Lobar pneumonia
Introduction
Introduction to lobar pneumonia Lobarpneumonia is mainly caused by Streptococcus pneumoniae. The lesion involves a lung tissue above the lung segment, and acute inflammation is mainly caused by diffuse cellulose exudation in the alveoli. The lesion begins in the local alveoli and spreads rapidly to a segment of the lung or to the entire lobules. Clinically, the onset is rapid, often starting with high fever and aversion to cold, followed by chest pain, cough, cough and rust, difficulty breathing, and signs of lung consolidation and increased white blood cell count in peripheral blood. The course of the disease lasted about a week, the body temperature plummeted and the symptoms disappeared. The disease mostly occurs in young men. Common causes of illness are cold, tired or rain. basic knowledge The proportion of sickness: 0.4% Susceptible people: Most occur in young adults. Mode of infection: non-infectious Complications: toxic shock syndrome sepsis lung abscess empyema
Cause
Causes of lobar pneumonia
Infection factor (20%):
A variety of bacteria can cause lobar pneumonia, but the vast majority are Streptococcus pneumoniae. Streptococcus pneumoniae is a Gram-positive cocci, with a capsule, and its pathogenicity is due to the invasion of the capsule of the polymer polysaccharide to the tissue. A few are Klebsiella, Staphylococcus aureus, Streptococcus hemolyticus, Haemophilus influenzae, and the like.
Reduced immunity (30%):
When the body suffers from cold, excessive fatigue, drunkenness, cold, diabetes, and low immune function, the respiratory defense function is weakened. The bacteria invade the alveoli through the allergic reaction, and the capillary permeability of the alveolar wall is enhanced, and the slurry and cellulose are exuded. The bacteria in the protein exudate rapidly multiply and spread to adjacent lung tissue through the alveolar hole or respiratory bronchi, affecting a segment of the lung or the entire lobe. The exudate of the spreading bacterium of the large leaves is caused by the dissemination of the leaf bronchus.
Body factor (10%):
Large lobar pneumonia lesions begin in the local alveoli and spread rapidly to a segment of the lung or the entire lobules. Clinically, the onset is rapid, the course of disease is about one week, often starting with high fever and aversion to cold, followed by chest pain, cough, cough and rust, difficulty breathing, and signs of lung consolidation and increased white blood cell count in peripheral blood.
Prevention
Prevention of lobar pneumonia
1, pay attention to prevent upper respiratory tract infections, strengthen cold-resistant exercise.
2, to avoid rain and cold, drunk, overwork and other incentives.
3, active treatment of primary disease, such as chronic heart and lung disease, chronic hepatitis, diabetes and oral diseases, can prevent lobar pneumonia.
Complication
Lobular pneumonia complications Complications toxic shock syndrome sepsis lung abscess empyema
1, toxic shock
Is the most serious complication of lobar pneumonia, more common in the elderly and infirm, bacterial toxins into the blood, so that the peripheral microcirculation vasodilation, blood pressure decreased, causing toxic shock, if not rescued in time, can cause death.
2, sepsis
When the body's resistance is extremely low or the pathogenic bacteria are too toxic, a large number of bacteria enter the bloodstream to cause sepsis, sometimes complicated by purulent meningitis, septic arthritis and acute bacterial endocarditis.
3, lung meat quality change
If the neutrophils infiltrating into the alveolar space are too small or too much cellulose, the exuded cellulose can not be completely dissolved and absorbed, and then it is replaced by granulation tissue to become mechanized, so that the diseased part of the lung tissue becomes brown meat-like fibrous tissue. , said the lung meat quality change, X-ray examination in the diseased lung leaves left a permanent irregular point flaky shadow.
4, lung abscess and empyema
The affected lung tissue is necrotic and liquefied to form a lung abscess. When the pleural lesion is severe, it can develop into fibrotic suppurative pleurisy or even empyema.
Symptom
Symptoms of lobar pneumonia Common symptoms Fever high fever chest pain cough rust color acute face cold war wet voice sounds weakened
1, rapid onset, chills, high fever, chest pain, cough, cough, rust, phlegm, a wide range of lesions may be associated with shortness of breath and purpura.
2, some cases have nausea, vomiting, abdominal distension, diarrhea.
3, severe cases may have neuropsychiatric symptoms, such as irritability, convulsions, etc., can also occur around the ring failure, and septic shock, called shock (or toxic) pneumonia.
4, acute illness, shortness of breath, nose flapping.
5, early lung signs are not obvious or only breath sound reduction and pleural friction sound, the consolidation period may have typical signs, such as weakened respiratory movements on the affected side, increased vocal fibrillation, percussion dullness, auscultation of respiratory sounds, wet rales or Pathological bronchial breath sounds.
Examine
Inspection of lobar pneumonia
1, the total number of white blood cells increased, neutrophils reached more than 0.80, the nuclear left shift, there are poisoning particles.
2. A large number of Gram-positive cocci were observed in the sputum smear.
3, , blood culture has pneumococcal growth.
4, serological test positive (cooperative agglutination test, convective immunoelectrophoresis detection of pneumococcal capsular polysaccharide antigen).
5, chest X-ray examination shows that the segment or leaf uniformity of the large sheet density increased shadow.
6, blood gas analysis and PaCO2 decreased, the original chronic obstructive pulmonary disease patients PaCO2 can rise.
Diagnosis
Diagnosis and diagnosis of lobar pneumonia
1, the disease occurs in young men and winter and spring and spring.
2. There are many incentives before the onset of illness. About half of the cases have prodromal performance such as upper respiratory virus infection.
3, sudden onset of chills, high fever.
4, cough, chest pain, shortness of breath, rust color sputum, severe patients can be accompanied by shock.
5, lung consolidation signs, severe patients often drop blood pressure below 10.5/6.5KPa (80/50mmHg).
6, the total number of white blood cells increased, neutrophils reached more than 0.80, the nuclear left shift, there are poisoning particles.
7. A large number of Gram-positive cocci are visible in the sputum smear.
8. Hey, blood culture has pneumococcal growth.
9, serological test positive (cooperative agglutination test, convective immunoelectrophoresis detection of pneumococcal capsular polysaccharide antigen).
10. Chest X-ray examination showed that the segmental or leafy uniformity of the large patch density increased the shadow.
11. Blood gas analysis showed a decrease in PaO2 and PaCO2, and PaCO2 in patients with chronic obstructive pulmonary disease increased.
Differential diagnosis:
1, cheese pneumonia has a history of tuberculosis, slow onset, white blood cell count is normal, tuberculosis can be found in the sputum, X-ray examination of the lungs may have a cavity.
2. The secondary infection of lung cancer is older, the onset is slow, the symptoms of poisoning are not obvious, and there may be blood in the sputum, X-ray examination and fiberoptic bronchoscopy or assisted diagnosis.
3, acute lung abscess often a large number of purulent sputum, X-ray examination has a fluid plane cavity formation, can be identified.
