Pneumonia.ppt
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Pneumonia,Definition,Pneumoniaisanacuteinfectionoftheparenchymaofthelung(肺实质),causedbybacteria,fungi(真菌),virus,parasite(寄生虫)etc.PneumoniamayalsobecausedbyotherfactorsincludingX-ray,chemical,allergen,Epidemiology,Themorbidityandmortalityofpneumoniaarehighespeciallyinoldpeople.,Etiology,Therearetwofactorsinvolvedintheformationofpneumonia,includingpathogensandhostdefenses.,Classification,ClassificationofanatomyClassificationofpathogenClassificationofacquiredenvironment,.Classificationbypathogen,Pathogenclassificationisthemostusefultotreatthepatientsbychoosingeffectiveantimicrobialagents,Bacterialpneumonia,
(1)AerobicGram-positivebacteria,suchasstreptococcuspneumoniae,staphy-lococcusaureus,GroupAhemolyticstreptococci
(2)AerobicGram-negativebacteria,suchasklebsiellapneumoniae,Hemophilusinfluenzae,Escherichiacoli(3)Anaerobicbacteria,Atypicalpneumonia,IncludingLegionnaiespneumonia,Mycoplasmalpneumonia,chlamydiapneumonia.,Fungalpneumonia,Fungalpneumoniaiscommonlycausedbycandida(念珠菌)andaspergilosis(曲菌).pneumocystisjiroveci(肺孢子虫),Viralpneumonia,Viralpneumoniamaybecausedbyadenoviruses,respiratorysyncytialvirus,influenza,cytomegalovirus,herpessimplex,Pneumoniacausedbyotherpathogen,Rickettsias(afeverrickettsia),(立克次体)parasites(寄生虫)protozoa(原虫),.Classificationbyanatomy,1.Lobar(大叶性):
Involvementofanentirelobe2.Lobular(小叶性):
Involvementofpartsofthelobeonly,segmentalorofalveolicontiguoustobronchi(bronchopneumonia).3.Interstitial(间质性),Lobarpneumonia,Lobularpneumonia,Interstitialpneumonia,Classificationbyacquiredenvironment,Communityacquiredpneumonia,CAP(社区获得性肺炎)Hospitalacquiredpneumonia,HAP,NP(医院获得性肺炎)Nursinghomeacquiredpneumonia,NHAP(护理院获得性肺炎)Immunocompromisedhostpneumonia,(ICAP)(免疫宿主低下肺炎),Diagnosis(诊断步骤),GiveadefinitediagnosisofpneumoniaToevaluatethedegreeofthepneumoniaTodefinitethepathogenofthepneumonia,Diagnosis,Historyandphysicalexamination(5W)X-rayexaminationPathogenidentification,Differentiation,PulmonarytuberculosisLungcancerAcutelungabecessPulmonaryembolismNoninfectiouspulmonaryinfiltration,Pathogenidentification,Sputum:
Morethan25whitebloodcells(WBCs)andlessthan10epithelialcells.NasotrachealsuctioningBAL,ETA,PSB,LABloodcultureorpleuraleffusioncultureSerologictesting(immunologicaltesting)MolecularTechniques,Theprincipaloftherapy,SelectantibioticsAccordingtoguideline,Therapy,Thetherapyshouldalwaysfollowconfirmationofthediagnosisofpneumoniaandshouldalwaysbeaccompaniedbyadiligentefforttoidentifyanetiologicagent.Empirictherapy,(4-8h)Combinedempirictherapytotargettherapy,Itisimportanttoevaluatetheseveritydegreeofpneumonia,Thecriticalmanagementdecisioniswhetherthepatientwillrequirehospitaladmission.Itisbasedonpatientcharacteristics,comorbidillness,physicalexaminations,andbasiclaboratoryfindings.,Thediagnosticstandardofseverpneumonia,AlteredmentalstatusPa0230/minBloodpressure90/60mmHgChestX-rayshowsthatbilateralinfiltration,multilobarinfiltrationandtheinfiltrationsenlargemorethan50%within48h.Renalfunction:
U20ml/h,and80ml/4h,CAP(社区获得性肺炎),CAPreferstopneumoniaacquiredoutsideofhospitalsorextended-carefacilities.Streptococcuspneumoniaeremainsthemostcommonlyidentifiedpathogen.OtherpathogensincludeHaemophilusinfluenzae,mycoplasmapneumoniae,Chlamydophiliapneumoniae,Moraxellacatarrhalisandects.Drugresistancestreptococcuspneumoniae(DRSP),Clinicalmanifestation,TheonsetisaccuteRespiratorysymptomsExtrapulmonarysymptoms,signs,ConsolidationsignsMoistralesRespiratoryrateorheartrate,Laboratoryexamination,WBCX-rayfeatures,Diagnosis,ClinicaldiagnosisPathogendiagnosisEvaluatetheseveritydegreeofpneumonia,Therapy,Antiinfectioustherapy(Combinedempirictherapytotargettherapy)Supportivetherapy,Empirictherapy
(1),Outpatient60yearsoldandnocomorbiddiseasesCommonpathogens:
Spneumoniaes,Mpneumoniae,Cpneumoniae,Hinfluenzaeandviruses,AnewgenerationmacrolideAbeta-lactam:
thefirstgenerationcephlosporinAfluoroquinolone,Empirictherapy
(2),Outpatient65yearsoldorhavingcomorbiddiseasesorantibiotictherapywithinlast3monthsCommonpathogens:
Spneumoniae(drug-resistant),Mpneumoniae,Cpneumoniae,Hpneumoniae,Hinfluenzae,Viruses,Gram-negativebacilliandSaureus,AfluoroquinoloneAbeta-lactam/beta-lactamaseinhibitorThesecondgenerationcephalosporinorcombinationofamacrolide,Empirictherapy(3),Inpatient:
Notseverelyill.Commonpathogen:
Spneumoniae,Hinfluenzae,polymicrobial,Anaerobes,Saureus,Cpneumoniae,Gram-negativebacilli.,ThesecondorthirdgenerationcephalosporinplusAmacrolideAbeta-lactam/betalactamaseinhibitor.Anewerfluoroquinolone,Empirictherapy(4),InpatientseverelyillCommonpathogens:
Spneumoniae,Gram-negativebacilli,Mpneumoniae,Saureusandviruses,Thesecondorthird