肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)培訓(xùn)課件

肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)WorldInfectionassociatedmortality1997/2002(21,000)(282,000)(285,000)(81,000)(745,000)(1,124,000)(2,866,000)(2,001,000)(1,644,000)(3,871,000)WHOTheworldhealthreport2002data(140,000)(275,000)(410,000)(605,000)(960,000)(2,100,000)(2,300,000)(2,455,000)(2,910,000)(3,745,000)200219972肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)CommunityAcquiredPneumoniaEpidemiology:4-5millioncasesannually~500,000hospitalizations~45,000deathsMortality2-30%<1%forthosenotrequiringhospitalizationfewestcasesin18-24yrgroupprobablyhighestincidencein<5and>65yrsmortalitydisproportionatelyhighin>65yrsBartlett.CID1998;26:811-38.3肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)CommunityAcquiredPneumoniaAdeelA.Butt,MD#in1000sIncidence4肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)CommunityAcquiredPneumoniaAdeelA.Butt,MD#in1000sMortality5肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)RiskFactorsforpneumoniaagealcoholismsmokingasthmaimmunosuppressioninstitutionalizationCOPDPVDdementiaCommunityAcquiredPneumoniaIDClinics1998;12:723.AmJMed1994;96:3136肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)何謂肺炎？肺炎的診斷依據(jù)？肺炎的定義為何？肺炎是否一定會(huì)發(fā)燒？不發(fā)燒是否就一定不會(huì)是肺炎？肺炎的治療？7肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)呼吸疾病病程與癥狀變化CraigC.Freudenrich,Ph.D.病毒感染呼吸道細(xì)胞被感染的細(xì)胞死亡杯狀細(xì)胞分泌黏液干擾素與細(xì)胞酵素引起發(fā)炎死亡的上皮細(xì)胞(病毒)發(fā)炎細(xì)胞分泌的黏液鼻咽喉移生的細(xì)菌增殖A.NasalcavityB.PharynxC.LarynxD.TracheaE.AlveoliF.BronchialtreeG.Diaphragm吸引發(fā)炎細(xì)胞聚集發(fā)燒、喉痛、噴涕發(fā)燒、流鼻水傳染期痰中耳炎鼻竇炎支氣管炎菌血癥病毒血癥肺炎膿胸8肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)社區(qū)性肺炎的病原微生物典型肺炎(細(xì)菌)S.pneumoniaeH.influenzaeS.aureusGNBOthers非典型肺炎Legionellaspp.M.pneumoniaeC.pneumoniae病毒性吸入性肺炎無(wú)病原診斷北美1967-95英國(guó)胸腔學(xué)會(huì)19871966-9520~30%20~60%3~10%3~5%3~10%3~5%10~20%2~8%1~6%4~6%2~15%6~10%30~60%60~75%4~5%1~5%RareNDNA2~5%5~18%NA8~16%NDNA65%12%2%1%3%12%4%7%1%3%NDND9肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)常見呼吸道病原之感染季節(jié)789101112123456副流感病毒流行性感冒病毒A&BQfever鏈球菌GAS肺炎球菌Sp退伍軍人肺炎桿菌Lp嗜血桿菌Hi月份霉?jié){菌Mp/披衣菌Cp腺病毒冠狀病毒原發(fā)性肺炎次發(fā)性肺炎伺機(jī)性肺炎CMV,PCP,Fungus10肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)肺炎的診斷臨床診斷肺炎的依據(jù)臨床癥狀理學(xué)檢查CXR檢查一般檢驗(yàn):ABGCBC/DCCRP肺炎的病因診斷？培養(yǎng)細(xì)菌染色:快速抗原:血清抗體:分子生物:PCR11肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)典型肺炎與非典型肺炎比較表典型肺炎(大葉型肺炎)非典型肺炎(間質(zhì)浸潤(rùn)型肺炎)常見癥狀發(fā)燒畏寒咳嗽帶痰胸痛發(fā)燒但較少胸痛及畏寒乾咳上呼吸道感染癥狀頭痛肌肉痛臨床檢驗(yàn)白血球上升通常可在痰中找到致病菌胸部Ⅹ光呈大葉型肺炎白血球微幅上升痰中通常找不到致病菌胸部Ⅹ光呈間質(zhì)性浸潤(rùn)常見病原體肺炎雙球菌嗜血桿菌克雷氏菌部分厭氧菌及革蘭氏陰性菌肺霉?jié){菌退伍軍人癥濾過(guò)性病毒等12肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)霉?jié){菌肺炎(Mp)流行病學(xué)(Seattle,1963-75)SeattleUS1963-75Incidence/1,000/yearDefinition:1.Mptiter>1:322.Mptiter4xrise3.Mpisolated13肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)高雄地區(qū)披衣菌肺炎(Cp)血清流行病學(xué)年齡%N=9726213121717384223781085Wang1993MIFIgG>1:1673.4%14肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)臨床診斷病因診斷培養(yǎng)染色:Gram,AFS快速抗原:血清抗體:分子生物:PCR肺炎的診斷流行病學(xué)信息臨床癥狀理學(xué)檢查CXR一般檢驗(yàn)季節(jié)性地域性接觸史傳染源與傳播力潛伏期痰(采集方式)咽喉拭子肋膜液血液尿液肺炎治療經(jīng)驗(yàn)治療專一性治療檢驗(yàn)方法適當(dāng)?shù)臋z體與采集輔助治療15肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)肺炎的病因診斷方式？顯微鏡抗原偵測(cè)抗體

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-血清微生物培養(yǎng)分子生物學(xué)檢體種類適合微生物痰氣管鏡抽取液胃液痰、氣管抽取液尿液鼻腔液、痰液血液痰氣管鏡抽取液胃液痰、氣管抽取液Sp,Hi,GNB,GPC,Tb,FungusSp,Hi,GNB,GPC,Tb,fungusTbVirus(Adv,Flu,PIF,RSV,SARSLegionellaLegionella,virus-specificMp,Cp,Ct,Legionella,Cb,Flu,Adv,CXB1-6,Mp,Bacteria,Legionella,TbMp,Bacteria,Legionella,TbTbAnyextrinsicpathogens16肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)臨床診斷與抗生素的使用OPDantibioticsprescription,dataofCDC17肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)肺炎的治療單一抗生素治療支持性治療強(qiáng)化性抗生素治療散彈槍抗生素治療預(yù)防性抗生素治療?臨床診斷病因診斷肺炎治療經(jīng)驗(yàn)治療專一性治療輔助治療單一抗生素治療化痰劑蒸氣物理治療肺炎治療臨床診斷18肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)臺(tái)灣地區(qū)主要的呼吸道致病菌抗藥性HsuehPR.AntimicroAgentsChemother200020肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)肺炎治療觀念與方法社區(qū)性支氣管肺炎或肺炎病毒性肺炎外因性肺炎病毒感染并發(fā)細(xì)菌性性肺炎院內(nèi)感染性肺炎低抵抗力肺炎>癥狀治療>體液補(bǔ)充>預(yù)防性抗生素?>癥狀治療>體液補(bǔ)充>處理并發(fā)癥>選擇治療性抗生素典型肺炎:S.pneumoniaeH.influenzaeOthers非典型肺炎:M.pneumoniaeC.pneumoniaeLegionellaspp.EnvironmentalS.pneumoniaeH.influenzaeLegionellaspp.EnterobacteriaeAdenovirusInfluenzaParainflu.RSVChickenpox%%%21肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)常見呼吸道疾病的抗微生物制劑選擇PenicillinAmoxicillinAmoxi/Clavu-Ampi-/Sulbact-TetracyclineErythromycinAzithromycinCefotaximeCefuroximeTrimeth-/Sulfa-Levofloxacin肺炎球菌嗜血桿菌厭氧菌GNB霉?jié){菌匹衣菌Legionella+++++++++-+/-++++++++-++++++++-+++++++++++++++++++++++++++-+-++++++++-+/-+++++++----+++++++++---+++----++++++++--+++++----+++++++++---+++Invitro22肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)PneumococcalDiseaseandPneumococcalVaccinesEpidemiologyandPreventionofVaccine-PreventableDiseasesRevisedDecember200423肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)StreptococcuspneumoniaeGram-positivebacteria90knownserotypesPolysaccharidecapsuleimportantvirulencefactorType-specificantibodyisprotective24肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)PneumococcalPneumonia

ClinicalFeaturesAbruptonsetFeverShakingchillsProductivecoughPleuriticchestpainDyspnea,tachypnea,hypoxia25肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)PneumococcalPneumoniaEstimated175,000hospitalizedcasesperyearUpto36%ofadultcommunity-acquiredpneumoniaand50%ofhospital-acquiredpneumoniaCommonbacterialcomplicationofinfluenzaandmeaslesCase-fatalityrate5%-7%,higherinelderly26肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)PneumococcalDiseaseEpidemiologyReservoir Humancarriers

Transmission Respiratory AutoinoculationTemporalpattern Winterearlyspring

Communicability Unknown Probablyaslongas

organisminrespiratory

secretions 27肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)InvasivePneumococcalDiseaseIncidencebyAgeGroup1998*Rateper100,000populationSource:ActiveBacterialCoreSurveillance/EIPNetwork28肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)InvasivePneumococcalDiseasebyAgeandYearChildren<5Years,1998-2002*<1yr2yrs3yrs4yrs1yr*2003dataarepreliminary.Source:ActiveBacterialCoreSurveillance/EIPNetworkAgegroup29肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)PneumococcalPolysaccharideVaccinePurifiedcapsularpolysaccharideantigenfrom23typesofpneumococcusAccountfor88%ofbacteremicpneumococcaldiseaseCross-reactwithtypescausingadditional8%ofdiseaseNoteffectiveinchildren<2years60%-70%againstinvasivediseaseLesseffectiveinpreventingpneumococcalpneumonia30肺炎簡(jiǎn)介專業(yè)知識(shí)培訓(xùn)PneumococcalConjugateVaccinePneumococcalpolysaccharideconjugatedtonontoxicdiphtheriatoxin(7serotypes)Vaccineserotypesaccountfor86%ofbacteremiaand83%ofmeningitisamongchildren<6yearsHighlyimmunogenicininfantsandyoungchildren,includingthosewithhigh-risk