社区获得性肺炎（非 COVID-19）
COVID-19 大流行
在大流行期间，对于存在咳嗽、发热或任何其他提示性症状的患者，除非证实为其他疾病，否则应考虑 COVID-19。
- 本专题并未涵盖 COVID-19 引发的肺炎。请参阅2019 冠状病毒病专题。
英国国家卫生与临床优化研究所（National Institute for Health and Care Excellence, NICE）发布了一项有关 COVID-19 大流行期间疑似或确诊 CAP 患者的管理的快速指南。1 NICE 暂时撤回了其先前针对成人肺炎诊断和管理的 COVID-19 指南。2
参考文献
小结
定义
病史和体格检查
关键诊断因素
- 咳嗽伴痰增多
- 呼吸困难
- 胸膜炎性胸痛
- 寒颤或者盗汗
- 发热
- 听诊异常
- 意识模糊
- 危险因素
其他诊断因素
- 肌痛
- 不适感
- 厌食
- 昏睡
- 已有疾病恶化
- 咽痛
- 头痛
- 恶心
- 腹痛
- 腹泻
危险因素
- 年龄＞65 岁
- 居住在医疗照护机构
- 慢性阻塞性肺疾病 (COPD)
- 暴露于香烟烟雾
- 酗酒
- 口腔卫生不佳
- 使用胃酸抑制类药物
- 与儿童接触
- 糖尿病
- 慢性肾病
- 慢性肝病
- 阿片类药物的应用
诊断性检查
首要检查
- 胸部 X 线检查
- 脉搏血氧测量测定法
- 动脉血气 （ABG）
- 尿素和电解质
- 全血细胞计数
- C 反应蛋白 (CRP)
- 肝功能检测
需考虑的检查
- 血培养
- 痰培养（± 革兰染色）
- 针对军团菌和肺炎球菌的尿抗原检测
- 聚合酶链反应（polymerase chain reaction, PCR）和/或血清学检测
- 胸部 CT 扫描
- 胸腔超声
- 胸腔穿刺术和胸水培养
- 计算机断层扫描肺动脉造影（CTPA）
- 支气管镜检查
治疗流程
疑似 CAP：在医院就诊且病情危及生命
疑似 CAP：在医院就诊且病情不危及生命
疑似 CAP：社区就诊患者
通过胸部 X 线检查确诊 CAP：医院就诊患者
通过胸部 X 线检查确诊 CAP：社区就诊患者
撰稿人
专家顾问
Jonathan Bennett, MD
Honorary Professor of Respiratory Sciences
University of Leicester
Respiratory Consultant
Glenfield Hospital
Leicester
UK
简介
JB is Chair of the British Thoracic Society.
利益声明
JB declares that he has no competing interests.
Acknowledgements,
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:
Catia Cilloniz MSc, PhD
Post-doctoral Research
Pneumology Department
Hospital Clinic of Barcelona
CIBERES
IDIBAPS
Barcelona
Spain
Antoni Torres MD, PhD
Professor of Medicine
Director
Pulmonary Intensive Care Unit
Respiratory Institute
Hospital Clinic of Barcelona
Barcelona
Spain
利益声明
CC and AT are each authors of a number of references cited in this topic.
同行评议者
Wei Shen Lim,
Consultant Respiratory Physician and Honorary Professor of Medicine
Nottingham University Hospitals NHS Trust
Nottingham
UK
利益声明
WSL was chairman of the British Thoracic Society community-acquired pneumonia guidelines committee and a member of the guideline development group for the National Institute for Health and Care Excellence pneumonia guidelines. His institution has received unrestricted investigator-initiated research funding from Pfizer for a multicentre study of pneumococcal pneumonia in which he was the chief investigator, and research funding from the National Institute for Health Research for studies in pneumonia in which he was the principal investigator. He is also an author of at least one reference cited in the topic.
编辑
Helena Delgado-Cohen,
Section Editor, BMJ Best Practice
利益声明
HDC declares that she has no competing interests.
Rachel Wheeler,
Lead Section Editor, BMJ Best Practice
利益声明
RW declares that she has no competing interests.
Julie Costello,
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Adam Mitchell,
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
鉴别诊断
- 2019 冠状病毒病（COVID-19）
- 急性支气管炎
- 充血性心力衰竭
更多 鉴别诊断指南
- 成人肺炎：诊断和管理（在 COVID-19 大流行期间停用）
- 社区获得性肺炎：抗菌药的处方
更多 指南医学计算器
CURB-65 肺炎严重程度评分
成人社区获得性肺炎严重程度指数 (pneumonia severity index, PSI)
更多 医学计算器患者教育信息
Pneumonia
Pneumonia: do I need a vaccine?
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