病理学——呼吸系统.pptVIP

医学 呼吸系统疾病 The Respiratory System 肺的结构与功能 快速气体交换 Rapid gas exchange Ventilation Perfusion Diffusion 清洁空气 Bronchus Bronchial epithelium Kulchitsky cells Bronchial Submucosal Glands 肺部感染 Pulmonary Infections 病原体 Pathogen 空气 contaminated air exposure 鼻咽部菌群 nasopharyngeal flora aspiration 宿主防御功能下降 Compromised defense mechanisms 肺部疾病 other common lung disease 免疫缺陷 Immunodeficiency 生活方式 Life style 分类 Classification 根据解剖和影像学 Anatomy and radiography 根据病因 Etiology 根据在哪获得 Setting in which they arise Community-Acquired Hospital-acquired (nosocomial ) 一、细菌性肺炎 大叶性肺炎 （95%肺炎链球菌） 小叶性肺炎 军团菌性肺炎 （肺炎+全身毒血症状） In the era before antibiotics… 充血水肿期 Hyperemia and edema 红肝期 Red hepatization 灰肝期 Gray hepatization 溶解消散期 Resolution (hopefully) 并发症 complications 肺脓肿，脓胸，脓气胸 败血症，脓毒败血症，感染性休克 肺肉质变 并发症 Complications 心力衰竭、呼吸衰竭 肺脓肿、脓胸、脓毒败血症 支气管扩张 二、病毒性肺炎/三、支原体性肺炎 轻者为急性间质性肺炎，旧称不典型性肺炎atypical 缺乏实变体征 WBC轻度升高 重者为急性呼吸窘迫症ARDS 肺泡弥漫性损伤 透明膜形成 Pneumonia in the Immunocompromised Host 机会致病原 opportunistic agents 常为多重感染 bacteria (P. aeruginosa, Mycobacterium spp., L. pneumophila, and Listeria monocytogenes) viruses (cytomegalovirus and herpesvirus) fungi (P. jiroveci, Candida spp., Aspergillus spp., and Cryptococcus neoformans) Pneumocystis Pneumonia 慢性阻塞性肺病 (COPD) Chronic Obstructive Pulmonary Disease limitation of airflow usually resulting from an increase in resistance caused by partial or complete obstruction at any level 肺气肿 Emphysema 慢性支气管炎 Chronic bronchitis 支气管扩张 Bronchiectasis 哮喘 Asthma 我国国家“十五”课题最新统计数据（2005年公布）显示40岁以上人口COPD患病率为8%。估计全国有2500万人罹患此病，每年因COPD死亡的人数达100万，致残人数达500～1000万，COPD居我国疾病负担的首位。 慢性支气管炎 Chronic bronchitis A persistent cough productive of sputum for at least 3 months, in at least 2 consecutive years 单纯型 Simple… 喘息型 Asthmatic… 阻塞型 obstructive… 病 因 etiology 吸烟和空气污染 Cigarette smoking and air pollutants 感染 Microbial infection Secondary role 使炎症持续，加重症状 maintaining the inflammation and exacerbating symptoms 发病机制 Pa