内科课件：Pneumonia肺炎.ppt

* Additional symptoms include: Headache Excessive sweating and clammy skin Loss of appetite Excessive fatigue Confusion in older people * A PA chest film demonstrates bilateral peripheral homogeneous opacities. No definite air bronchograms are identified and there is a certain degree of heterogeneity and nodularity to the opacities overlying the right costophrenic angle and left perihilar region. Bronchopneumonias such as this one caused by Staphylococcus typically do not have air bronchograms and may be slightly more nodular and heterogeneous than conventional pyogenic infections.  * A PA chest film demonstrates a large left pneumothorax which spontaneously occurred in a patient with underlying Pneumocystis carinii pneumonia. Pneumothorax occurs in approximately 5% of patients with PCP and AIDS. There may be significant difficulty in treating these pneumothoraces as they frequently are a result of bronchopleural fistula created between a pneumatocoele and the adjacent pleural space * Figure 2. Frontal Chest Radiographs in a 46-Year-Old Man. Panel A shows an obvious area of air-space shadowing (arrows) on the left side. A follow-up chest radiograph showed progression of the disease, with multiple, bilateral areas of involvement (Panel B). A subsequent chest radiograph shows improvement of bilateral lung opacities after therapy (Panel C). * * * * * * 病情评估 年龄、基础病、意识障碍 高热或低温、R30,P125, BP90/60mmHg WBC 、PLT、PH7.3,PO260mmHg, BUN及Cr升高， X线多叶病变或胸水，菌血症或肺外病灶 中国CAP指南重症肺炎判断 出现下列征象中1项或以上者 意识障碍 呼吸频率≥30次/min PaO2＜60 mmHg,PaO2/FiO2 ＜300,需行机械通气 动脉收缩压＜90 mmHg 并发脓毒性休克 胸片双侧或多肺叶受累，或入院48h内病变扩大≥50％ 尿＜20 ml/h, 或＜80 ml/4h，或并发急性肾功衰需要透析 中华医学会呼吸病学分会.中华结核和呼吸杂志, 2006, 29:651-655 * a SARS patient 4 days after onset of symptoms two days later * 鉴别诊断 * 结核中毒症状 肺实变历久不消散，多位于肺尖 伴空洞，肺内播散 肺结核(干酪性肺炎) * TUBERCULOSIS * LUNG CANCER * pulmonary embolism * Foreign Body Aspiration * Bronchiectasis * Lung Abscess * 其他鉴别疾病 间质性肺炎 肺水肿 肺血管炎 社区获得性肺炎的治疗 CAP guidelines Australia 2000 Information to b