重症肺炎的诊治.ppt

免疫受损患者增多 AIDS Cancer organ transplantation Immunossupresive therapy mildly impaired host immunity diabetes mellitus, malnutrition, alcoholism, advanced age, Prolonged corticosteroid administration chronic obstructive lung disease 特殊人群的肺部感染 Pulmonary infections in HIV/AIDS CD4 counts below 200 cell/mm3 ：PCP, cytomegalovirus, atypical mycobacteria CD4 count above 500 cells/mm3：bronchial infections;bacterial pneumonia non-AIDS immunocompromised patients Fungi ： neutropenic phase of BMT (up to 3 weeks) Aspergillus species：肺移植气道内定植 CMV：器官移植3月内? 细菌感染：器官移植1月内 PCP Viral PneumoniaAfter Hematopoietic Stem Cell Transplantation 死亡率20-78% 死亡率达73% 病毒性肺炎的诊断 临床表现-不特异 开始表现为上呼吸道症状 咽痛、流涕 咳嗽，痰少 发热 病情进展表现为呼吸急促、低氧血症 体征：肺部湿罗音、捻发音 病毒性肺炎的诊断 影像学改变具有一定特点 胸部X线 疑诊患者 监测病变的范围和进展 发现并发症(如：空洞、脓肿、气胸、胸腔积液) 指导有创操作 肺部薄层CT：横断面影像：病变形态和分布清晰 结节影 磨玻璃影 局限性实变 树芽征 胸水，空气潴留征等 不同免疫抑制患者组的病原体差异 Axial CT image shows bilateral centrilobular nodules and pleural effusion in Cytomegalovirus infection in a 38-year-old bone marrow recipient Axial CT image shows bilateral centrilobular nodules, ground-glass densities and thickening of bronchial walls predominantly in the right lower lobe in a bone marrow recipient with Cytomegalovirus antigenemia A 43-year-old woman with CMV pneumonia 1 year after allogeneic HSCT for non-Hodgkin lymphoma. A and B, CT images show patchy bilateral and asymmetric ground-glass opacities and 1 to 2mm centrilobular nodules in a peribronchovascular distribution (arrows). asymmetric ground-glass opacities 1 to 2mm centrilobular nodules 24y, CMV pneumonia,allogeneic HSCT for non-Hodgkin lymphoma. HRCT: multiple poorly defined centrilobular nodules (arrowheads) scattered tree-in-bud opacities multiple poorly defined centrilobular nodules scattered tree-in-bud opacities (arrows). 13-year-old female with chronic myelogenous leukaemia and cytomegalovirus pneumonia. High resolution CT at the level of the middle lobe shows diffuse ground-glass attenuationand a large irregular nodule at periphe