肺炎的诊断治疗.ppt

*重要表现及并发症重要表现气急紫绀病变广泛、ARDS出血点DIC、败血症巩膜黄染败血症低血压休克并发症休克、胸膜炎、脓胸心包炎、脑膜炎和关节炎ClinicalManifestationsinspectionpalpationpercussionAusculation*实验室和其它检查血液检查(血常规、炎性指标、血清学、血培养)痰涂片及痰培养(痰、纤支镜)尿抗原实验经皮细针穿刺细胞学或肺活检影像学**LobarPneumoniaStaphylococcusPneumoniaViralPneumoniaAconed-downviewofthechestdemonstratesfinetomediumheterogeneousreticularopacitiesinbothlowerlobes.ThispatternisthemosttypicalseenwithcytomegalovirusPneumocystisCariniiPneumoniaWithPneumothorax香港SARS病例*细菌性肺炎诊断标准主要标准次要标准胸片：新出现或进展性浸润影发热或体温不升呼吸道症状体征：叩诊浊音、管状呼吸音、罗音白细胞，N%*病情评估年龄、基础病、意识障碍高热或低温、R30,P125,BP90/60mmHgWBC、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/minPaO2＜60mmHg,PaO2/FiO2＜300,需行机械通气动脉收缩压＜90mmHg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＜20ml/h,或＜80ml/4h，或并发急性肾功衰需要透析*aSARSpatient4daysafteronsetofsymptomstwodayslater*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*LUNGCANCER*pulmonaryembolism*ForeignBodyAspiration*Bronchiectasis*LungAbscess*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CAPguidelinesAustralia2000InformationtobeupdatedCanada2000CanadianInfectiousDiseasesSociety/CanadianThoracicSocietyChina1999/2006中华医学会呼吸病学分会France2001FrenchSocietyofInfectiousDiseasesGermany2000GermanRespirAssociation/PaulEhrlichSocietyforChemotherHongKong2001HongKongUniversityandHongKongHospitalAuthorityJapan2001/2005JapanRespirSocietyCAPTreat.GuidelineCreationCommitteeLatinAmerica2002AsociaciónLatinoamericanadelTóraxThePhilippines1998PhilippineSocietyforMicrobiologyandInfectiousDiseasesPortugal2000PortugueseRespiratorySocietySingapore2000PhysiciansAcademyofMedicineofSingaporeSouthAfrica1996SouthAfricanPulmonarySociety/AntibioticStudyGroupSouthAmerica2001ConsenSurSouthAmericanWorkingGroupSpai