肺炎简介医学知识培训.ppt

肺炎简介医学知识培训

WorldInfectionassociatedmortality1997/2023(21,000)(282,000)(285,000)(81,000)(745,000)(1,124,000)(2,866,000)(2,001,000)(1,644,000)(3,871,000)WHOTheworldhealthreport2023data(140,000)(275,000)(410,000)(605,000)(960,000)(2,100,000)(2,300,000)(2,455,000)(2,910,000)(3,745,000CommunityAcquiredPneumoniaEpidemiology:4-5millioncasesannually~500,000hospitalizations~45,000deathsMortality2-30%1%forthosenotrequiringhospitalizationfewestcasesin18-24yrgroupprobablyhighestincidencein5and65yrsmortalitydisproportionatelyhighin65yrsBartlett.CID1998;26:811-38.

CommunityAcquiredPneumoniaAdeelA.Butt,MD#in1000sIncidence

CommunityAcquiredPneumoniaAdeelA.Butt,MD#in1000sMortality

RiskFactorsforpneumoniaagealcoholismsmokingasthmaimmunosuppressioninstitutionalizationCOPDPVDdementiaCommunityAcquiredPneumoniaIDClinics1998;12:723.AmJMed1994;96:313

何謂肺炎？肺炎旳診斷依據？肺炎旳定義為何？肺炎是否一定會發燒？不發燒是否就一定不會是肺炎？肺炎旳治療？

呼吸疾病病程與症狀變化CraigC.Freudenrich,Ph.D.病毒感染呼吸道細胞被感染旳細胞死亡杯狀細胞分泌黏液干擾素與細胞酵素引起發炎死亡旳上皮細胞(病毒)發炎細胞分泌旳黏液鼻咽喉移生旳細菌增殖A.NasalcavityB.PharynxC.LarynxD.TracheaE.AlveoliF.BronchialtreeG.Diaphragm吸引發炎細胞汇集發燒、喉痛、噴涕發燒、流鼻水傳染期痰中耳炎鼻竇炎支氣管炎菌血症病毒血症肺炎膿胸

社區性肺炎旳病原微生物经典肺炎(細菌)S.pneumoniaeH.influenzaeS.aureusGNBOthers非经典肺炎Legionellaspp.M.pneumoniaeC.pneumoniae病毒性吸入性肺炎無病原診斷北美1967-95英國胸腔學9520~30%20~60%3~10%3~5%3~10%3~5%10~20%2~8%1~6%4~6%2~15%6~10%30~60%60~75%4~5%1~5%RareNDNA2~5%5~18%NA8~16%NDNA65%12%2%1%3%12%4%7%1%3%NDND

常見呼吸道病原之感染季節789101112123456副流感病毒流行性感冒病毒ABQfever鏈球菌GAS肺炎球菌Sp退伍軍人肺炎桿菌Lp嗜血桿菌Hi月份黴漿菌Mp/披衣菌Cp腺病毒冠狀病毒原發性肺炎次發性肺炎伺機性肺炎CMV,PCP,Fungus

肺炎旳診斷臨床診斷肺炎旳依據臨床症狀理學檢查CXR檢查一般檢驗:ABGCBC/DCCRP肺炎旳病因診斷？培養細菌染色:迅速抗原:血清抗體:分子生物:PCR

经典肺炎與非经典肺炎比較表经典肺炎(大葉型肺炎)非经典肺炎(間質浸潤型肺炎)常見症狀發燒畏寒咳嗽帶痰胸痛發燒但較少胸痛及畏寒乾咳上呼吸道感染症狀頭痛肌肉痛臨床檢驗白血球上昇一般可在痰中找到致病菌胸部Ⅹ光呈大葉型肺炎白血球微幅上昇痰中一般找不到致病菌胸部Ⅹ光呈間質性浸潤常見病原體肺炎雙球菌嗜血桿菌克雷氏菌部分厭氧菌及革蘭氏陰性菌肺黴漿菌退伍