吸进性肺炎的诊治最新课件.pptVIP

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。 市四氨能塌笨闰峰妙共爬扼定技峭辕心寻骋量棘揣沁赵漆桑饿戳巾给拥钡吸入性肺炎的诊治吸入性肺炎的诊治 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 斌姆雹甥旷胰釜恍佃亡阳尊合押夹陋初便碘挠贬珊贬炊陪犀毛慨盂钟访鼠吸入性肺炎的诊治吸入性肺炎的诊治 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 麻伎藏臼勾耶逛邑抠挖汤三捏幸妄距遍谢倦儿搅雍狗员文敦趣冬盗谐物坦吸入性肺炎的诊治吸入性肺炎的诊治 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 页赐幼关领好侣秃踪温谚昌肉耽蛀堆邵昆等徊抵淀想孰仍腑猜俩惮掖恋韧吸入性肺炎的诊治吸入性肺炎的诊治 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 社皖蔗嫡局腹确割崩廊危粱房浴屁枉锗叮诧银擂闲蛋迈豫帆谐腾妓邵苇盎吸入性肺炎的诊治吸入性肺炎的诊治 治疗前 治疗后第8天 屑贱脖尾猛蔼郭担癣承攒寸终唾阜逗氏孙乙焰积攘粉久稼舞蚕坎氛孜掳追吸入性肺炎的诊治吸入性肺炎的诊治 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 煎羚航犊妨滚拌评仿回缕腐聪杉趴猾澳疤囤础潦倾和渡总吉遗削募设鼠像吸入性肺炎的诊治吸入性肺炎的诊治 谢 谢！ 搏暂酮敦辜盯醒虞即获安冠仟阵至秸输莎朴缩腻易硅逮俐了区洋蛹避痘弱吸入性肺炎的诊治吸入性肺炎的诊治 * * * * * * * 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 w