医学资料肺炎球菌肺炎课件

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1、重庆医科大学附一院肺科陈虹PneumococcalpneumoniaDefinition肺炎球菌Pneumococcus肺大叶性炎变肺炎链球菌streptococcuspneumoniae院外感染最常见的肺炎多见于青壮年InflammationvesselcongestionserumRBC/WBCfibrinexudationabsorption(血管充血)(渗出实变)(吸收)（荚膜致病）Cohn支气管充气征PathologyCongestion(充血)RedHepatization(红色肝样变)GrayHepa

2、tization(灰色肝样变)Resolution(消散)acuteonsetofII.X-rayfindingscomplications◇Pluaritis（胸膜炎）◇Shock:BP,coldextremities,sweat,cyanosis(紫绀),tachycardia(心动过速)◇Toxicmyocarditis（中毒性心肌炎）II.X-rayfindingsLeftlowerlobepneumoniaDiagnosisTypicalfeaturesConsolidationsignsorralesW

3、BCX-rayfindingsSputumandbloodculture(+)DifferentialdiagnosisCaseouspneumonia(干酪性肺炎)Obstructivepneumonia（阻塞性肺炎）III.Pneumoniacausedbyothermicro-organismsCaseouspneumonia(干酪性肺炎)(Tuberculosis)◇Lowfever◇Nightsweat(盗汗)◇Lackofchill◇Insensitivetoantibiotics◇Tubercleba

4、cilli结核菌素试验（+）II.ObstructivepneumoniaForeignbody/Neoplasm◇slowabsorption◇recurrent(复发)◇fibrobrochoscopy(纤维支气管镜检查)III.Pneumoniacausedbyothermicroorganismsstaphylococcusstaphylococcuspneumonia(葡萄球菌肺炎)klebsiellaklebsiellapneumonia(克雷伯杆菌肺炎)legionellalegionairesdis

5、ease（军团菌肺炎）mycoplasmamycoplasmalpneumonia（支原体肺炎）Treatment◇Pinicillin(青霉素)◇AllergicorresistanttoPinicillin：Erythromycin(红霉素)orVancomycin(万古霉素)Qinolones（喹诺酮类）orCephalothins(头孢菌素)I.AntibioticsDuration:5—7daysor3daysafterdefeverness(退热)TreatmentDuration:5—7daysor3

6、daysafterdefeverness(退热)TreatmentII.Supporttherapy◇Rest,waterandnutritionfood……◇Alleviation(pain/fever/cough/sputum)◇Oxygen★Anti-shocktherapy★Othercomplications☆adequateinfusion☆vasoactiveagonist(血管活性药物)☆antibiotics☆corticosteroid(糖皮质激素):抗过敏，抗休克，抗毒☆纠正水、电解质及酸碱平

7、衡紊乱redlips,warmextremtysystalticpressure>90mmHgpulserate<100/minuteurine>30milliliter/hourCVP>10cmH2OIII.Therapytocomplications