Pneumonia is caused byBacteria、VirusesOr other microorganismspulmonary infectionThis kind of infection mainly infringesAlveoliBacterial and viral pneumonia are the most common.In addition to infection with pathogens, it may also be caused by physical and chemical factors, immune damage, allergy and drugs.A total of 15.5%~38.2% of pneumonia patients have a high mortality rate.The high incidence population includes children under 2 years old, the elderly over 65 years old, people with poor living conditions, people with bad habits such as smoking, drinking, fatigue, and low immunity (suffering from immune deficiency diseases, taking immunosuppressants), long-term bedriddenrespirator, and people with chronic respiratory diseases are also susceptible to pneumonia.
The clinical symptoms of pneumonia include fever, cough, dyspnea, etc. Some cases will show persistent high fever and cough.Viral pneumonia can pass a short distanceDroplet transmissionIt has certain characteristics of group aggregation.Common diagnostic methods include medical history combined with imaging examination, assessment of disease severity and identification of pathogenic microorganisms through body fluid samples.
The treatment of pneumonia is mainly divided into anti infection treatment and prevention of complications. Common drugs include cough medicinesAntipyretic analgesicsandantibioticEtc.Patients with acute and severe pneumonia may need to be evaluated for cachexia status and treated accordingly.
TCM disease name
pneumonia
Visiting department
Respiratory Department, Infection Department, Emergency Department
Multiple population
Children under 2 years old and the elderly over 65 years old, people with poor living conditions, people with bad habits such as smoking, drinking, fatigue, people with low immunity or long-term bed rest, people who use ventilators or have chronic respiratory diseases
Pneumonia is caused by the pathogen invading the lung parenchyma and overgrowing in the lung parenchyma beyond the host's defense ability, resulting in exudates in the alveolar cavity, causing pneumonia.The occurrence and severity of pneumonia are mainly determined by the balance between pathogen factors and host factors.
Pathogenesis
Pathogens generally invade human respiratory tract through air inhalation, blood transmission, and spread of nearby infected parts.The normal respiratory immune defense mechanism is to keep the respiratory tract below the tracheal carina sterile. After the pathogen arrives in the lower respiratory tract, it will breed, causing alveolar capillary congestionedemaFibrin exudation and cell infiltration in the alveoli.The most common cause of pneumonia isBacteriaandViruses。
Outbreak in Wuhan at the end of 2019COVID-19It is an acute infectious pneumonia, and its pathogen is a new coronavirus that has not been found in humans before, namely2019 new coronavirus。
Predisposing factors
Age
Pneumonia can affect anyone, but the two age groups with the highest risk are children aged 2 and below and people aged 65 and above.
Other risk factors
smoking
Smoking can damage the lung's natural defense against bacteria and viruses.
Air turbidity
People with crowded indoor living, poor ventilation, dirty air or long-term exposure to dust.
Impaired immune function
For example, when AIDS patients or the defense mechanism has obstacles, the susceptibility to respiratory infection will be greatly increased.
Hospitalization
Patients in hospital intensive care unit, especially usingrespirator% of patients have a higher risk of pneumonia.
symptom
Announce
edit
The signs and symptoms of pneumonia vary from mild to severe, depending on factors such as the type of bacteria causing the infection, age and overall health.Mild signs and symptoms are usually similar to colds or flu but last longer.
a precursor
Pneumonia actually has no real omen, but some cases can induce pneumonia, so it is of certain significance to guard against the occurrence of pneumonia.
Some pneumonia can progress from upper respiratory tract infection, so there is often a history of upper respiratory tract infection before pneumonia;
Before the onset of pneumonia, patients are likely to have experienced events that lead to decreased immunity or respiratory resistance, such as taking immunosuppressive drugs, getting cold, drinking too much, etc;
If it is caused by infectious pathogenic microorganisms, the patient may have been in a crowded, unventilated environment or contacted with infectious disease patients;
In addition, stay in bed and useInvasive ventilator(endotracheal intubation/tracheotomy), food aspiration, drowning and other events are also prone to pneumonia.
early symptom
Cough is generally the earliest symptom of pneumonia. Depending on the pathogen, it can be manifested as dry cough, and then gradually cough, or cough and expectoration begin.
Fever, general pain, fatigue, anorexia and other general symptoms are also early symptoms of pneumonia. Due to different pathogens and the impact of treatment, heat has great uncertainty.
Typical symptoms
The common symptoms of pneumonia include cough, expectoration, sometimes thick sputum or blood sputum, accompanied by shortness of breath, dyspnea and other symptoms.Infants under 2 years old have an acute onset of disease, and they have symptoms of upper respiratory tract infection a few days before the onset, mainly as follows:fever、cough、Shortness of breath, lung fixed rale, etc.
The specific symptoms are as follows:
Poor spirit: loss of appetite, mental depression, irritability, lethargy;
Fever: most patients have irregular fever, and the temperature of severely infected persons or infants can be normal or lower than normal;
Shortness of breath: most of them appear after coughing and fever, and patients with large lesions may have dyspnea and respiratory distress;
Cough and expectoration: cough frequently, which may be irritating dry cough in the early stage and expectoration in the later stage.
The nature of expectoration caused by different pathogens is different.
The patient coughs rusty sputum.Infants may experience high fever, shortness of breath, nasal agitationCyanosis, chest pain and other symptoms.Those who are serious may become delirious.
The patient coughed a lot of purulent sputum, occasionally with bloodshot.Infantile patients may be accompanied by various types of rashes, such as urticaria or scarlatina like rashes.
The patient coughed brick red jelly like sputum.Infants have respiratory tract infection symptoms for several days, and systemic poisoning symptoms are obvious, including fever, mental depression, lethargy, dyspnea, pale face, cyanosis of lips, and even shock.
Most of the patients with viral pneumonia are seasonal, and some of them have group onset. The symptoms are cough, less sputum, and occasionally white sticky sputum, which can lead to hemoptysis. Infants are prone to moderate symptoms of digestive tract and nervous system, such as diarrhea, vomiting, coma, lethargy, convulsion, etc.
Most of the patients are children or young people, and the elderly are rare, mainly with dry cough, with little or no sputum.Infants have an acute onset, a long course of disease, and a serious condition, which are characterized by dyspnea, wheezing, and stridor.
Accompanying symptoms
Acid base imbalance and electrolyte disorder
Severe hypoxia, together with high fever and reduced food intake, can cause acid-base balance disorder, hyponatremia, hypokalemia, etc. to varying degrees, which are manifested by accelerated respiration, fatigue, oliguria, lethargy, etc.
Nervous system disorder
Severe hypoxia and acid-base imbalance can cause cerebral vasodilation, which will increase intracranial pressure and formCerebral edema, manifested as irritability, lethargy, coma, etc.
Gastrointestinal dysfunction
Hypoxemia and toxins secreted by pathogenic bacteria can cause gastrointestinal mucosal erosion, bleeding, diarrhea, vomiting, and gastrointestinal bleeding in patients taking glucocorticoid.
Cardiovascular system disorder
Concurrentmyocarditis、pericarditisCongenital heart disease patients are prone to heart failure, which is more common in infants. It is characterized by high heart rate, low heart sound, and distension of jugular vein in quiet state.
Medical treatment
Announce
edit
In case of dyspnea, chest pain, persistent fever (body temperature>39 ℃ or higher), and persistent cough, you should go to the hospital in time, especially for the elderly over 65 years old, children under 2 years old, people with potential health conditions or weakened immune system, you should go to the hospital as soon as possible.
The severity of pneumonia needs comprehensive assessment.The simplest evaluation criteria: select CURB-65 score for adults.C refers to the state of consciousness, U refers to the urea nitrogen level in the biochemical examination, R refers to the respiratory rate, B refers to the blood pressure, and 65 refers to whether the patient is older than 65 years.
Diagnostic basis
Pneumonia diagnosis includes the following aspects:
Through medical history and imaging examination, such as chest X-ray film and CT, it is clear that there are lung diseases, and it is excludedTuberculosis、tumour、embolism、pulmonary edema、AtelectasisAnd other diseases.
To assess the severity, the criteria for severe pneumonia are as follows:
Main criteria: invasive mechanical ventilation is required;There is septic shock, which requires vasoactive drug treatment.
Secondary criteria: respiratory rate ≥ 30 times/minute;Oxygenation index ≤ 250;Multilobed lung involvement;Presence of awareness/orientation barriers;There is azotemia;The number of white blood cells is lower than the normal level;Platelets below normal level;Body temperature is lower than normal;Low blood pressure requires fluid resuscitation.
Those who meet one main criterion or more than three sub criteria can be diagnosed as severe pneumonia.
The sputum, alveolar lavage fluid, lung biopsy, blood, pleural fluid and other samples were smeared and cultured to find the pathogenic microorganisms causing pneumonia.
To sum up the above three conclusions, the diagnosis of pneumonia can be made clear.
Visiting department
Respiratory Department, Infection Department, Emergency Department, Pediatrics Department, Severe Medicine Department, etc.
Relevant inspection
The doctor will first ask the patient's medical history and perform physical examination, including listening to the lungs with a stethoscope to check whether there is abnormal blistering or crackling. If pneumonia is suspected, further examination is required.
routine blood test
Patients with bacterial pneumonia may have increased leukocyte count, neutrophil count and proportion.The degree of leukocytosis is an important indicator of the severity of inflammation, which decreases rapidly after effective treatment.Blood routine examination is an important indicator to determine the severity of pneumonia and the effectiveness of treatment.
C-reactive protein and procalcitonin
Serum C-reactive protein (CRP) and procalcitonin (PCT) increased significantly in bacterial infection, but not significantly in non bacterial infection.CRP and PCT are important indicators to distinguish bacterial infection and non bacterial infection, and also key indicators to judge whether treatment is effective.
Oxygenation assessment and arterial blood gas analysis
For elderly patients with pneumonia, basic diseases, especially those with chronic heart and lung diseases and rapid respiratory rate, peripheral blood oxygen saturation should be checked. If necessary, arterial blood gas analysis should be performed to understand the status of oxygenation and acid-base balance.
Sputum smear, sputum culture and drug sensitivity test
Sputum was reserved for pathogen identification, and sensitive antibiotics were selected according to drug sensitivity test.
Imaging examination
Pulmonary computed tomography (CT) or chest X-ray can identify the location and severity of pneumonia, observe whether the treatment is effective, monitor the degree of recovery, and can also be used for the differential diagnosis of other lung diseases.
China is a country with a high burden of tuberculosis. The main symptoms of tuberculosis are low afternoon heat, night sweats, fatigue, weight loss, insomnia and other symptoms. Women may have irregular menstruation or amenorrhea.
Imaging examination showed that the lesions were mostly located in the lung apex or supra clavicle, and could spread in cavities or lungs.Mycobacterium tuberculosis in sputum can be diagnosed.
It mostly occurs in people who have a long and heavy smoking history, and the symptoms are cough, expectoration, hemoptysis, weight loss, etc.
Imaging examination showed that lung cancer or repeated pneumonia occurred at the same site. Pathological examination found that tumor cells could be diagnosed as lung cancer.
It mostly occurs in people with risk factors of venous thrombosis, such as thrombophlebitis, cardio pulmonary diseases, trauma, surgery and tumor.The symptoms are cough, expectoration, hemoptysis, and dyspnea.
The imaging examination found that the regional pulmonary vascular markings were reduced, and sometimes wedge-shaped shadows could be seen, with the tip pointing to the pulmonary hilum.
treatment
Announce
edit
The treatment of pneumonia includes anti infection treatment and prevention of complications.People with community-acquired pneumonia can usually receive medical treatment at home. Although cough, expectoration, fever and other symptoms are mostly relieved in a few days or weeks, fatigue and tiredness can last for a month or more.
The specific treatment depends on the type of pathogen, the severity of pneumonia, etc. The commonly used drugs include cough medicines, antipyretic analgesics, and antibiotics.
Acute and severe treatment
When the inflammation of lung tissue develops to a certain stage, it can become severe pneumonia, which may lead to organ dysfunction and even endanger life.Both community acquired pneumonia and hospital acquired pneumonia can cause severe pneumonia.
custody
Severe pneumonia patients may soon be arranged to ICU for treatment and comprehensive monitoring of the changes in the body condition.
Oxygen therapy and assisted breathing
Patients with severe pneumonia should breathe oxygen through nasal catheter or mask to maintain blood oxygen saturation of 94%~98%. If patients with severe pneumonia are complicated with acute respiratory distress syndrome and cannot be improved by conventional mechanical ventilation, they can use extracorporeal membrane oxygenation (artificial lung).
drainage
The bedridden patients should turn over and pat their backs regularly to avoid choking, coughing and aspiration, and help discharge respiratory secretions.
medication
antibiotic therapy
Patients with severe pneumonia should be given appropriate empirical antimicrobial treatment immediately.
Glucocorticoid
For patients with septic shock, short-term use of small and medium dosesGlucocorticoidIt can reduce the mortality rate. The commonly used drug is hydrocortisone succinate, which is generally used for no more than 7 days. The drug should be stopped immediately after shock correction.Application of glucocorticoid may causehyperglycemiaRecurrence of latent tuberculosis.
Glucocorticoid is not recommended for severe pneumonia patients without septic shock.
Gamma globulin
Some studies have shown that intravenous injectionGamma globulinIt can assist in the treatment of severe pneumonia patients and improve the prognosis of pneumonia.
Symptomatic support treatment
Including nutritional support, respiratory support, electrolyte balance, etc., these measures will affect the prognosis of patients.
General treatment
When the patient is diagnosed with pneumonia, antibiotic treatment should first be carried out according to the pathogen, and the earlier treatment, the better prognosis.After the condition is stable, the intravenous use of antibiotics can be changed to oral treatment, and the course of antibiotics is 7-10 days or longer.
It takes 72 hours to evaluate whether pneumonia has improved: body temperature ≤ 37.8 ℃;Heart rate ≤ 100 times/minute;Respiratory frequency ≤ 24 times/minute;Systolic blood pressure ≥ 90mmHg;Oxygen saturation ≥ 90% (or arterial oxygen partial pressure ≥ 60mmHg, under the condition of air suction).
If the above criteria are met, it indicates that the treatment is effective and can be discharged for oral medication;If there is no improvement, we need to continue to find the cause of disease and adjust treatment.In addition, it shall also:
Pay attention to rest, avoid getting cold and tired, and reduce sports and outdoor activities;
Patients with basic diseases such as hypertension and diabetes should pay close attention to the changes of blood pressure and blood sugar;
Oxygen inhalation is required when there is hypoxia, such as restlessness and arterial partial pressure of oxygen is reduced;
Regularly recheck blood routine examination and imaging examination, and observe the change of condition.
medication
Anti infection treatment
Patients with community-acquired pneumonia are usually treated with oral antibiotics outside the hospitalPenicillins、Macrolides、cephalosporinorQuinolonesDrugs, such as amoxicillin, amoxicillin and clavulanic acid.
The inpatients should use antibiotics early and choose appropriate antibiotics according to the pathogens.
Different drugs need to be selected according to the type of virus.Influenza virus can use oseltamivir, and cytomegalovirus can be usedGanciclovirWhen combined with bacterial infection, appropriate antibiotics can be selected according to the type of infected bacteria.
Symptomatic treatment
Oxygen therapy and respiratory support
Patients with hypoxemia and hypercapnia need to breathe oxygen through catheters or masks to adjust the oxygen concentration and maintain blood oxygen saturation.
Treatment of cough and expectoration
For patients with dry cough, antitussive drugs such as licorice tablets can be used as appropriate;If there is excessive sputum or purulent sputum, expectorants can be given, such as ambroxol, or airway atomization can be used to promote sputum excretion.Arrhythmias may occur in some patients when using such drugs, and may occur in a few patientsUrticariaGastrointestinal discomfort.
Heat treatment
For patients with fever, physical cooling or antipyretic drugs such as ibuprofen, loxoprofen can be used.But antipyretic drugs can cause patients to sweat a lot and increase the risk of gastrointestinal bleeding.
surgical treatment
The disease generally does not require surgical treatment.
Nutrition support treatment is very important for the recovery of pneumonia patients.Pneumonia patients have decreased appetite and can eat light food. If they cannot eat due to severe pneumonia, they can be given nasal feeding of gastrointestinal nutrition emulsion.
prognosis
Announce
edit
In most cases, pneumonia prognosis does not leave scars, and the structure and function of the lung can return to normal, but pneumonia caused by Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, and fungi may lead to necrosis of lung tissue and formation of cavities.
In addition, elderly patients with a long history of heavy smoking, chronic heart and lung diseases, and low protein history usually have a long hospital stay and poor prognosis.
Curative
The vast majority of pneumonia caused by infection can be cured by anti infection treatment. Pneumonia caused by non infectious factors can also be cured after the cause is removed.
harmfulness
Pneumonia has strong respiratory system and systemic symptoms, which seriously affects the life, work and personal image of patients;
Pneumonia caused by some pathogens can be infectious, such as various types of coronavirus and Legionella, which can cause adverse social impact;
Pneumonia mostly occurs in people with weak constitution, and often causes acute exacerbation of common chronic diseases such as the old people's original respiratory and circulatory systems. It is a common cause of indirect/direct death for elderly patients with chronic diseases, and those who have been in bed for a long time.
It is because the bacteria invade the lungs and produce purulent exudate, which forms suppurative infection and leads to empyema.The main manifestations are high fever, increased dyspnea, and decreased breath sounds.The treatment methods mainly include anti infection treatment, closed thoracic drainage, etc.
Pyothorax
It is due to the rupture of the abscess at the edge of the lung and the communication with the alveoli or bronchioles, resulting in pyothorax.The main manifestations are sudden aggravation of dyspnea, severe cough, restlessness, decreased or disappeared breath sounds.The main treatment methods are anti infection treatment, closed thoracic drainage, etc.
As the alveolar structure is damaged, the alveoli expand and rupture to form pulmonary bullae.Small size may cause no symptoms, while large size may cause dyspnea.No treatment is needed for asymptomatic patients, and drainage is needed for symptomatic patients.
