肺炎英文版课件.ppt

Pneumonia Case DiscussionXu ChangqingAddress:Hangzhou City,Wenzhou Road No.16Email：2023/1/292023/1/291 1The condition of the patientn n1,Yu Jinyu,male,64 years old,1,Yu Jinyu,male,64 years old,n n2,5 months ago,the patient started coughing 2,5 months ago,the patient started coughing without a cause,coughing white sputum.More without a cause,coughing white sputum.More severely:fever with a severely:fever with a temperature temperature of 38.In of 38.In the the local community local community hospital he was treated for hospital he was treated for 2 days 2 days without any without any improvement.improvement.S So he came to our o he came to our hospital to be admitted with pulmonary infection.hospital to be admitted with pulmonary infection.2023/1/292023/1/292 2The condition of the patient3,Examination 3,Examination of pulmonary CT:Double of pulmonary CT:Double pneumonia pneumonia lesions,for lesions,for anti infection,anti infection,stop cough and stop cough and phlegm and other phlegm and other treatments.The treatments.The temperature temperature dropped gradually and dropped gradually and the condition improved.the condition improved.4,The patient was 4,The patient was careless careless as to inhale food one as to inhale food one month beforehand,then the patient began to coughmonth beforehand,then the patient began to cough,sputum,sputum,and have feverand have fever.After.After being hospitalized,being hospitalized,feeding through a feeding through a nasogastric tube nasogastric tube,anti anti infection,infection,and phlegm treatment.The and phlegm treatment.The condition improved.condition improved.Multiple hospitalizations.Multiple hospitalizations.2023/1/292023/1/293 3The condition of the patient4,1 day 4,1 day ago,the patients condition ago,the patients condition worsened.He worsened.He was was admitted to the hospital for further treatment,admitted to the hospital for further treatment,quasi quasi“Pneumonia“Pneumonia,Parkinsons disease,admitted to,Parkinsons disease,admitted to our department.our department.Has Parkinsons Has Parkinsons disease history for 5 years.disease history for 5 years.2023/1/292023/1/294 4The condition of the patientPhysical examination:P 90/R 19/BP 119/72mHg T 36.6.Physical examination:P 90/R 19/BP 119/72mHg T 36.6.Clear Clear consciousness,bed consciousness,bed rest,nasal feeding.Skin and sclera without rest,nasal feeding.Skin and sclera without yellow dye,no lips cyanosisyellow dye,no lips cyanosis,a soft and not swollen,a soft and not swollen superficial superficial lymph node of lymph node of neck,neck,no jugular vein no jugular vein enlargementenlargement,tracheae,tracheae,no no chest deformity,the intercostal space without broadening,chest deformity,the intercostal space without broadening,double lung breathing symmetry,no change,fremitus without double lung breathing symmetry,no change,fremitus without change,bilateral percussion sound,two pulmonary respiration change,bilateral percussion sound,two pulmonary respiration crude and obviously,no rales or rhonchi;crude and obviously,no rales or rhonchi;heart has no heart has no enlargement,heart rate 90,the law is neat;the abdomen is soft,enlargement,heart rate 90,the law is neat;the abdomen is soft,complete abdomen tenderness,complete abdomen tenderness,no rebound tenderness,below no rebound tenderness,below liver lienal costal liver lienal costal region region without palpable mass,renal area without palpable mass,renal area without percussion pain;lower extremities edema,neurological without percussion pain;lower extremities edema,neurological examination:limbs adverse events,activities joint degree is examination:limbs adverse events,activities joint degree is limited,muscle tension increased,strength can not check.limited,muscle tension increased,strength can not check.2023/1/292023/1/295 5The condition of the patient2013-11-27 chest CT scan:comparison of the front 2013-11-27 chest CT scan:comparison of the front sheet(2013-10-28)two pulmonary sheet(2013-10-28)two pulmonary infections infections with with bilateral pleural effusion was improved;hint at the bilateral pleural effusion was improved;hint at the thoracic inlet endotracheal nodular protrusion.thoracic inlet endotracheal nodular protrusion.2023/1/292023/1/296 6Normal Chest CT Scan2023/1/292023/1/297 7Lung:the right lung left lung two leaf clover.The pulmonary fissures(oblique fissure,horizontal fissure)boundary,appeared as low density pancivascular area or linear high densityPulmonary segments:the right lung left lung is divided into ten segments,eight segments.Segmental bronchusTube in the lung,pulmonary artery segment center.Alveolar:filled with gas,so the lung showed low density shadow.Bronchus:filling gas,the tubular low-density gas as the characteristics of.Pulmonary vascular:pulmonary intravascular filling blood,showed high density.Chest CT scan of the patient2013-11-262014-01-022023/1/292023/1/298 8Recurrent cough,feverThrough a variety of antimicrobial treatmentThe first,second,three line antibioticsPenicillin,Cephalosporinsseflosp:rnz,Fluoroquinolonesflrokwanlonz,Carbapenemsk:bpenemz etc.There are 4 possibilities1,The diagnosis is not clear2,The older3,Abnormal immune functions4,Combined with various underlying diseases2023/1/292023/1/299 9ThoughtWe can see,the patients condition has improved,but We can see,the patients condition has improved,but there is no obvious improvement in imaging,there is no obvious improvement in imaging,This This is characteristic of aspiration pneumonia,is characteristic of aspiration pneumonia,pulmonary lesions difficult to absorb,pulmonary lesions difficult to absorb,Patients Patients with low immunity,easy recurrence of with low immunity,easy recurrence of pneumoniapneumoniaSoSo,the patients with recurrent pneumonia,so he has,the patients with recurrent pneumonia,so he has to stay in the hospitalto stay in the hospital2023/1/292023/1/291010Thought Symptoms Symptoms of bacterial pneumonia is larger,can be of bacterial pneumonia is larger,can be light weight,determined by the pathogen and host light weight,determined by the pathogen and host state.state.The The common symptoms were cough,expectoration,common symptoms were cough,expectoration,or the original respiratory symptoms increased,and or the original respiratory symptoms increased,and the emergence of purulent sputum or sputum with the emergence of purulent sputum or sputum with blood,with or without chest pain.blood,with or without chest pain.2023/1/292023/1/291111 Pneumonia Pneumonia disease range can have difficulty disease range can have difficulty breathing,respiratory distress.Most of the patients breathing,respiratory distress.Most of the patients have have fever.fever.Early signs have no obvious abnormity,serious Early signs have no obvious abnormity,serious person can have high respiratory rate,flaring of person can have high respiratory rate,flaring of nares,cyanosisnares,cyanosis.2023/1/292023/1/291212ThoughtClinical manifestation Pulmonary Pulmonary consolidation with typical signs,such as consolidation with typical signs,such as enhanced,fremitus percussion dullness and enhanced,fremitus percussion dullness and bronchial breath sounds,can also be heard and rales.bronchial breath sounds,can also be heard and rales.Pleural Pleural effusion,ipsilateral chest percussion effusion,ipsilateral chest percussion dullness,dullness,diminished diminished breath sounds.breath sounds.2023/1/292023/1/291313Differential diagnosis1,Pulmonary tuberculosis Many symptoms of systemic poisoning,afternoon fever,night sweats,fatigue,weakness,weight loss,insomnia,heart palpitations and other symptoms.X-ray visible lesions in the apical or supraclavicular,uneven density,dissipated slowly,and can form a cavity or intrapulmonary spread.Mycobacterium tuberculosis can be found in the sputum.The conventional antibiotic therapy.2023/1/292023/1/291414Differential diagnosis2,Lung cancer Often has a history of smoking.Has a cough,sputum,bloody sputum symptoms.White blood cell count is not high,if found that the cancer cells in sputum can be confirmed.Be accompanied with obstructive pneumonia,after antibiotic treatment inflammation is not easy to dissipate,or visible hilar lymph node enlargement,sometimes appears atelectasis.It is necessary to do the CT,MRI,fiberoptic bronchoscopy and sputum cytologic examination.2023/1/292023/1/291515Differential diagnosis3,Acute pulmonary abscess The early clinical manifestation is similar.As the disease progresses,expectoration of purulent foul sputum for lung abscess.The X-ray films showed the abscess cavity and fluid level.2023/1/292023/1/291616Differential diagnosis4,Pulmonary thromboembolism Many risk factors for venous thromboembolism,Many risk factors for venous thromboembolism,can occur hemoptysis,syncope,respiratory can occur hemoptysis,syncope,respiratory difficulties are obvious,jugular venous engorgement.difficulties are obvious,jugular venous engorgement.X-ray showed partial reduction of lung markings,X-ray showed partial reduction of lung markings,wedge-shaped shadow visible tip pointing to the wedge-shaped shadow visible tip pointing to the hilar,common hypoxemia and hypocapnia.hilar,common hypoxemia and hypocapnia.The two D-dimer,CT pulmonary angiography,The two D-dimer,CT pulmonary angiography,radionuclide lung ventilation/perfusion scan and radionuclide lung ventilation/perfusion scan and MRI examination can help identify.MRI examination can help identify.2023/1/292023/1/291717Differential diagnosis5,Non infectious pulmonary infiltration To exclude non infectious pulmonary diseases,such as pulmonary fibrosis,pulmonary edema,atelectasis,pulmonary eosinophilia and pulmonary vasculitis.2023/1/292023/1/291818TreatmentA stable condition after from intravenous to oral therapy.Pneumonia antibiotic treatment for at least 5 days,most of the patients need 7-10 days or a longer course of treatment,If the temperature is normal for 48-72 hours,without any a pneumonia clinical instability signs,can disable antibiotics2023/1/292023/1/291919TherapyIn view of the patientIn view of the patientAnti Anti infection treatment of penicillin injection and infection treatment of penicillin injection and Ciprofloxacin Ciprofloxacin Injection for 7 days.Injection for 7 days.2023/1/292023/1/292020Therapy Patients in addition to bed rest,drinking lots of Patients in addition to bed rest,drinking lots of water,oxygen,positive sputum,the main aspects of water,oxygen,positive sputum,the main aspects of the treatment of pneumonia is an infection.the treatment of pneumonia is an infection.According to patient age,underlying diseases,According to patient age,underlying diseases,whether have aspiration level factors,serious illness,whether have aspiration level factors,serious illness,selection of antimicrobial agents and route of selection of antimicrobial agents and route of administration.administration.2023/1/292023/1/292121Therapy Treatment of bacterial pneumonia pathogens Treatment of bacterial pneumonia pathogens(including the treatment of choice in vitro according(including the treatment of choice in vitro according to sputum culture and drug sensitivity test results,to sputum culture and drug sensitivity test results,sensitive antibiotics).sensitive antibiotics).Empirical treatment(antibiotics selection may Empirical treatment(antibiotics selection may cover the pathogen).cover the pathogen).2023/1/292023/1/292222Therapy Suspected pneumonia immediately give first dose of Suspected pneumonia immediately give first dose of antibiotics.A stable condition after the intravenous to antibiotics.A stable condition after the intravenous to oral therapy.oral therapy.Pneumonia antibiotic treatment for at least 5 days,Pneumonia antibiotic treatment for at least 5 days,the majority of patients to 7 10 days or longer the majority of patients to 7 10 days or longer course of treatment,the normal body temperature of course of treatment,the normal body temperature of 48 72 hours,without any a pneumonia clinical 48 72 hours,without any a pneumonia clinical instability signs,can disable antibiotics.instability signs,can disable antibiotics.2023/1/292023/1/292323Therapy1,Young adults with and without underlying 1,Young adults with and without underlying diseases of community acquired pneumoniadiseases of community acquired pneumonia Selection of penicillin,first generation Selection of penicillin,first generation cephalosporins antibiotics,the drug resistance of cephalosporins antibiotics,the drug resistance of Streptococcus pneumoniae can use special effects on Streptococcus pneumoniae can use special effects on respiratory tract infection(fluoroquinolone respiratory tract infection(fluoroquinolone moxifloxacin,levofloxacin).moxifloxacin,levofloxacin).肺炎链球菌46%流感嗜血杆菌10%肺炎支原体25%肺炎衣原体14%金黄色葡萄球菌5%2023/1/292023/1/292424Therapy2 2,Elderly people have basic diseases,or need to be Elderly people have basic diseases,or need to be hospitalized with community-acquired pneumoniahospitalized with community-acquired pneumonia The fluorinated quinolones,second/three The fluorinated quinolones,second/three generation cephalosporins,beta lactam/beta generation cephalosporins,beta lactam/beta lactamase inhibitor,can be combined with large ring lactamase inhibitor,can be combined with large ring vinegar.vinegar.流感嗜血杆菌需氧 G 杆菌60%肺炎衣原体5%金黄色葡萄球菌卡他莫拉氏菌5%15%肺炎链球菌15%2023/1/292023/1/292525Therapy3,Hospital acquired pneumonia3,Hospital acquired pneumonia The second/three generation cephalosporins,beta The second/three generation cephalosporins,beta lactam/beta lactamase inhibitor,quinolones or lactam/beta lactamase inhibitor,quinolones or carbapenems.carbapenems.2023/1/292023/1/292626Therapy4,Severe pneumonia4,Severe pneumonia The preferred broad-spectrum strong antibacterial The preferred broad-spectrum strong antibacterial drugs,drug combination is sufficient.drugs,drug combination is sufficient.Severe community acquired pneumonia with beta Severe community acquired pneumonia with beta lactam combined with large ring vinegar or lactam combined with large ring vinegar or fluoroquinolones;fluoroquinolones;Hospital acquired pneumonia available Hospital acquired pneumonia available fluoroquinolones or aminoglycoside combined fluoroquinolones or aminoglycoside combined antipseudomonal beta lactam,ampicillin/beta in antipseudomonal beta lactam,ampicillin/beta in any kind of amide enzyme inhibitors,carbapenems,any kind of amide enzyme inhibitors,carbapenems,when necessary,can be combined with vancomycin,when necessary,can be combined with vancomycin,teicoplanin and linezolid.teicoplanin and linezolid.2023/1/292023/1/292727Pneumonia clinical stability criteria:n nThe T 37.8;The T 37.8;n nThe heart rate 100/min.;The heart rate 100/min.;n n Respiratory Respiratory frequency 24/min.;frequency 24/min.;n nThe blood pressure:SBP 90mmHg;The blood pressure:SBP 90mmHg;n nIndoor air conditions and breathe the oxygen Indoor