吸入性肺炎的诊治.ppt

持续癫痫致吸入性肺炎 ? 立即给予高浓度氧吸入 ?呼气末正压呼吸治疗“急性呼吸窘迫综合征” ?纠正血容量不足用白蛋白或低分子右旋糖酐等。 ?避免左心室负担过重和胶体液渗漏入肺间质，用利尿剂。 ?抗生素只用于控制继发性感染，而不主张用于预防细菌性感染，因不能减少继发细菌感染的发生，且易产生耐药菌株。 误吸的预防和治疗 短期鼻饲 口腔清洁 药物治疗 增加咳嗽和吞咽的感觉：ACEI抑制P物质降解 避免镇静剂 大量误吸导致严重呼吸困难 肺叶灌洗 全肺灌洗 吸入性感染性肺炎的治疗 严重病例：抗厌氧和需氧菌的广谱方案 按社区和院内感染指南治疗 PG和克林霉素耐厌氧比例增加 新喹诺酮(莫西沙星）、哌拉西林敏感性较高，可考虑用 BIPAP和CPAP对神经病变导致上气道塌陷性吸入性肺炎有效 男，62岁，农民，倒在稻田中。次日起，高热、咳黄痰，三日后入我院。 入院时体温39度，WBC：21000/uL 诊断：吸入性肺炎 治疗：莫西沙星0.4QD IV 治疗次日体温开始下降，三日后降至正常。 WBC三日后降至13000/uL 治疗前 治疗后第8天 治疗前 治疗后第8天 小结 老年人误吸发生率高 CAP中吸入占15%-23% 应鉴别吸入性化学性肺炎和吸入性感染性肺炎 吸入性感染性肺炎常为混合性感染（G+球菌、G-杆菌和厌氧菌等） 吸入性感染性肺炎，特别是严重患者，起始经验抗菌治疗应覆盖厌氧菌 谢 谢！ * * * * * * * Left:Chest CT scans show subcarinal lymphadenopathy (arrow), small bilateral pleural effusions, and radiation pneumonitis in the medial portion of left upper lung zone. Right: Two weeks later, acute onset of symptoms suggestive of pneumonia have developed in this patient on a course of radiation therapy.Chest radiograph shows consolidation in right upper lobe and left perihilar area. Follow-up CT scans show complete necrosis and cavitation of the subcarinal lymph node (arrow), resulting in bronchoesophageal fistula and aspiration pneumonia in both upper lobes. * * A 6-year-old white boy with a history of developmental delay and a seizure disorder was found to have an infiltrate in his RUL on a CXR obtained during an orthopedic evaluation for thoracic scoliosis. He had no signs or symptoms of respiratory disease at that time. He was treated with one 10-day course each of amoxicillin with clavulanic acid and cefazolin during a 2-month period. The patient continued to be asymptomatic, but a follow-up CXR showed persistence of the infiltrate and the patient was referred to our center for further evaluation. The patient had a long history of constipation with daily use of mineral oil. He was fed by mouth and had occasional episodes of coughing and choking during feeding.