急性肺脓肿的介绍精.ppt

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1、急性肺脓肿的介绍第1页，本讲稿共14页急性肺脓肿的概述急性肺脓肿的概述 肺脓肿是由于多种病原菌引起的肺部化脓性感染，早期为肺组肺脓肿是由于多种病原菌引起的肺部化脓性感染，早期为肺组织的感染性炎症，继而坏死、液化、外周有肉芽组织包围形成脓肿。临织的感染性炎症，继而坏死、液化、外周有肉芽组织包围形成脓肿。临床特征为高热、咳嗽，脓肿破溃进入支气管后咳出大量脓臭痰。床特征为高热、咳嗽，脓肿破溃进入支气管后咳出大量脓臭痰。x x线显示线显示含气液平的空腔。多发生于壮年，男多于女。自抗生素广泛应用以来，含气液平的空腔。多发生于壮年，男多于女。自抗生素广泛应用以来，发病率有明显降低。发病率有明显降低。第2页

2、，本讲稿共14页 An overview of acute lung abscess Lung abscess was caused by a variety of pathogenic bacteria suppurative lung infection,early infection to the lung tissue inflammation,and necrosis,liquefaction,peripheral has surrounded by granulation tissue abscess formation.Clinical features for high fev

3、er,cough,burst into the abscess after bronchial cough out a lot of purulent sputum.X-ray showed cavity containing gas and liquid flat.Develops in mature,male more than female.Since antibiotics are widely used,has a significantly lower incidence.第3页，本讲稿共14页急性肺脓肿的病因急性肺脓肿的病因 急性肺脓肿感染的细菌一般与口腔、上呼吸道的常存细急性肺

4、脓肿感染的细菌一般与口腔、上呼吸道的常存细菌相一致，包括需氧、兼性厌氧和厌氧细菌。较重要的厌氧菌菌相一致，包括需氧、兼性厌氧和厌氧细菌。较重要的厌氧菌有胨链球菌、胨球菌、核粒梭形杆菌，产黑色素杆菌、口腔炎有胨链球菌、胨球菌、核粒梭形杆菌，产黑色素杆菌、口腔炎杆菌和韦荣球菌等；常见的需氧和兼性厌氧菌为肺炎球菌、金杆菌和韦荣球菌等；常见的需氧和兼性厌氧菌为肺炎球菌、金黄色葡萄球菌、溶血性链球菌、克雷白杆菌、大肠杆菌、绿脓黄色葡萄球菌、溶血性链球菌、克雷白杆菌、大肠杆菌、绿脓杆菌、变形杆菌等。杆菌、变形杆菌等。第4页，本讲稿共14页The cause of acute lung abscess Ac

5、ute lung abscess infection of bacteria generally consistent with endure the bacteria in the mouth,tongue,upper respiratory tract,including aerobic,anaerobic and facultative anaerobic bacteria.Is more important,peptone peptone streptococcus aureus,anaerobic bacteria nuclear spindle coli,produces mela

6、nin bacillus,stomatitis WeiRong coccus and bacillus,etc.;Common aerobic and facultative anaerobic bacteria for pneumococcus,staphylococcus aureus,hemolytic streptococcus,white clay bacilli,escherichia coli,pseudomonas aeruginosa,proteus,etc.第5页，本讲稿共14页急性肺脓肿的症状急性肺脓肿的症状 肺脓肿患者中，有肺脓肿患者中，有70709090的病例为急性起

7、病，且多数的病例为急性起病，且多数有齿、口咽部的感染灶、或手术、劳累、受凉等病史。患者感畏有齿、口咽部的感染灶、或手术、劳累、受凉等病史。患者感畏寒、高热，体温达寒、高热，体温达39394040，伴有咳嗽、咳粘液痰或粘液脓性痰。，伴有咳嗽、咳粘液痰或粘液脓性痰。炎症累及胸膜可引起胸痛，且与呼吸有关。病变范围大，会出现炎症累及胸膜可引起胸痛，且与呼吸有关。病变范围大，会出现气急。同时还有精神不振、全身乏力、食欲减退等全身毒性症状。气急。同时还有精神不振、全身乏力、食欲减退等全身毒性症状。如感染不能及时控制，于发病的如感染不能及时控制，于发病的10101414天，突然咳出大量脓臭痰天，突然咳出大量

8、脓臭痰及坏死组织，每日可达及坏死组织，每日可达300300500ml500ml。臭痰多系厌氧菌感染所致。臭痰多系厌氧菌感染所致。约有约有1 13 3病人有不同程度的咯血，偶有中、大量咯血而突然窒息病人有不同程度的咯血，偶有中、大量咯血而突然窒息致死。一般在咳出大量脓痰后，体温明显下降，全身毒性症状随致死。一般在咳出大量脓痰后，体温明显下降，全身毒性症状随之减轻，数周内一般情况逐渐恢复正常。部分病人缓慢发病，有之减轻，数周内一般情况逐渐恢复正常。部分病人缓慢发病，有一般的呼吸道感染症状，如咳嗽、咳脓痰和咳血，伴高热、胸痛一般的呼吸道感染症状，如咳嗽、咳脓痰和咳血，伴高热、胸痛等。等。第6页，本讲

9、稿共14页 The symptoms of acute lung abscess In patients with lung abscess,70%-90%of cases of acute onset,and most teeth,throat infection kitchen,or surgery,history of overworked,catch cold catch cold,etc.Patients are chills,fever,body temperature up to 39 and 40,accompanied by cough,cough phlegm phlegm

10、 and mucus is purulent sputum.Inflammation of the involvement of the pleura can cause chest pain,and associated with breathing.Large range of lesions,there will be short of breath.As well as fatigue,muscle weakness,loss of appetite and systemic toxic symptoms.Such as infection is not control in time

11、,from 10 to 14 days of the disease,she suddenly produce a large number of purulent sputum and necrotic tissue,can reach 300-300 ml per day.Stinking phlegm is due to anaerobic bacteria infection.About one-third of the patients have different degree of haemoptysis,occasionally,a large number of haemop

12、tysis and suddenly choked to death.Generally after cough out a lot of phlegm,temperature decreased significantly,then reduce systemic toxicity symptoms,weeks general situation gradually returned to normal.Some patients slowly come on,have a common respiratory infection symptoms,such as coughing,coug

13、hing up phlegm and coughing up blood,with high fever,chest pain,etc.第7页，本讲稿共14页急性肺脓肿的检查急性肺脓肿的检查一一.实验室检查：实验室检查：血常规：血白细胞总数达（血常规：血白细胞总数达（20203030）109109l l，中性粒细胞，中性粒细胞在在9090以上。以上。痰细菌学检查：细菌的药物敏感试验有助于选择有效抗生痰细菌学检查：细菌的药物敏感试验有助于选择有效抗生素。素。二二.x.x线检查：线检查：x x线呈大片浓密模糊浸润阴影，边缘不清，或为团片状浓密阴影，线呈大片浓密模糊浸润阴影，边缘不清，或为团片状浓密

14、阴影，分布在一个或整个肺段。或有空腔、液平。分布在一个或整个肺段。或有空腔、液平。三三.纤支镜检查纤支镜检查：有助于发现病因和及时治疗。：有助于发现病因和及时治疗。第8页，本讲稿共14页Check with acute lung abscess A.Laboratory tests:Routine blood,blood white cell total(20-30)x 109/l,neutrophils in more than 90%.Sputum bacteriology examination:bacteria,drug sensitive test helps to choose e

15、ffective antibiotics.2.X-ray:X-ray shows large thick fuzzy infiltrates shadows,edge is not clear,or for the group sheet thick shade,distribution in one or the entire lung segment.Free or cavity,liquid level.3.The fiber lens check:help to find the cause and treatment in time.第9页，本讲稿共14页急性肺脓肿的治疗急性肺脓肿的

16、治疗急性肺脓肿的治疗原则是抗菌和痰液引流。急性肺脓肿的治疗原则是抗菌和痰液引流。1 1、常规治疗、常规治疗 按一般呼吸系统疾病诊疗常规处理。按一般呼吸系统疾病诊疗常规处理。2 2、抗感染治疗、抗感染治疗 原则上应根据细菌学和药敏试验结果选用抗生素。原则上应根据细菌学和药敏试验结果选用抗生素。可先用青霉素可先用青霉素G320G320万万960960万万U/dU/d，分，分2 23 3次静脉滴注，阿米卡星次静脉滴注，阿米卡星0.40.40.8g/d0.8g/d，静滴，待细菌学和药敏报告后再调整用药。，静滴，待细菌学和药敏报告后再调整用药。合并厌氧合并厌氧菌感染者可加大青霉素菌感染者可加大青霉素G

17、G剂量或加用林可霉素剂量或加用林可霉素1.8g/d1.8g/d，加入葡萄糖液，加入葡萄糖液内静滴，或内静滴，或0.6g0.6g，2 23/d3/d，肌注，甲硝唑，肌注，甲硝唑0.4g0.4g，3/d3/d，口服。严重者，口服。严重者可静滴头孢西丁等。在全身用药基础上可行局部治疗，如经鼻可静滴头孢西丁等。在全身用药基础上可行局部治疗，如经鼻导管或经纤支镜气管内滴药等。总疗程为导管或经纤支镜气管内滴药等。总疗程为4 48 8周。阿米巴肺脓肿周。阿米巴肺脓肿应用甲硝唑等抗阿米巴治疗。应用甲硝唑等抗阿米巴治疗。第10页，本讲稿共14页Treatment of acute lung abscess Ac

18、ute lung abscess treatment principle is antibacterial and sputum drainage.1,the conventional treatment in accordance with the normal processing general respiratory disease diagnosis and treatment.2,anti-infection treatment in principle should select antibiotics according to the results of the bacter

19、ium and drug sensitive test.Can use first penicillin G320 9.6 million U/d,in 2 3 intravenous drip,amikacin 0.4 0.8 g/d,the static drop,bacteriology and drug susceptibility report after the adjustment.Merger or anaerobic bacteria infection can increase the penicillin G doses of lincomycin 1.8 G/d,joi

20、n into the liquid glucose is static,or 0.6 G,2 3/d,muscle injection and metronidazole 0.4 G,3/d,oral.Severe cases can be static drops of cefoxitin,etc.Based on systemic medication feasible local treatment,such as nasal endotracheal catheter or by flexible bronchoscopy mirror dropping,etc.Total treat

21、ment course is 4 8 weeks.Lung abscesses,amebic fight amoebic treatment such as application of metronidazole.第11页，本讲稿共14页急性肺脓肿的治疗急性肺脓肿的治疗3 3、体位排痰和药物祛痰、体位排痰和药物祛痰 根据脓肿部位和病情采取体位引流，根据脓肿部位和病情采取体位引流，2 23/d3/d，每次，每次151530min30min。给予祛痰药物口服，如必嗽平、沐舒。给予祛痰药物口服，如必嗽平、沐舒痰等，必要时行超声雾化。痰等，必要时行超声雾化。4 4、经纤支镜冲洗、经纤支镜冲洗 脓痰较

22、多或有明显痰液阻塞征象者，可行脓痰较多或有明显痰液阻塞征象者，可行纤支镜冲洗和吸引。加强支持治疗，必要时少量多次输血。纤支镜冲洗和吸引。加强支持治疗，必要时少量多次输血。5 5、中药治疗、中药治疗 败脓强肺草，清热益肺、止咳化痰、消痈排脓，主败脓强肺草，清热益肺、止咳化痰、消痈排脓，主治肺脓肿。治肺脓肿。6 6、外科治疗、外科治疗 经内科常规治疗经内科常规治疗3 3个月以上仍咳脓痰、脓腔无明个月以上仍咳脓痰、脓腔无明显改变者，或合并威胁生命的大咯血或不能与肺癌等鉴别时可显改变者，或合并威胁生命的大咯血或不能与肺癌等鉴别时可行手术治疗。行手术治疗。治愈标准及随访：发热消退，无脓痰，治愈标准及随访

23、：发热消退，无脓痰，X X线检查示病灶消失或纤线检查示病灶消失或纤维化，认为治愈。病愈出院后，半年内随访检查维化，认为治愈。病愈出院后，半年内随访检查1 12 2次，注意有次，注意有无复发。无复发。第12页，本讲稿共14页Treatment of acute lung abscess 3,position row of phlegm and expectorant drugs according to position and condition to take position abscess drainage,2 3/d,15 30 min every time.Will give ora

24、l expectorant drugs,such as flat,MuShu phlegm,etc,necessary:ultrasonic atomizer.4,the fiber lens flush phlegm more or have obvious signs of sputum blocking,feasible bronchoscopy washing and attract mirror.Strengthen support treatment,if necessary,a small amount of blood transfusion for many times.5,

25、Chinese medicine treatment of sepsis is strong lung grass,heat profit lung,cough phlegm,anti abscess,lung abscesses,attending.6,surgery medical conventional treatment more than 3 months still coughing up phlegm,pus cavity has no obvious change,or combined with lung cancer and other life-threatening

26、hemoptysis or cannot identify feasible surgical therapy.Cure:criteria and follow-up fever subsided,no phlegm,X-ray lesions disappeared or fibrosis,think to cure.Recover after discharge,half a year follow-up examination at 1 2 times,pay attention to the presence of recurrence.第13页，本讲稿共14页谢谢关注谢谢关注Thank you for your attention 第14页，本讲稿共14页