2011秋-药学-慢支、肺心病、肺炎.ppt

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1、呼吸系统疾病RespiratorySystemDisease肺炎、慢性支气管炎、肺心病(pneumonia,ChronicBronchitis,corpulmonale)张庆玲FlusymptomArewereadytomeetbirdfluchallenge?SARS-themysteryillnessPneumonia-howcommonitis!Pulmonarytuberculosis-olddiseaseContinuingWagingwaronlungcancerRespiratorysystemanatomicalchartBronchiPneumonia

2、P142--AcuteexudativeinflammationLunginfectionSymptoms:coughwithsputumproduction,fever,andsharpchestpainoninspiration(breathingin)ThesixthleadingcauseofdeathintheUnitedStatesover3millionpeopledeveloppneumoniaeachyearintheUnitedStates.Overahalfamillionofthesepeopleareadmittedtoahospitalfor

3、treatment.Approximately5%willdiefrompneumonia.TypesofpneumoniaPhysicalandchemicalfactorsEtiologyPlacescopeCharacterBiologicalfactors:Bacterial,Viral,MycoplasmalPhysicalandchemicalfactorsLobarpneumoniaLobularpneumoniaInterstitialpneumoniaSegmentalpneumoniaSerousFibrinousSuppurativeHemorrh

4、agicCaseousGranulomatousAlveolarpneumoniaSegmentalpneumonia引起肺炎的病原体有哪些？细菌：肺炎链球菌、肺炎杆菌、流感嗜血杆菌、溶血性球菌、葡萄球菌、结核杆菌、非典型分枝杆菌、绿脓杆菌、大肠杆菌、变形杆菌、军团菌病毒：流感病毒、呼吸道合胞病毒、腺病毒、副流感病毒、麻疹病毒、单纯疱疹病毒、巨细胞病毒、冠状病毒、禽流感病毒支原体：肺炎支原体衣原体：沙眼认原体、鹦鹉热衣原体真菌：新型隐球菌、曲霉菌、毛霉菌、念珠菌放线菌、诺卡氏菌立克次体：伯纳特立克次体→Qfever寄生虫：弓形体、卡氏肺囊虫、血吸虫幼虫、肺吸虫一、大叶性

5、肺炎LobarpneumoniaIntroductionEtiology&PathogenesisPathologicalchangesClinicalrelationsDiffusefibrinousinflammationinalveoliYoungtomiddleagedpersonsClinicalmanifestations:Rapid;chill,highfever,chestpain,cough,rustysputum,dyspnea;consolidationoflung;WBC↑Naturalcourseofdisease:5-10daysIntrod

6、uction浆液性渗出物细菌在肺泡中繁殖肺泡孔呼吸细支气管带菌渗出液大叶间蔓延叶支气管邻近肺组织机体抵抗力↓呼吸道防御能力↓→细菌感染(肺炎球菌)→变态反应→血管扩张，通透性↑→浆液、纤维素渗出肺炎链球菌（1,2,3,7型）金黄色葡萄球菌溶血性链球菌90％Etiology&PathogenesisMostlylaterallung，inferiorlobeofleftorrightlungAlsomorethantwopulmonarylobesFourstagesPathologicalchanges★(一)充血水肿期（1－2天）★大体：肿大重量增加暗红镜下：肺泡壁毛

7、细血管扩张、充血肺泡腔大量浆液,少红、中性粒、巨噬细胞,大量细菌高热、咳嗽，毒血症湿性啰音、淡薄阴影GramStainofafilmofsputum(二)红色肝样变期（3－4天）★大体：肿大、质实、灰红镜下：肺泡壁毛细血管扩张充血，肺泡腔大量RBC渗出，少数WBC、纤维素发绀、咳嗽、铁锈色痰、胸痛、支气管呼吸音、湿性罗音、致密阴影Thisstageisreferredtoas“Redhepatization”inlobarpneumonia.Thealveolicontainmoreredcellsandserumandlessneutr