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临床医学专业04级八年制《内科学》教案姓名胡必杰业务职称教授聘任授课职位授课教授授课题目肺炎pneumonia学时数2授课班级2004级八年制班授课日期2007年9月一、教学目的（掌握、熟悉、了解的具体内容）ObjectivesTounderstandthedefinition,classification(mainlycommunity-acquiredpneumoniaandhospital-acquiredpneumonia),commonetiologicalpathogens,pathology,clinicalmanifestation,X-rayandCTimaging,clinicalandetiologicaldiagnosis,antimicrobialtherapyandpreventionofpneumonia.ContentsRequestedpoints:1.Definitionandclassificationsofpneumonia:includingcommunity-acquiredpneumonia(CAP)andhospital-acquiredpneumonia(HAP)ornosocomialpneumonia(NP),typicalandatypicalpneumonia,immune-compromisedhostpneumonia,ventilatorassociatedpneumonia(VAP).2.CommonetiologicagentsofCAPandHAP3.Clinicalmanifestation,X-rayandCTimaging4.Mainpointsforclinicaldiagnosis,differentialdiagnosis,methodsforetiologicaldiagnosis5.PrincipalofantimicrobialtherapyUnderstand:1.Pathogenesis,focusonpossibleroutesofCAP2.PathogensofatypicalPneumonia3.Criteriaforseverecommunityacquiredpneumonia4.Mainpointsofetiologicpathogensandantibioticchoicefor6CAPgroups(I,II,IIIa,IIIb,IVa,IVb)5.MainitemsforpreventionofHAP二、执行方案：(一)内容及时间分配1．Epidemiologyanddefinitionofpneumonia5min2．Classifications&Terminology6min3．Pathogenesis,pathophysiologyandpathology6min4．EpidemiologyandpathogensofCAP8min5．ManifestationandGeneralLabExaminationsofCAP10min6．ClinicalandmicrobiologicaldiagnosisofCAP10min7．TreatmentofCAP10min8．ProphylaxisforCAP2min8．EpidemiologyandpathogensofHAP8min9．PathogenesisandriskfactorsofHAP5min10．EtiologicalpathogensofHAP7min11．DiagnosisanddifferentialdiagnosisofHAP5min12．AntibiotictreatmentandpreventofHAP8min(二)重点和难点1．Classificationsofpneumonia2．CharacteristicsofCAPandHAP3．Microbiologicaldiagnosisofpneumonia4．Mainpointsofetiologicpathogensandantibioticchoice5．Possibleroutesformicroorganismsfromoutsidetothelung(三)中文和英文关键词社区获得性肺炎CommunityAcquiredPneumonia医院内肺炎NosocomialPneumoniaORHospitalAcquiredPneumonia呼吸机相关肺炎VentilatorAssociatedPneumionia大叶性肺炎Lobar(segmental)Pneumonia节段性肺炎segmentalPneumonia小叶性（支气管肺炎）lobular（bronchopneumonia)Pneumonia间质性肺炎InterstitialPneumonia非典型肺炎AtypicalPneumonia免疫功能受损宿主肺炎Immune-compromisedHostPneumonia(ICHP)细菌，病毒，真菌，寄生虫Bacterial,viral,fungal,parasitic肺炎链球菌Streptococcuspneumoniae青霉素不敏感肺炎链球菌Penicillin-NonsensitiveStreptococcusPneumoniae流感嗜血杆菌Haemophilusinfluenza甲氧西林敏感金黄色葡萄球菌methicillin-sensitivestaphylococcusaureus,MSSA甲氧西林耐药金黄色葡萄球菌methicillin-resistancestaphylococcusaureus,MRSA肺炎克雷伯杆菌KlebsiellaPneumoniae大肠埃希杆菌Escherichiacoli肠杆菌属,变形杆菌,沙雷菌Enterobacter,Proteus,Serratia铜绿假单胞菌Psuedomonasaeroginosa不动杆菌Acinetobacter厌氧菌Anaerobicbacteria肺炎衣原体ChlamydiaPneumoniae分枝杆菌Mycobacterium肺炎链球菌肺炎PneumococcalPneumonia金葡菌肺炎StaphylococcalPneumonia克雷伯杆菌肺炎KlebsiellaPneumonia支原体肺炎MycoplasmaPneumonia军团菌肺炎LegionellaPneumonia肺孢子菌肺炎Pneumocystispneumonia（PCP）经气管穿刺吸引Transtrachealaspiration（TTA）气管内吸引Endotrachealaspiration（ETA）防污染双套管毛刷Protectedspecimenbrush（PSB）支气管肺泡灌洗Bronchialalveolarlavage（BAL）经胸壁肺穿刺吸引Lungaspiration（LA）细胞学筛查Cytologicalscreening抗菌药物AntimicrobialAgents青霉素GpenicillinG,苯唑西林Oxicillin阿莫西林/克拉维酸Augmentin,氨苄西林/舒巴坦ampicillin/sulbactam头孢菌素（头孢唑啉，头孢呋辛，头孢曲松）cephalosporins大环内酯类（红霉素,阿奇霉素，克拉霉素）Macrolide（erythromycin,Azithromycin,Clarithromycin）氨基糖苷类（阿米卡星）Aminoglycoside（amikacin）四环素（强力霉素）Tetracycline（Doxycycline）克林霉素clindamycin氟喹诺酮类（左氧沙星、莫西沙星、加替沙星）Fluroquinolone(levofloxacin,moxifloxacin,gatifloxacin)碳青霉烯类carbepenem万古霉素Vancomycin(四)复习和思维题（请用英文出两道选择题，一道简答题。）1.WhichoneismostsuitablechoicefortreatingpneumoniacausedbyMRSAamongthefollowingantimicrobialagents?A．OxicillinB．Ampicillin/sulbactamC．1stcepholasporinsD．3rdcepholasporinsE．Vancomycin2.WhichdescriptionaboutPneumococcalpneumoniaiswrong?A．generallyoccurssporadicallybutmostfrequentlyinwinterB．themostcommonidentifiablecauseofbacterialpneumoniaC．accountsfor2/3ofbacteremicCAPD．mostcommonlyinpersonsatageextremesE．almostnohealthypersonsarecarriersofpneumococci3.Describethemainmethodsthatmightbeusedformicrobiologicaldiagnosisofpneumonia.三、参考书及文献目录1．Harrison’sPrincipleofinternalmedicine.-16thEd.(2005)2．《实用内科学》陈灏珠主编，人民卫生出版社2005，第12版