呼吸系统肺炎全英文ppt课件

Contents（一）、pandect··········································3（二）、Pneumonia in general····················8（三）、Etiology··········································13（四）、Signs···············································34（五）、Treatment······································49（六）、Prevention·····································582024/8/22uRespiratory SystemuRespiratory Systemnose（nas/o OR rhin/o）larynx (laryn/o)Lungs  (pneumon/o OR pulmo )bronchus  (bronch/o)diaphragm (diaphragm/o)mediastinum（一）（一）pandect Organs 3 Functions ØBreathing process ØExchange of Oxygen and Carbon DioxideØEnable speech productionoxygencarbon dioxideAlveolar/0-Hyperpnea Cyanosis02co2uRespiratory System（一）（一）pandect4 The influencing factors of respiratory diseasesuRespiratory System（一）（一）pandectØ Air pollution and smokingØ Inhaled allergensØ The variation of etiology and  Drug resistance increases      Signs and symptomsØCough Laryngitis/ bronchitis/ bronchial asthma/ chronic obstructive pulmonary disease (COPD)/ lung cancerØExpectoration     Lung abscess/ bronchiectasis/ pneumoniaØHemoptysis     pulmonary TuberculosisØDyspnea     Pneumothorax/ pleural effusion/ left heart  failureØStethalgia hemothorax/ Pulmonary thromboembolismuRespiratory System（一）（一）pandect Lab and other inspectionØBlood testsØantigen skin testØ phlegm examination Øpleural effusionØthoracicopunctureØradio examination uRespiratory System（一）（一）pandectØbronchoscopyØThoracoscopeØ lungobiopsyØsupersonic inspectionØrespiratory function testØPulmometry  DefinitionPneumoniaPneumonia is an acute infection is an acute infectionof the of the parenchymap'rekm  parenchymap'rekm   of   of  the lung,the lung,肺炎是肺肺炎是肺实质实质的急性感染的急性感染   ，(lower-(lower-respiratory tract) respiratory tract) 下呼吸道下呼吸道caused  by caused  by microorganism microorganism makr':gnzmmakr':gnzm   由微生物引起由微生物引起,  , comes with fever , focal chest comes with fever , focal chest symptoms , shadowing on symptoms , shadowing on CXRCXR（chest X-raychest X-ray胸部胸部x x线检查）线检查）. .伴随发热，局灶性胸部症状，胸片阴伴随发热，局灶性胸部症状，胸片阴影。影。Respiratory System2024/8/22Defense mechanism di'fens 'meknizmof the respiratory tract（呼吸道防御机制）（呼吸道防御机制）ØFiltrationfil'trein  and deposition'dep'zn 滤除及沉积（nasal function鼻功能）pathogens'pædns  in the upper airways 上呼吸道病原体Cough reflex 咳嗽反射ØMucociliarymju:k'slr clearance 黏液纤毛清除Ømacrophages'mækrfed  巨噬细胞ØHumoral'hju:mrl  and cellular 'seljl(r) immunity 体液及细胞的免疫ØOxidative 'ksdetv metabolism mtæblzmof the     neutrophils 中性粒细胞的氧化代谢uRespiratory System（二）、Pneumonia in general2024/8/22 鼻炎咽炎耳炎扁桃体炎喉炎细支气管炎uRespiratory SystemSinus/-itis 'san'sats 鼻窦炎鼻窦炎 Pharyng/-itis .færn'dats 咽炎咽炎Laryng/-itis lærn'dats 喉炎喉炎Bronch/-itis br'kats 支气管炎支气管炎2024/8/22rootmeaningexamplePneum(o)-Lung,airpneumothoraxnju:m':ræks气胸  pneumonia肺炎  pneumatic nu:'mætk充气的   pneumocystisn'jumssts肺囊虫  pneumonectomynju:m'nektm 肺切除术   pneumonrrhagia nju:m'rei:d 肺出血  pneumograph'nju:mgr:f 呼吸描计议  pneumocytenju:m'st肺细胞  pneumatocele'nju:mtsi:l 肺膨出Pulmo(o)-Pulmonary'plmnri肺的,肺病的Path(o)-pathologyPathobiologypæba'ld 病理学  Pathogenpædn病原体Pathogenesis pædenss 发病机理    pathologistpldst 病理学家Muc(o)-SlimeMucoid'mju:kd粘液样的       mucociliarymju:k'slr 黏液纤毛的 mucositism'ju:ksats 黏膜炎Myx(o)-Myxomamks'm粘液瘤  myxobacteriamksbæk'tr 黏细菌myxiod粘液样的Bronch(o)-bronchiBronchogenicbrnkd'enk 支气管原的    bronchoscopyb'rntskp支气管镜检查术    bronchitisbrkats 支气管炎       bronchospasm'brkspæzm支气管痉挛Bronchoconstrictionbrnt'knstrkn支气管狭窄2024/8/22rootmeaningexampledys-有病的、不正常的、有障碍的dyspnea（呼吸困难）ds'pni: 、dyscrasia（恶病质）ds'krezj 、dysentry（痢疾）'dsntr 、dysplasia（发育异常）ds'ple pnea呼吸eupnea（呼吸正常）ju:p'ni: 、tachypnea（呼吸急促）tækp'ni: hyper-超出、在······之上、高于、过度hyperadenosis（腺增大）hapræd'nss 、hyperaemia（充血）hap'ri:m 、hyperinsulinism（胰岛素分泌过多）hap'nslnzm 、hyperpiesia（血压过高）hap(:)pa'zj 、hyperthyroid（甲状腺功能亢进）hap'ard hypo-在······下、次于、不足hypothermia（低体温）hap:mi 、hypoglottis（舌下部）hap'glts 、hypoacidity （胃）酸过少 hp'sdt 、hypocalcemia（低血钙）hapkæl'si:m 、hypoglycemia（低血糖）hapgla'si:m uRespiratory System2024/8/22Etiology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 uRespiratory System2024/8/22Causative 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bækt'rmj bactericide杀菌剂bæk'trsad bacill-杆菌bacillemia杆菌血症bs'li:m -coccus球菌diplococcus双球菌dpl'kks 、gonococcus淋球菌'gn'kks strept-链streptococcus链球菌属strept'kks staphyl-葡萄staphylococcus葡萄球菌属stæfl'kks 、staphyloma葡萄肿stæf'lm monil-念珠菌moniliasis念珠菌病mn'lass 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2024/8/22Classification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 uRespiratory System2024/8/22Classification by anatomy按解剖按解剖分类分类 ØLobar大叶性大叶性 : Involvement of an entire lobe                         一个完整的叶的参与 ØLobular小小叶叶性性 : 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； ØInterstitial间间质质性性ntstl  : Involvement of the interstitial tissue of the lungs肺间质组织参与 uRespiratory System2024/8/22Classification by pathogen按病原体分按病原体分类类Pneumococcal pneumonia ,njum'kkl肺炎球菌肺炎Staphylococcal pneumonia stæfl'kkl 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 kænd'dass 肺念珠菌病Pulmonary aspergillosisæspdilusis 肺曲霉菌病klebsiella pneumoniaklebziel 克雷伯杆菌肺炎legionaires disease li:d'ne 军团菌肺炎uRespiratory System2024/8/22Classifications by acquired environment按患病环境分类按患病环境分类 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 older 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 intubation  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。 2024/8/22SymptomsCoughDyspnea呼吸困难 ds'pni: Pleuritic肋膜炎的 pl'rtk  chest pain胸痛Fever or hypothermia发热或低体温 Myalgias肌痛 ma'æld Chills/Sweats发冷/出汗Fatigue疲劳 fti: HeadacheDiarrhea腹泄 sinusitis鼻窦炎sansats   expectoration咳痰 uRespiratory System2024/8/22全身怕冷湿冷发青痰痰短气胸膜炎的pl'rtk  胸痛咳血h'mptss 疲劳f'ti: 食欲差情绪波动血管的væskjl(r) 恶心n:zi呕吐呕吐 关节痛Pneumococcal pneumonia肺炎链球菌肺炎The pneumonia that is caused by Streptococcus pneumoniae nearly half 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. uRespiratory SystemThe pathological change病理变化is divided into 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 uRespiratory SystemThis is noted clinically as oedema水肿di:m  and congestion充血 in lung, alveolar exudate肺泡渗出,hematid'hemtd  infiltration红细胞浸润,leukocyte'lu: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 alveolar 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。uRespiratory SystemIn 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 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。uRespiratory System2024/8/22Etiology and pathogenesis     organismS.pneumoniaeDynamic balance 2024/8/22  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.uRespiratory System2024/8/22Etiology 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”.  uRespiratory System2024/8/22Etiology 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.uRespiratory System2024/8/22Etiology 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 pathogenic factor and lead to the occurance of disease .uRespiratory System2024/8/22Streptococcus pneumoniae high-risk groups ：      Smokers, dementia, Chronic Bronchitis , bronchiectasis, cardiac failure,chronic disease,immunosuppressants users, the elderly, infants and young children 2024/8/22Laboratory 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)2024/8/221.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.2024/8/223. 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 æsidusis  .What are pneumonia symptoms and signs?Initially have symptoms of a cold（upper respiratory infection, for example, 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 condition known as “cyanosis ”）due to their blood.SymptomsThis 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 babies 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.Complications         Serious and potentially lethal  · Pleural effusion and empyema  · Infective shock  · Toxic myocarditis  · ARDS （Acute Respiratory Distress Syndrome )  · Organized pneumonia  ·Pleuritis  ·Meningocephalitis   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 chest.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.Sputum SamplesSputum 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 can help in directing more appropriate therapy.A 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 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.Hematology laboratoryComplete blood count（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 glucoseBronchoscopyBronchoscopy is a procedure in which a 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 obtained.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 skin 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.   Diagnosis1·Preceding history of common cold or other URI；2. Symptoms：abrupt onset, 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 infectionDiffuse interstitial pneumoniaLobar pneumoniaCriteria of severe  pneumonia1. Respiratory rate>30/min；2. Blood pressure<90/60mmHg；3. Blood gas :PaO2<60mmHg， PaO2/FiO2 <300 mmHg；4. BUN>7.1mmol/L(30mg/DL)；5. X-ray:two lobes are involved；Need for vasopressorsRenal FailureCaseous pneumonia(lung tuberculosis）Differential diagnosisApicallocationInsidious onset with lower fever，night sweats，Fatigue and weight lossNot respond to antibioticsSputum smear for tubercle bacilli(+)Differential diagnosisLung abscessCopious purulent foul-smelling sputumDifferential diagnosisObstructive pneumoniasuperimposed hilar shadowrecurrent pneumonia at the same site happended in patients over 40, which does not respond well to the antibiotic treatmentfiberoptic bronchoscopy2024/8/22TreatmentAntiinfectious therapySupportive therapyTherapy of complications2024/8/22 TreatmentThe more serious pneumonia,  requires antibiotics such as penicillin. 2024/8/22TreatmentAll 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 status /adverse rea- ction or complication that occur 2024/8/22TreatmentFor patients who are believed to be allergic to penicillin(青霉素青霉素), one may select the first or second generation cephalosporin(头孢菌素头孢菌素) or advanced macrolide(大环内酯物大环内酯物)+  -lactam(-内酰胺内酰胺)or respiratory fluoroquinolone(氟喹诺酮氟喹诺酮) alone.2024/8/22TreatmentIn 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 days2024/8/22Supportive 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(止痛剂止痛剂) to relieve pleuritic (胸膜炎的胸膜炎的)pain -Replacing fluids, if the patient is dehydrated(脱水的脱水的) 2024/8/22Supportive measureCorrecting electrolytes(电解质电解质)Oxygen therapy 2024/8/22Treatment of complicationsEmpyema(脓胸脓胸) develops in appoximately 5% of patients with pneumococcal pneumonia, although pleural effusion(胸膜渗出物胸膜渗出物) commonly develop in 10%- 20% patientsChest X-ray with lateral decubitus（侧卧位）（侧卧位） films are often useful in the early recognition of pleural effusion, pleural fluid that is removed should be subjected to routing examination2024/8/22Treatment of complicationsExtra pulmonary（胸部的）（胸部的） complications such as arthritis（关节炎）（关节炎）, endocarditis（心内膜炎）（心内膜炎） must be excluded, because the therapy requires higher dosages（剂量）（剂量） Treatment of infections shock2024/8/22PreventionThe most important preventive tool available is using a pneumococcal vaccine（疫苗）（疫苗） in those with chronic lung diseases, chronic liver diseases, splenectomy（脾（脾切除术）切除术）, diabetes mellitus（糖尿病患者）（糖尿病患者） and aged2024/8/22PreventionThe germs（微生物） that cause many of the different types of pneumonia can be contagious（有传染性的） and are spread through coughing and sneezing. You can prevent pneumonia by following good hygiene habits, such as:-Cough or sneeze into a tissue.-Use separate drinking glasses and eating utensils.-Wash your hands frequently with warm soapy water.2024/8/22PreventionDo not visit sick patients with pneumonia. If you have pneumonia, do not visit older people, visit older people, babies or sick people.2024/8/22PreventionImprove immunity ：   follow these well-known measures to stay healthy and keep the immune system ready:      -Eat healthy-Sleep well-Avoid smoking-Exercise-Reduce stress-Do not drink alcohol in excess 2024/8/22