小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 发热
- 排痰性咳嗽
- 空洞性（空瓮性）呼吸音
其他诊断因素
- 心脏杂音
- 胸膜炎性胸痛
- 全身性症状
- 恶病质
- 苍白
- 牙龈疾病
- 口臭
- 无咽反射
- 呼吸困难
- 咯血
- 寒颤
- 虚弱
- 关节痛
- 出血性病变
- 吸气性湿啰音
- 支气管呼吸音
- 呼吸音减弱
- 单侧固定干啰音
危险因素
- 容易吸入胃内容物
- 口腔卫生不佳和拔牙
- 支气管阻塞
- 免疫抑制
- 慢性疾病
- 肺外脓毒症
- 肺炎
诊断性检查
首要检查
- 全血细胞计数 (FBC）
- 胸部 X 线检查
- 痰液革兰氏染色
- 痰培养
- 血液培养
- 脓胸液培养
需考虑的检查
- 胸部 CT
- 支气管镜检查
- 防污染毛刷标本定量培养
- 防污染支气管肺泡灌洗标本定量培养
- 经皮针吸和培养
- 痰液细胞学
- 肺部超声
- 超声心动图
- D-二聚体快速酶联免疫吸附测定（enzyme-linked immunosorbent assay, ELISA）
- 胸部多排 CT
- 通气-灌注扫描
治疗流程
革兰阴性或多重耐药微生物可能性低
革兰氏阴性或多重耐药微生物可能性高
革兰阴性或多重耐药微生物可能性低
革兰阴性或多重耐药微生物感染可能性高：有或无青霉素/头孢菌素过敏
撰稿人
作者
Ioannis P. Kioumis, MD, PhD
Professor of Respiratory Medicine and Infectious Diseases
Aristotle University of Thessaloniki
Respiratory Failure Clinic
General Hospital G. Papanikolaou
Thessaloniki
Greece
利益声明
IPK declares that he has no competing interests.
Georgia G. Pitsiou, MD, PhD
Professor of Respiratory Medicine
Aristotle University of Thessaloniki
Respiratory Failure Clinic
General Hospital G. Papanikolaou
Thessaloniki
Greece
利益声明
GGP declares that she has no competing interests.
同行评议者
William G. Cheadle, MD
Professor of Surgery
University of Louisville
Associate Chief of Staff for Research and Development
VAMC Louisville
Louisville
KY
利益声明
WGC declares that he has no competing interests.
Nicholas Maskell, MD
Senior Lecturer and Consultant Physician
North Bristol Lung Centre
Southmead Hospital
Bristol
UK
利益声明
NM declares that he has no competing interests.
Najib Rahman, BM, BCh, MA (Oxon), MRCP (UK)
MRC Training Fellow and Specialist Registrar, Respiratory Medicine
Oxford Centre for Respiratory Medicine
Churchill Hospital
Oxford
UK
利益声明
NR declares that he has no competing interests.
Philip W. Ind, BA (Cantab), MB BChir, MA (Cantab), FRCP
Consultant Physician
Honorary Senior Lecturer
Imperial College Healthcare Trust
Hammersmith Hospital
London
UK
利益声明
PWI declares that he has no competing interests.
鉴别诊断
- 肿瘤（原发性或转移性肺癌、淋巴瘤）
- 结核病
- 坏死性肺炎
更多 鉴别诊断指南
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- 适宜性标准：对感染性积液的放射学管理
更多 指南
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