呼吸系统疾病教程.ppt

Aetiology and Pathogenesis 理化因素 感染因素 过敏因素 内在因素 Morphology Chronic inflammation of bronchi wall 呼吸道粘液-纤毛系统损伤 Cilium 粘连 倒伏 脱落 Cell 变性 坏死 gland hypertrophy, hyperplasia glandular metaplasia Mucus hypersecretion Mucus retention Inflammation of bronchioles and milieu tissue 管壁充血、炎细胞浸润 以淋巴细胞、浆细胞为主 软骨、平滑肌破坏 纤维组织增生 Clinic and Correlation with Pathology Symptom： Cough — 反复炎症、分泌物刺激 Sputum — 白色粘液泡沫状 Gasp — 痉挛/狭窄/阻塞引起 Auscultation：哮鸣音、干湿啰音 Complication Emphysema、cor pulmonale Bronchiectasis （自学） Bronchopneumonia Summary Defined clinically as cough and sputum for 3 months in 2 consecutive years Mucus hypersecretion with bronchial mucous gland hypertrophy Respiratory bronchiolitis Most cases caused by smoking Pulmonary emphysema Concept Pulmonary emphysema is Defined anatomically as enlargement of alveolar airspaces with destruction of elastin in walls Aetiology and Pathogenesis obstructive ventilatory disorder （阻塞性通气障碍） Elastase （弹性蛋白酶）增多、活性增高 obstructive ventilatory disorder 弹性蛋白酶增多, 活性增高 炎症时： Besides: deficiency of α1-anti-Trypsin →emphysema α1-AT 抑制多种蛋白水解酶 Type and Morphology Alveolar emphysema Centriacinar emphysema Periacinar emphysema Panacinar emphysema Pneumatocele/bullac lung Interstitial emphysema Paracicatricial emphysema (瘢痕灶旁肺气肿) 不规则型肺气肿 瘢痕附近的肺组织 肺腺泡不规则受累 Bullae lung（肺大泡） 局灶性肺泡破坏 小叶间隔破坏 2cm以上大囊泡 Interstitial emphysema Morphology Microscopic 末梢组织呈囊性扩张 肺泡扩张，肺泡孔扩大 肺泡壁变窄 断裂→融合成大囊腔 肺毛细血管床 →破坏、明显减少 肺小动脉内膜 →纤维性增厚 小、细支气管 →慢性炎症 Gross: 体积增大、边缘钝圆 弹性减弱、颜色灰白 表面肋骨压痕 切面蜂窝状 触之捻发音 Clinic and correlation with pathology Hypoxia（低氧症状） 症状 呼气性呼吸困难、气促、 胸闷、发绀等 体征 桶状胸，叩诊过清音 胸透肺野透明度增加 结局 并发肺心病，气胸，肺性脑病 Chronic cor pulmonale Etiology and pathogenesis COPD chronic bronchitis and emphsema Accounted for 80％～90% Cases Thorax disease Vascular disease of lung Morphology Lesions of lung 肺组织 原有病因所致病变 肺血管 肌型小动脉中膜增厚 无肌细动脉肌化现象 肺小A炎 毛细血管床减