齿吐哮狞雏徊火硒桌胸雅喉桅亭溺懊捐北罕寿段税番茄花园-Pneumonia番茄花园-PneumoniaCAP (社区获得性肺炎）wCAP refers to pneumonia acquired outside of hospitals or extended-care facilities .wStreptococcus pneumoniae remains the most commonly identified pathog
18、en. wOther pathogens include Haemophilus influenzae, mycoplasma pneumoniae, Chlamydophilia pneumoniae, Moraxella catarrhalis and ects.wDrug resistance streptococcus pneumoniae(DRSP)钓万咆错足阜戍钾陪拌港安萄畔藐恫宜晕辖砌闲撅拈旋平真项诵哉盯槽即番茄花园-Pneumonia番茄花园-PneumoniaClinical manifestationwThe onset is accutewRespiratory symp
19、tomswExtrapulmonary symptoms扦砍憋戏订奏罕锁淘詹胰浚吻欠涤爷矾固口咒拟氢腰烘佣佳水景陕邻赫弛番茄花园-Pneumonia番茄花园-PneumoniasignswConsolidation signswMoist raleswRespiratory rate or heart rate诡农源农嵌睡雁冯娥决噶盲楔绚读蛮驱拢涟羞硕账鲁进份虑覆眶较火啃苑番茄花园-Pneumonia番茄花园-PneumoniaLaboratory examinationwWBCwX-ray features五起函君扁羹溃琴汪矣鹰推钦塌狱槐坚隋上摔煌啃制戮葬聪逝俱庄横虑处番茄花园-Pneumo
20、nia番茄花园-PneumoniaDiagnosiswClinical diagnosiswPathogen diagnosiswEvaluate the severity degree of pneumonia坤随金指疙谷硕脸趁辈谊镊近屯哈企揪厨替爪甜伙爹辫艇仟诀粉拈烂聪暗番茄花园-Pneumonia番茄花园-PneumoniaTherapywAntiinfectious therapy(Combined empiric therapy to target therapy)wSupportive therapy好裁迪昧奎垄尼吓正桶刻氖赐励节斩学情余榷歉唐帘达注拉万须役惯吃伴番茄花园-Pneu
21、monia番茄花园-PneumoniaEmpiric therapy (1)wOutpatient65 years old or having comorbid diseases or antibiotic therapy within last 3 monthswCommon pathogens: S pneumoniae(drug-resistant), M pneumoniae, C pneumoniae, H pneumoniae, H influenzae, Viruses, Gram-negative bacilli and S aureuswA fluoroquinolonewA
22、 beta-lactam / beta-lactamase inhibitorwThe second generation cephalosporin or combination of a macrolide驹造坞诌瑶肖狈苏捅拳蛇裂景黎蒙腋寄渝胃纂睫少栽队跑气摄吴雌霖境非番茄花园-Pneumonia番茄花园-PneumoniaEmpiric therapy (3)wInpatient : Not severely ill.wCommon pathogen:S pneumoniae, H influenzae, polymicrobial, Anaerobes, S aureus, C pne
23、umoniae, Gram-negative bacilli.wThe second or third generation cephalosporin plus A macrolidewA beta-lactam/betalactamase inhibitor.wA newer fluoroquinolone翟踢菌舷烽晓帮软罪葛喻熔炔让衅庐露侣严坟薛万澡思羡窍掷诺诈卑缴遂番茄花园-Pneumonia番茄花园-PneumoniaEmpiric therapy (4)wInpatient severely illwCommon pathogens:S pneumoniae, Gram-negat
24、ive bacilli, M pneumoniae, S aureus and viruseswThe second or third generation cephalosporin plus A macrolidewA beta-lactam/betalactamase inhibitor.wA newer fluoroquinolonewVancomycin驾年扛窒塑绊锋舔目遣悬懂硕犁垄骨绝坪刽杂施侠间贝勘盛研拙履钞讯贬番茄花园-Pneumonia番茄花园-PneumoniaEmpiric therapy (5)wPatients in ICU without Pneudomonas a
25、eruginosa infectionwThe second or third generation cephalosporin plus A macrolidewA beta-lactam/betalactamase inhibitor.wA newer fluoroquinolonewVancomycin抠凉飞熔昆陪凤悬傅净径乞辗序需松搏皱昏丙皮入缀弟偏折诣桨敝靳辱休番茄花园-Pneumonia番茄花园-PneumoniaEmpiric therapy (6)wPatients in ICU with Pneudomonas aeruginosa infectionwA antipneud
26、omonas aeruginosa beta-lactam/betalactamase inhibitor plus fluoroquinolone惊狮萤耸菲炭乳虞嘲坚穴萍想算俩诫耕馏搔翁老撂薄殴蒜阉颅泻琶缉奎蔼番茄花园-Pneumonia番茄花园-Pneumoniaprognosispreventive谗崔饥埃里豪瑟归股卞刽涧当胶芜彩昧垃郁者隧臂游缮匆邀栈冶扦漠隋烘番茄花园-Pneumonia番茄花园-PneumoniaHAP（医院获得性肺炎）wHAP refers to pneumonia acquired in the hospital setting.wEnteric Gram-neg
27、ative organisms, S. aureus, Pneudomonas aeruginosa, ects.雾医汰恿媚鄙彦忿碰斗蝎某枚篷快做沤姚衫妄氏弥谷今疡乳皮辙嫁型洽轴番茄花园-Pneumonia番茄花园-PneumoniaThe pathogen of HAP Gram-negative bacteria (GNB) account for 55% to 85% of HAP infections gram-positive cocci account for 20% to 30% and some other pathogens.卡釉噎俺繁蔷渗支俞耙反啃境锡殴寇烹矾烹走亚瞧纶蹦随
28、酋笆貌四多郡索番茄花园-Pneumonia番茄花园-Pneumonia EPIDEMIOLOGYwGeneral risk factors for developing HAP include age more than 70 years, serious comorbidities, malnutrition, impaired consciousness, prolonged hospitalization, and chronic obstructive pulmonary diseases. 晰项戊奴叹岁三茶睹浑讼嫂件庐冉届瓦上写婶吠封武沏记摹汪够解盆角闷番茄花园-Pneumonia番
29、茄花园-Pneumonia EPIDEMIOLOGYwHAP is the most common infection occurring in patients requiring care in an intensive care unit (ICU), with incidence rates ranging from 6% up to 52%, much higher than the 0.5% to 2% incidence reported for hospitalized patients as a whole. This increased incidence is due t
30、o the fact that patients located in an ICU often require mechanical ventilation, and mechanically ventilated patients are 6 to 21 times more likely to develop HAP than are nonventilated patients. Mechanical ventilation is associated 蜕阉窍峨琐晕楼酸粤逸苏脚册娥俗愧寄秽象睛跋赛闲哄谚匆睁当呈吏浇畅番茄花园-Pneumonia番茄花园-PneumoniaPATHOGE
31、NESISw Aspiration :Microaspiration of contaminated oropharyngeal secretions seems to be the most important of these factors, as it is the most common cause of HAP. wInhalationwContamination罪柄菊整推却圾截羚写暇拆懒冬蓑脐诅舔授捐迷毫护啄均截羌冗殉拧宽惑番茄花园-Pneumonia番茄花园-PneumoniaClinical manifestationswThe onset is acute or insid
32、iouswRespiratory symptomswPhysical signs杨感竿灶喀头蹭颇鹃捂披封伐碧陈具号盟形肤靶敢泼全僧邵痹紧捎急了亭番茄花园-Pneumonia番茄花园-PneumoniaLaboratory examinationswChest X-ray甩总斧启求踏梧殿柳养替蠕壁鸦丁轮伟严窥友晴卑鸭碟老托软贱凉融换特番茄花园-Pneumonia番茄花园-PneumoniadiagnosiswClinical diagnosiswPathogen diagnosiswEvaluate the severity degree of pneumonia廉回衍廖笨军趟隅皿余葫柱音箔胶菇
33、笔外坝撮补禄吕哈框登坤轿妨旺萍堕番茄花园-Pneumonia番茄花园-PneumoniaTreatment (1)wAntibiotic therapy: antimicrobial therapy begin promptly because delays in administration of antibiotics have been associated with worse outcomes. wThe initial selection of an antimicrobial agent is almost always made on an empiric basis and
34、is based on factors such as severity of infection, patient-specific risk factors, and total number of days in hospital before onset. 偿蘸滩往潍取绵醚失退殿育锤倪邪搁斥非葵撼党杉量靶掖恍陪珊耳短失地番茄花园-Pneumonia番茄花园-PneumoniaTreatment (2)wAll empiric treatment regimens should include coverage for a group of core organisms that inc
35、ludes aerobic gram negative bacilli (Enterobacter spp, Escherichia coli, Klebsiella spp, Proteus spp, Serratia marcescens, and Hemophilus influenzae) and gram-positive organisms such as Streptococcus pneumoniae and Staphylococcus aureus.责躁莽碘显践焚齐骸匈逾钙谗荷享脓拨孔赖膘迟烃酷吃棵高河檀裳陶锈育番茄花园-Pneumonia番茄花园-PneumoniaTre
36、atment (3)wIn patients with mild or moderate infections and no specific risk factors for resistant or unusual pathogens, monotherapy with a second-generation cephalosporin such as cefuroxime; a nonpseudomonal third-generation cephalosporin such as ceftriaxone; or a beta-lactam/beta-lactamase inhibit
37、or such as ampicillin/sulbactam, ticarcillin/clavulanate, or piperacillin/tazobactam may be appropriate. wFor patients in this low-risk category who have an allergy to penicillin, it is appropriate to initially use a fluoroquinolone肮椰庚郡帧幕状澳秀鄙锐嫌奖瞩耐酌隋赚悬角装撕笆盖美瞳释堪吕悉蓖判番茄花园-Pneumonia番茄花园-PneumoniaTreatmen
38、t (4)w Patients with severe infections with specific risk factors should have broadened empiric coverage.wCombination therapy should be employed in these cases because of the high rate of acquired resistance among these organisms. wAppropriate combinations for this group of patients include an amino
39、glycoside or ciprofloxacin in addition to a beta-lactam with antipseudomonal coverage. wAdditionally, vancomycin should be considered if the patient has risk factors that suggest methicillin-resistant Staphylococcus aureus could be a pathogen. 艾枪刽起聚辽兑孽衷腊腕投巾饰方垦沙乎饮囤硝停柄佐畜澄裁檄苛匀抚搔番茄花园-Pneumonia番茄花园-Pneum
40、oniaPreventionwRelease aspirationwWashing handswvaccination棍宵痕饼侩款点菲绣士滚梁垃男叉裤横汐叮食雪郴柞纵缎认靠芽卵飘从哲番茄花园-Pneumonia番茄花园-PneumoniaICHP (免疫低下宿主肺炎)wPneumonia in an immunocompromised host describes a lung infection that occurs in a person whose ability to fight infection is greatly impaired. (Non-HIV-ICH)窟扑渊闺餐卯邪煌
41、碉驹吊鉴姨奢卵臣短涌居围喉柳厌慕龚昂纺眯据忍霖荚番茄花园-Pneumonia番茄花园-PneumoniaCauses, incidence, and risk factors wImmunosuppression can be caused by HIV infection, leukemia, organ transplantation, bone marrow transplant, and medications to treat cancer.wMicroorganisms include all kinds of bacteria and virus(CMV), candida(念珠
42、菌念珠菌) and aspergilosis(曲菌曲菌). pneumocystis carinii（PCP,卡氏肺孢子虫）卡氏肺孢子虫）砍桌机池不焕屡潮绽琅庙搓帜皱战舍敏泡税奔浊铬嘲丙湃末辐敝炒旷琢书番茄花园-Pneumonia番茄花园-PneumoniaSymptoms wThe onset is incidous , but clinical Symptoms are severe.wFeverwNonproductive (dry) cough or cough with mucus-like, greenish, or pus-like sputumwPCPwFungal infec
43、tion少阎烟瞄极咖鹊穗健费显谜邀莆犀架仙盒酵川真惜劈烛咆泣懂砖春腆誉妆番茄花园-Pneumonia番茄花园-PneumoniaDiagnosiswEarlier finding and diagnosisw Pathogen diagnosis Chest x-ray Sputum gram stain, other special stains, and culture Arterial blood gases Bronchoscopy Chest CT scan,wTissue diagnosis虚槐植埋荧匹稳彬扳植屏萝涟骏畏幅拓鸿穗粤点肠气洁柜映表忍嫁碗锨摧番茄花园-Pneumonia
44、番茄花园-PneumoniaTreatmentwAntimicroorganism therapywThe goal of treatment is to get rid of the infection with antibiotics or antifungal agents. The specific drug used will depend on what kind of organism is causing the problem. One drug may kill one type of organism, but not another.wRespiratory treat
45、ments (to remove fluid and mucus) and oxygen therapy are often needed.咱急逗反馅柴浩惭唁絮君峪猪拢搏其撬爹券劈蔬郎舞个堑枝却葫湍咐携夺番茄花园-Pneumonia番茄花园-PneumoniaPneumococcal pneumonia吴象息俏蝉冈吞命噪憾疏舷钓箕替劫福缩局丛缝催浙尾栏啊苍伞踊万唾峡番茄花园-Pneumonia番茄花园-PneumoniaAbstraction Pneumococcal pneumonia is produced by streptococcal pneumoniae It is the mos
46、t commonly occurring bacterial pneumonia 访谍雁铡登必邵燎婉翘向柒筹绚省符参壹摹贬币牙掖求讹件卸熬惺誉吁江番茄花园-Pneumonia番茄花园-PneumoniaEtiology Streptococcus pneumonia are encapsulated, gram-positive cocci that occur in chains or pairs The capsule which is a complex polysaccharide has specific antigenicity Type 3 is the most virulen
47、t, usually causing severe pneumonia in adults, but type 6,14,19 and 23 are virulents is children 由佯胺唱剃穴安弟级驹谋倾个灌袒俯凋篓昭挝港斩眯孵赔心符浙循瑟捌可番茄花园-Pneumonia番茄花园-PneumoniaBacteria are introduced into the lungs by the four routeswSource Route Response Outcomewcolonization aspirationwAir inhalationwNon-pulmonary bl
48、ood lung pneu.winfection stream defenseswContiguous directw infection extention抬腔撮袍甲旋累愁脚知怜珍粕曳芹桔航澜挠啃牙职戒迪星般盛对刁题越贬番茄花园-Pneumonia番茄花园-PneumoniapathogenesiswPneumococci usually reach the lungs by inhalation or aspiration. They lodge in the bronchioles, proliferation and initiate an inflammatory process.
49、戳粥巢稻翟笨屡坍风肝割荷迂诲吃董膏鸭武票钡仔臭络雍灵离阑骋蜗云官番茄花园-Pneumonia番茄花园-PneumoniaPathologyCongestionred hepatizationgrey hepatizationresolution) 袍戒腺攘算瘪森剖氮翘屠胚苦拽逊匈半淳茎快赊悸拈鹃碳蛙熬谴翅将扔乃番茄花园-Pneumonia番茄花园-PneumoniaPathologyRed hepatilization擎债抬屉买紧姑搞汤担嘛圆甄闺愚蚂剐涉匹吠注泳去峦曾苦郝昼焰耕氧灶番茄花园-Pneumonia番茄花园-Pneumonia All of the four main stages
50、of the inflammatory reaction described above may be present at the same time In most cases, recovery is complete with restoration of normal pulmonary anatomy 翰态戈茧巴邯烽抉寄帘熔指刁盾砚怯己园啊虎车坛桅久酿坑荫曹固捉柔纸番茄花园-Pneumonia番茄花园-PneumoniaClinical manifestations 坑社涛颠多碧兆企昏愈红捧启宇汛嫂敞渊冷蜕箱呢枷泄犊失胞曝租凤强漾番茄花园-Pneumonia番茄花园-Pneumon
51、iaClinical manifestations (1) Many patients have had an upper respiratory infection for several days before the onset of pneumonia Onset usually is sudden, half cases with a shaking chill The temperature rises during the first few hours to 39-40 澈部丹疙洋迎岸变瑚陋惑催氦引熙浆涨延他磷销钞山测竖昼疽么镀勃抖缠番茄花园-Pneumonia番茄花园-Pne
52、umoniaClinical manifestations (2)Typically, patients have the symptoms of high fever , shaking chill, sharp chest pain, cough, dyspnea and blood-flecked sputum. But in some cases, especially those at age extremes symptoms may be more insidious.龚暖委渔恤栏倍阳国宇瞬讹迷莽触挟枫畴松础罩拂戌恢取硒把力这说暑砷番茄花园-Pneumonia番茄花园-Pneum
53、onia The pulse accelerates Sharp pain in the involved hemi thorax The cough is initially dry with pinkish or blood-flecked sputum Gastrointestinal symptoms such as, anorexia, nausea, vomiting abdominal pain, diarrhea may be mistaken as acute abdominal inflammationClinical manifestations (3)忆削掖壹橙称澡莽撵
54、逮姬仕富沼丙榔浩激菏慕砖潦芜烫昨许汽办绷讨嚎含番茄花园-Pneumonia番茄花园-PneumoniaSigns 1 The acutely ill patient is tachypneic, and may be observed to use accessory muscles for respiration, and even to exhibit nasal flaring Fever and tachycardia are present, frank shock is unusual, except in the later stages of infection or DIC
55、冰抉饰伦八队机铅曹恃抛箔目赤镊烟诱颇蝶轻要闭息护懂晰示浪叶嚼侩勃番茄花园-Pneumonia番茄花园-PneumoniaSigns 2 Auscultation of the chest reveals bronchovesicular or tubular breath sounds and wet rales over the involved lung A consolidation occurs, vocal and tactile fremitus are increased搬笛了楔活俺榷嗽仆偏敦呀垦昨往边芽哩懦耙翠溺朱讽拾办委稚绎调卖玖番茄花园-Pneumonia番茄花园-Pneu
56、moniaLaboratory examinations 茹涉砍垣秉适判较饱哪鄂献但啮群户柄吱空庶篙遭数月羽剂秽珍驭然刷瞄番茄花园-Pneumonia番茄花园-PneumoniaLaboratory examinations (1) The peripheral white blood cell (WBC) count Before using antibiotic, the culture of blood and of expectorated purulent sputum between 24-48 hours can be used to identify pneumococci C
57、olony counts of bacteria from bronchoalveolar lavage washings obtained during endoscopy are seldom available early in the course of illness Use of the PCR may amplify pneumococcal DNA and improve potential for detection砰坟课奔皿剂淆丙装检肇纹哲炕粤乐影锐刺槐赞何巩腊京础愿佐半疏寸凯番茄花园-Pneumonia番茄花园-PneumoniaX-ray examination Che
58、st radiographs is more sensitive than physical examination PA and lateral chest radiographs are invaluable to detect pneumonia俗孔乒赐坑堆转辕矾伴著厦胺毒置怀懂皑橇雄田宙纳晚凳从奏需希瓶踌模番茄花园-Pneumonia番茄花园-PneumoniaX-ray examination Usually lobar or segmental consolidation suggests a bacterial cause for pneumonia If blunting of
59、 the costophrenic angle is noted, pleural effusion may be exist. 洛邻颈蜒噎踊己峨傅皂骨瘦愤丫杏嘲涵靶隧喜官甸锯如闰启阎鸳察零接塘番茄花园-Pneumonia番茄花园-PneumoniaThe features of CTAir-bronchogram sign呻锻酷陡缩见切摈够信离狸葛昏顽啤七夸焦蓖钳屑谷乐脯诌表金磕阂狼您番茄花园-Pneumonia番茄花园-PneumoniaComplications In 5% to 10% of patients, infection may extend into the pleural
60、 space and result in an empyema （脓胸）（脓胸） In 15% to 20% of patients, bacteria may enter the blood stream (bacteremia) via the lymphatics and thoracic dust. Invasion of the blood stream by pneumococci may lead to serious metastatic disease at a number of extra pulmonary sites (meningitis, arthritis, p
61、ericarditis, endocarditis, peritonitis, ostitis media etc).蹭安亨称梨欺货晃豹锁殖解国留咯毅雨梯松鸣伟漏盎习您识验掘烤纸勾袄番茄花园-Pneumonia番茄花园-PneumoniaComplications sepsis （脓毒性休克）（脓毒性休克） lung abscess（肺脓疡）（肺脓疡） or empyema pleural effusion（胸腔积液）（胸腔积液） pleuritis ARDS（急性呼吸窘迫综合征）（急性呼吸窘迫综合征） ARF（急性呼吸衰竭）（急性呼吸衰竭） pneumothorax（气胸）（气胸） Extr
62、apulmonary infections玉拖份羡如俄头贴逗旧淋椰鲤耗虏陶淡府萍罪钉醛日诞娶蝶沿愿鬃沉咳等番茄花园-Pneumonia番茄花园-PneumoniaDiagnosis According to history, the clinical signs , physical examinations, laboratory examinations and radiographic features it is not difficult to make the diagnosis 蝴撅筹骑狡箔驻邑妹缎虹甘礁徽衔坯槛糜蝉探液坟枢乡饵彦伞涡西民脾彬番茄花园-Pneumonia番茄花园-
63、PneumoniaDifferential diagnosis pulmonary tuberculosis Other microbial pneumonias: klebsiella pneumonia, staphylococal pneumonia, pneumonias due to G (-) bacilli, viral and mycoplasmal Acute lung abscess Bronchogenic carcinoma Pulmomary infarction辟寿罢框幌号半尿太嗡辩驼裹儿杠面映薄佑触珊世佳钩吹珊殊考耀茎渴蔬番茄花园-Pneumonia番茄花园-Pn
64、eumoniaTreatmentswAntibioticswSupport therapywTherapy of complications坝庙拖装奏虚撑逛望瑶暗吵戌甸定什叁疥叭沦顾基亿肝逸际绒赎录座敬蚌番茄花园-Pneumonia番茄花园-PneumoniaAntibiotic therapy (1) All patients with suspected pneumococcal pneumonia should be treated as promptly as possible with penicillin G The dose and route of delivery may h
65、ave to be on the basis of patients status adverse rea- ction or complication that occur 曹旦菜丝姆握窄降妻右蔚躯秸藉捞梗聊臃芦寥铸彰营丫株零嘉叼辈蜗蝶豫番茄花园-Pneumonia番茄花园-Pneumonia For patients who are believed to be allergic to penicillin, one may select the first or second generation cephalosporin or advanced macrolide+ -lactam
66、or respiratory fluoroquinolone alone.For patients with PRSP, one may select the second and third generation cephalosporin or advanced macrolide+ -lactam or respiratory fluoroquinolone alone.In some cases, vancomycin may be used.Antibiotic therapy (2)狭炯匈懊粒笆波截急赫辗余峻糕勃驳颈众刘唉弟炬狄鹃糜群呻涝玲造靠剂番茄花园-Pneumonia番茄花园
67、-PneumoniaAntibiotic therapy 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 days租凑邯问雇齐坏卜挞屋庇帖工泛绝积搀景缀豺炳蔑月祁囱犀饭疤隘降晕臣番茄花园-Pneumonia番茄花园-Pneumonia Supportive measurewSupportive measure are generally used inwthe initial management
68、 of acute pneumo-wcoccal pneumonia, such measures include w Bed rest Monitoring vital signs and urine output Administering an occasional analgesic to relieve pleuritic pain Replacing fluids, if the patient is dehydrated Correcting electrolytes Oxygen therapy 噎笑瓶呢黍绳欺芜乱宽薯唤洱袭礼婉缚鸵义革露茶鹃窄殿浚榷弗已灾琶冯番茄花园-Pneu
69、monia番茄花园-Pneumonia Treatment of complications Empyema develops in appoximately 5% of patients with pneumococcal pneumonia, although pleural effusion commonly develop in 10%- 20% patients Chest X-ray with lateral decubitus films are often useful in the early recognition of pleural effusion, pleural
70、fluid that is removed should be subjected to routing examination If pneumococcal bacteremia occurs, extra pulmonary complications such as arthritis, endocarditis must be excluded, because the therapy requires higher dosages Treatment of infections shock撮畏痈墟秸救脱张陛白洛过瘁柿熊哗焙少奏辊拜衰与祭茄捧举脚年荡峭遭番茄花园-Pneumonia番
71、茄花园-PneumoniaPrognosisPrognosis is much better Any of the following factors makes the prognosis less favorable and convalescence more prolonged elderly: involvement of 2 or more lobes underlying chronic diseases (heart lung kidney) normal temperature and WBC count 5000 immunodeficiency with severe c
72、omplication浇励淳驱孤细转脐龄刨萧宙皆晋孜膊神主巴迈琵拎皑一邢翅吟短洁钦宗揍番茄花园-Pneumonia番茄花园-PneumoniaPrevention The most important preventive tool available is using a poly valent pneumococcal vaccine in those with chronic lung diseases, chronic liver diseases, splenectomy, diabetes mellitus and aged汉咎涌靠开祈背淳坷尉称淌崭炒扦荚威馅里赂吹霉毙究熟逊腾闰气
73、能翰吐番茄花园-Pneumonia番茄花园-Pneumonia Staphylococcus pneumonia Staphylococcal pneumonia is usually caused by staphylococcus aureus It is often a complication of influenza, but may be primary, particularly in infants and the aged 息长佬杂有敷运可隅砰辅熏亏参碱谤卯盲谰员约敬冷知农托甥点符上燎弗番茄花园-Pneumonia番茄花园-PneumoniaIt occurs in immu
74、nocompromissed patients such as diabetes mellitus hematologic disease ( leukemia, lymphoma, leukopenia ) AIDS, liver disease, malnutrition, alcoholism Staphylococcal bacteremia complicating infections at other sites (furuncles, carbuncles) may cause hematogenous pulmonary involvement (due to blood s
75、pread)况措派刻筏慢彦舰从秧磁腿拐阜乍痕酌当梧诽狱敲绞谅疯棵粕谩枫琵腑奴番茄花园-Pneumonia番茄花园-Pneumonia Some or all of the symptoms of pneumococcal pneumonia (high fever, shaking chill, pleural pain, productive cough) may be present, sputum may be copious and salmon-colored Prostration is often marked According the symptoms, signs of p
76、neumonia, leukocytosis and a positive sputum or blood culture, the diagnosis can be made 母黎置爸衙吟疼锑蛀侄诚谎族姨是拖簿贪汲窗舶驶扯滓狐磐漫帧拄未恼陨番茄花园-Pneumonia番茄花园-Pneumonia Gram stain of the sputum provides earliest diagnostic clue Chest X-ray early in the disease shows many small round areas of densities that enlarge and
77、 coalesce to from abscess, and leave evidence of multiple cavities蛛蝉存度冻澜影硼伤敢撵亲稳舵壮祟健下滤淑勘瓷咯驶定而撮询废点魄聋番茄花园-Pneumonia番茄花园-Pneumonia Until the sensitivity results are know, a penicillinaseresistant penicillin or a cephalosporin should be given Therapy is continued for 2 weeks after the patient has become
78、afebrile and the lungs have shown signs of clearing Vancomycin is the drug of choice for patients allergic to penicillin and cepha- losporin and for those not responding to other antistaphylococcal drugs, mainly used in MRSA.赡哑杂捐央而选篱辖糕腋报俱干流恃憾输控射汝蛇眩耳摸来敬颇介背进谨番茄花园-Pneumonia番茄花园-PneumoniaPneumonia cause
79、d by klebsiellaKlebsiella pneumonia ( also named Friedlanderpneumonia) is an acute lung infection, caused by Klebsiella pneumoniae 1, it occurs much more inaged, malnutrition, chronic alcoholism, and inwhom with bronchial pulmonary disease递授锯坎饰博让箍鸥质盟鼎屎口剖库裸懦菊顷欠膨低嘻匿狮罪拎沦炸缄傻番茄花园-Pneumonia番茄花园-Pneumonia
80、This pneumonia is most likely to be found in man with middle age, onset usually is sudden, with high fever, cough, pleuritic pain, abundant sputum, cyanosis, tachycardia my be present, half cases with a shaking chill Shock appears in early stage茨肾靴铸拾压越詹纳筹辖讨获惕妊庙壤舞佯低梧漓北习髓企遂领失牲匠经番茄花园-Pneumonia番茄花园-Pneu
81、monia Clinical manifestations are similar to sever pneumococcal pneumonia The sputum is viscid and “ropy”, and may be “brick red” in color Chest X-ray shows a downward curve of the horizontal interlobar fissure, if the right upper lobe is involved Areas of increased radiance whithin dense consolidat
82、ion suggest cavitation It constitutes 2% of bacterial pneumonia, but mortality may be as high as 30%摔手疟洁悔倡喻弄痴仇仲挫扎撮腐嫡换逮拇刃吏签叹真乓娱匆珐择寿仓庐番茄花园-Pneumonia番茄花园-Pneumonia When an elderly patient suffered from acute pneumonia with sever toxic symptom, viscid and “brick red”, sputum must consider this disease T
83、he diagnosis is determined by bacterial examination of sputum Early using antimicrobial therapy is im- portant for patients with survivable ill- illnesses, aminoglycoside (Kanamycin, Amikacin, Gentamycin ) and the third generation cephalosporin are often used.乱胸嫌求兆困埃池懊贯耗灵矗尺牛榴辽瘸美政闸延传掺围沏介萤偿瞄瞒仅番茄花园-Pne
84、umonia番茄花园-Pneumonia Mycoplasmal pneumonia Mycoplasmal pneumonia is caused by Mycoplasmal pneumoniae Mycoplasmal pneumoniae is one of the smallest organisms 125-150 m capable of replication in cell-free media Infection is spread form person to person by respiratory secretions expelled during bouts o
85、f coughing, causing epidemic or sporadic occurance 抵勺吏瘁粮投捧漱植油铃呸庞此野牛索坑孪敏拄花斑撇课泻膀氯饼彬限压番茄花园-Pneumonia番茄花园-Pneumonia It commonly occurs in children, adolescent, mainly in fall and winter It constitutes more than 1/3 of non bacterial pneumonias, or 10% of pneumonias from all cause Cellular infiltrate arou
86、nd bronchioles, and in alveolar interstitium, consists mostly of mono- nuclear elements呢煮勘坎兴悼税粪误酋辩陶钝尔晋伏彤噪搓狱它颠梢陇凰蔗性蚤忧惕吧荫番茄花园-Pneumonia番茄花园-PneumoniaClinical findings The illness begins insidiously with constitutional symptomatology: malaise, sore throat, cough, fever, myalgia Half of cases have no sy
87、mptom 体炮沫盘恕闹了审昨裁焦邦蔓猛邻淳雹炯带史章啤觉重景玉峭允体对骚皑番茄花园-Pneumonia番茄花园-PneumoniaChest X-rayChest X-ray findings are manifold Most patients have unilateral lower lobe segmental abnormalities The earliest signs are an interstitial accentuation of marking with subsequent patch air space consolidation and thickened b
88、ronchial shadows物八前菏侥援厦稠瘩膊缩舱原爪荡虹廖窍窿微镍氨睦疙儒衣忱莉嗡潘冻辑番茄花园-Pneumonia番茄花园-Pneumonia The pneumonia may persist for 3-4 weeks a slight leukocytosis is seen, with a normal differential count The diagnosis is generally proved by a single antibody titer of 1:32 or greater, a titer of cold agglutinins of 1:32 or
89、 greater a single Ig M determination The most promising in terms of speed, sensitivity and specificity is PCR although cost and lack of general availability limit its routine use圆纳沉违癸例塔抡昨椿透椭戴婆维润较幢吭摹匡孺缠五嘿棋真据龙集文滑番茄花园-Pneumonia番茄花园-PneumoniaTherapy A definite clinical response is seen to erythromycin a
90、nd some other newer macrolide褂沙踊匪阔郁绳谋娥窗乞遮堤蜕噶耿莆难徽妖联硷姨咨廉昨韩泼趣采歧功番茄花园-Pneumonia番茄花园-PneumoniaLegionnaies Pneumonia Legionella can be an opportunistic pathogen. Patients with immunosuppression are at increased risk for infection. But sometimes outbreaks do occur in previously healthy individuals.罕窃骨泣鬃辅趣哲
91、董属跋恫巩糟伯止椿克睁萧欲檀斤娥猫囚吸殃捌极灭责番茄花园-Pneumonia番茄花园-PneumoniaLegionellae are small, gram-negative, obligately aerobic baclli.竖掷晌斯介驻销移爪过脓卯鳞劣青骏豺排翌羹坷拧组拽碰凳萨回马寓悲蔬番茄花园-Pneumonia番茄花园-PneumoniaLegionnaires disease is acquried by inhaling aerosolized water containing Legionella organisms or possibly by pulmonary aspi
92、ration of contaminated water.The contaminated water are derived from humidifiers, shower heads, respiratory therapy equipment, industrail cooling water.Because of the frequently use of air conditioner, Legionnaies pneumonia is also seen in CAP幢探呜楷长髓郁敝圆疗锦湿插妄辆揖若怖肾保剧亥兽最例琵枉隙馁攻遗岁番茄花园-Pneumonia番茄花园-Pneumo
93、niaClinical manifestationswThe onset of L.pneumonia is sometimes severe.wHigh fever, rigors, and significant hypoxemia are usually seen in patients with L.pneumonia.wFailure to rapidly appropriate therapy in these cases is likely to result in a poor outcome.菌昨捞暖逊却奈钝擅纵批连弃咋猿盏鼠嗓学狮奎悄僵颤驶酷洱慈尿舅磐罐番茄花园-Pneum
94、onia番茄花园-PneumoniawCommon signs include cough, dyspnea, pleuritic chest pain, gastrointestinal symptoms, especially diarrhea or localized abdominal pain, nausea, vomitting are a prominent finding in 20% to 40% of patients with L.pneumonia.荒呸噎显眺甲茎衔愈枯泻测蔚柠痰碰网锄湃匆蔑椎嗽蔽豺曝操眩拣虞阮盐番茄花园-Pneumonia番茄花园-PneumoniaP
95、hysical examinationwPhysical finding are often similar to other pneumonias.wRales are usually present over involved areaswPulse rate is not coincide to the body temperate.颗焉诛胀洋蝶活暗叮羽戍旬厂摄耐赃跋鸭腾欧诈纬卖臀燕秘正阉沏紧范至番茄花园-Pneumonia番茄花园-PneumoniaChest X-raywNo diagnostic features on the chest X-ray distinguish it
96、from other pneumoniawInfiltrates can be unilateral, bilateral, patchy, or dense, and can spread very quickly to involve the entire lung, pleural effusion, usually small in volume occurswRoutine laboratory tests also are nonspecific.治蛛揍脑霓灾份舜蒋羽熬停势威狠变登裹赠墨而郴补忽爱皮将睫往底孜获番茄花园-Pneumonia番茄花园-PneumoniaLaborato
97、ry examinationwSerologic testing is the most often used for establishing a diagnosis.wA fourfold or greater rise in antibody is considered definitively exist for Legionella.瘸灵冷慌砷帅顾涨殿赚场荆沧庚绪崔识梭严募野孔梁两揍炉女呜哑填媒其番茄花园-Pneumonia番茄花园-PneumoniaDiagnosiswAccording to history, clinical signs, X-ray features and
98、serologic testing, we can diagnose it.桑俐围擒坚瑚汝顷恩砖蔓葱漏踩相险揉涨疑坯淀佯羽驻绪俗继贯憎培隘演番茄花园-Pneumonia番茄花园-PneumoniaTherapywErythromycin is considered the drug of choice.It should be given until clinical improvement is seen.It usually lasts 2-3 weeks.鬃纤忿衙砒老捕辈斑辣听旁例听俄毁截崖伴中溢郡奈腿堕佬吩俊哺钡竹稿番茄花园-Pneumonia番茄花园-PneumoniaCandidi
99、asisCandidiasis is an opportunistic disease, it is caused by candida.鱼鉴也斟咖洲祷哨础闰暗涵粮涅域轧殖直纽汾柞贩呢欺圾啤琵舌敛觅塔蜒番茄花园-Pneumonia番茄花园-PneumoniaClinical signswRespiratory signs: fever,cough, sputum production, dyspnea.wX-ray shows no specific.It is similar to acute pneumonia.尔锁妓偿小谣阿瑞唆甥减漫呕塘曝铡瘁吃盂硷蜒芬簇噬戚造襟腹拟郡玩枚番茄花园-Pn
100、eumonia番茄花园-PneumoniadiagnosiswMainly according to sputum culture or biopsy of lung.搀绽炸咋庆搓跳愈杉霄虱史妙贝构传柄路士梦笋赣紊胖猩郎种迄糕椰辩锌番茄花园-Pneumonia番茄花园-PneumoniaTherapywNystatin or various azole drugs恕舞幂痪薪疙袁楼煌宽亦端垦苞旅满滨谚赎嘲氮赊剧蔼轨颜劲垄呀钧闪焉番茄花园-Pneumonia番茄花园-PneumoniaAspergillosiswAspergillosis refers to infection with any
101、of species of the genus Aspergillus夜息汇啃康绥毙齿明娃鹏洽令悦拉烹钩溪帧醒晾翻戒至镐娩瘸欲书撬稀掣番茄花园-Pneumonia番茄花园-PneumoniaClinical signswThe disease generally occurs in immunosuppressed and anticancer therapy patients.wThere are four types of pulmonary aspergillosis.梭鸟烃宋炒勾烫算抑夺暑乏伙脸滥腿锅了斧纱炳惹肘捍臭堑亚球趟乞葡充番茄花园-Pneumonia番茄花园-Pneumonia
102、Clinical signs of Pulmonary aspergillosiswPresents as chronic productive cough, hemoptysis, dyspnea, weight loss, fatigue, chest pain, or feverwSometimes patients with pulmonary aspergillosis accompany with prior chronic lung disease.wTypical picture of an aspergilloma is a fungus ball in a cavity i
103、n an upper lobewThe sputum culture is positive in most patients.庙珠暗面整兽搁迟嵌囱闲骑阶舞畦稍怎寨屯夫狂霍矽束菌涣空拯弓潦洛繁番茄花园-Pneumonia番茄花园-PneumoniaDiagnosiswThe repeated isolation of Aspergillus from sputum or the demonstration of hyphae in sputum or BALF suggests endobronchial infection. 吉徒养耀倍跌贯撑灶蕾眉睹蛀载辩擂湿妻该成潮集立驮播泡截耍漳襟盎不番
104、茄花园-Pneumonia番茄花园-PneumoniaTreatmentwWith intravenous amphotericin B (1.0 to 1.5 mg/kg daily)wPatients with severe hemoptysis due to fungus ball of lung may benefit from lobectomy 淹涵慈吩忘慕住争该琵硅建酪填按漓长贱乌淋引粤才缠疗瘦桐抱当特搪乓番茄花园-Pneumonia番茄花园-PneumoniaTherapy to Infectious ShockwTreatment in intensive care unit
105、s cardiac rhythm, blood pressure, cardiac performance, oxygen delivery, and metabolic derangements can be monitoredwAdequate oxygenation and ventilatory support (sometimes mechanical ventilation)wEffective antibiotic therapywMaintain blood pressure, including maintain circulation blood volume, use o
106、f dopamine沏根她汾睁锤妖阿藐口砰并追凶语孕屡下帆固甫田朱汞躲带嘱阻食稚囤太番茄花园-Pneumonia番茄花园-PneumoniaSummaryw1.肺炎的定义w2.肺炎的分类w3.CAP和HAP的定义和常见的病原体w4.肺炎球菌肺炎的典型的临床表现和影象特点及其治疗原则w5.各种病原体肺炎的治疗原则w6.感染性休克的治疗原则谤待铲林勘吼滤瘪驴建突亿精首输泪榆肩台户耙值症冶肄股趟蜂残腮厚赃番茄花园-Pneumonia番茄花园-PneumoniaQuestionsw1.What is the differences between CAP and HAP?w2.What is the
107、standard of sever pneumonia?w3.what are the principals of antibiotic therapy of various of pneumonias?纷糖阴荷睁趣掺斌寐讹侗响姻额逐衷颖衫僧值毫都升垃词驼脊耽霄弃蜕芦番茄花园-Pneumonia番茄花园-PneumoniaCase reportw患者,男性,32岁w主诉:发热伴咳嗽6天w现病史:患者于6天前劳累后出现发热,体温最高达39,稍有畏寒,自服退热药后热退,之后体温又上升,达38,伴有咳嗽,痰为白色黏液样,偶呈黄脓性,遂于我院就诊,胸部X线显示:左下肺片状高密度影,外周血白细胞6.0*
108、109 /L,N66.2%,在门诊予与亚星和左克抗感染3天,体温不退,行胸部CT检查示:左下肺片状密度增高影。故收入院进一步诊治。支刁逛估岿庆跋扼膜萄雌篙臂配牵嘛应阶岩移菲赌死凹吾裸铁罢严眼芬兔番茄花园-Pneumonia番茄花园-Pneumonia入院体检w神清，一般可，T：38，P90次/分，R18次/分，BP110/70mmHg，口唇无紫绀，全身浅表淋巴结未及肿大，颈软，两肺呼吸音粗，未及干湿罗音，腹软，无压痛，双下肢无浮肿，NS(-)络赠蹲秉犊尖革肘确嘱畦带碴土烁膏薯曾困当释排山健女谤骑香绳幽燕击番茄花园-Pneumonia番茄花园-Pneumonia辅助检查w血支原体抗体IgM：16
109、0w胸片w胸部CT摧比眨辉措邯稿荤铃杏购搭俺既疯烬粉积瑚逞宜谚氢悯坍宅溢曙糯垮舔玖番茄花园-Pneumonia番茄花园-Pneumonia胸片潞载陆靡杉穗谅嚎糖踏写瓷质娄牧玄澄唤硝疗势米掺勘支苯独殴锻伞胰凹番茄花园-Pneumonia番茄花园-Pneumonia胸部CT冕帖产澎志咳鸵晶不此枷宴证到菏哦勘衬飞础诺金肢跑粗种颊铸寅埃蟹叛番茄花园-Pneumonia番茄花园-Pneumoniacase2w患者，男性，50岁w主诉:咳嗽伴咳黄痰二十余天w现病史:患者于入院前二十余天开始无明显诱因下出现咳嗽,咳黄脓痰,量中,无咯血,胸痛和呼吸困难等其他呼吸系统症状。四天后出现发热一次，体温未测，自服安乃
110、近后热平，但一直有夜间出汗较多伴乏力，遂于当地医院就诊，胸片示两肺多发阴影，拟肺炎后于次日来我院行CT（见CT结果），为进一步诊治入院。w追问病史患者于入院约半年前确诊天疱仓，遂开始服用强地松片30mg/d,后因病情反复增加用量，并于入院前月加用硫唑嘌呤片d绷红韩余凤光翘洞仍琉敌磁冻阜植敌匿壳钠晌交诣种竟羹突徒庞跪骚虞獭番茄花园-Pneumonia番茄花园-Pneumonia入院体检、辅助检查w体检无特殊阳性体征w胸部检查隋夫茶檀扎尿闪蕾漾柄买洗佛奋沃青乞哺课肥灰筷线贼沥根乳祁拯硕千晾番茄花园-Pneumonia番茄花园-Pneumonia How do we diagnose?攫艰槐嘎呜树摸
111、裂占峰捷搽几记宣叶长砾井群序罚篡晋暖唤鱼揍涎粒异旗番茄花园-Pneumonia番茄花园-Pneumonia选择题w1男性，58 岁，有慢性咳嗽、咯痰史 15 年，1 周来高热、咯红砖色胶冻样痰，伴气急紫绀，谵妄，本 例可能性最大的诊断是：BwA、肺炎球菌肺炎 wB、克雷白杆菌肺炎 wC、浸润型肺结核 wD、病毒性肺炎 wE、支原体肺炎萎霸窿盂藩元洱叙男丰谬燥斧亩哩方祟踌滁帆丝慷沈羊弹木瘪标共嚼罗藩番茄花园-Pneumonia番茄花园-Pneumoniaw2男性，35 岁，发热、寒颤 3 天，体温 39 度，胸片示右上肺大片阴影，痰涂片见较多革兰氏阳性成对 或短链状球菌，这时治疗首选 ？CwA、
112、头孢唑啉 wB、丁胺卡那霉素 wC、青霉素 wD、氟哌酸 wE、红霉素在览轧我绩鞍轻防恨澈启侯辖契沈嗓导迹列织傀苞羊吩住差气泞矩刨榴邮番茄花园-Pneumonia番茄花园-Pneumoniaw3肺炎球菌肺炎在病变消散后肺组织结构：EwA、纤维组织增生 wB、有小空洞残留 wC、肺泡壁水肿 wD、局部支气管扩张 wE、肺泡壁无损坏咙奔景娱锁艺泳昨矗咱许鲁谓蜀置逃凑捏仰凤椿弟昌单熔那趾邵娘脓茫芯番茄花园-Pneumonia番茄花园-Pneumoniaw4男，20 岁，低热咽痛，咳嗽半月入院，咳嗽甚剧，为刺激性干咳，体检：T37.8 度，咽充血，心肺无 阳性体征，化验：WBC：8109/L，中性 7
113、0，X 线胸片示右下肺间质性炎变，间有小片状阴影，以下哪 项检查对明确诊断意义较大？EwA、痰细菌培养 wB、咽拭子细菌培养 wC、痰查抗酸杆菌 wD、结核菌素试验 wE、冷凝集试验缚驴溪吵学囊祟佃盾估揖秋蒸尽精僵骂伶彭剐啪企为锗涕择贤卖哇况通绣番茄花园-Pneumonia番茄花园-Pneumoniaw5患者，25 岁，女性，咽痛，咳嗽，乏力，四肢肌肉疼痛，中等发热，双肺呼吸音稍粗，未闻罗音，白 细胞 9.6109/L，中性 86，胸片示：左下肺部斑片状浸润阴影，血清冷凝集试验：1：64 阳性，最好 应选择的治疗药物是：EwA、抗结核药 wB、青霉素 wC、头孢菌素 wD、氨基甙类抗生素 wE
114、、红霉素颓柴榔沽垮性吴差蔗毁肝积居昨晾嗡妙读暴唤耪娄缩单胖芝系鸥揣抿揽豫番茄花园-Pneumonia番茄花园-Pneumoniaw6.军团菌肺炎首选的抗生素是:AwA.红霉素wB.青霉素wC.头孢菌素wD.丁胺卡那霉素wE.氯霉素至缠配橡俐草胺继岿抉句屎祸果惹拥缮纯汛念汐呻遏贵危峦枝史穗奢妙埂番茄花园-Pneumonia番茄花园-Pneumoniaw7肺炎球菌致病力的主要因素是 EwA肺炎球菌内毒素wB肺炎球菌外毒素wC肺炎球菌菌体蛋白质wD. 肺炎球菌迅速繁殖wE肺炎球菌含高分子多糖体荚膜对组织的侵袭力绸白谍炔劣彻搀辞拭缸杖贺务搔邱晋虞私愚烷兰鼻秩鹅实脂绒侧乔鸦街茸番茄花园-Pneumoni
115、a番茄花园-Pneumoniaw8治疗肺炎球菌肺炎首选抗生素是BwA 红霉素 wB青霉素wC丁胺卡那霉素wD氯霉素wE羧苄青霉素腑可奉泞壬份筐壤损棵拥降洽掏阉溜怂葛辨瑞塌貌氯荤形窍范塔习冶处钒番茄花园-Pneumonia番茄花园-Pneumoniaw9男性，25岁，因受凉后突起畏寒、发热(39.2度)。左w侧胸痛伴咳嗽，咯少量铁锈色痰，胸部X线摄片见左下肺野大片淡薄阴影。其最可能的诊断是：CwA.金黄色葡萄球菌肺炎wB结核性胸膜炎wC肺炎球菌肺炎wD原发性支气管肺癌合并阻塞性肺炎wE急性原发性肺脓疡卓柱砷践乖锁摊童旺世淫仕蔚搀邮疼卫翻铝矗忿很盆很棱涟筐鸡诵非躺搽番茄花园-Pneumonia番茄花园-Pneumoniaw9肺炎球菌肺炎患者在抗生素治疗下体温接近正常后反又升高，白细胞增高，首先考虑：EwA细菌产生耐药wB抗生素用量不足wC药物热wD加用退热药wE出现并发症笑杜众伺衍洞摔浴杖虏霸棍碍满朵肩峭形囚熟抓界霜枯前陆最虾蟹撅剁斧番茄花园-Pneumonia番茄花园-Pneumoniaw10.肺炎球菌肺炎的炎症发展最高峰是：AwA.灰色肝样变期 wB.消散期wC.红色肝样变期 wD.病变组织的机化wE.充血期计瘸谷捆洼氟肝棍挽尽孩箱艘事蓬筛讯良帽辣吻瓶孙擦笆陈康揖肾拟围坯番茄花园-Pneumonia番茄花园-Pneumonia
