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RespiratorySystemnose(nas/o
ORrhin/o)larynx(laryn/o)Lungs(pneumon/oORpulmo
)bronchus(bronch/o)diaphragm(diaphragm/o)mediastinum(一)pandectOrgans目前一頁\總數(shù)五十七頁\編于十五點(diǎn)2
FunctionsBreathingprocessExchangeofOxygenandCarbonDioxideEnablespeechproductionoxygencarbon
dioxideAlveolar/0-HyperpneaCyanosis02co2RespiratorySystem(一)pandect目前二頁\總數(shù)五十七頁\編于十五點(diǎn)3
TheinfluencingfactorsofrespiratorydiseasesRespiratorySystem(一)pandect
AirpollutionandsmokingInhaledallergensThevariationofetiologyandDrugresistanceincreases
目前三頁\總數(shù)五十七頁\編于十五點(diǎn)
SignsandsymptomsCoughLaryngitis/bronchitis/bronchialasthma/chronicobstructivepulmonarydisease(COPD)/lungcancerExpectoration吐痰
Lungabscess/bronchiectasis/pneumoniaHemoptysis咯血
pulmonaryTuberculosisDyspnea
Pneumothorax氣胸/pleuraleffusion/leftheartfailureStethalgia胸痛
hemothorax/PulmonarythromboembolismRespiratorySystem(一)pandect目前四頁\總數(shù)五十七頁\編于十五點(diǎn)
LabandotherinspectionBloodtestsantigenskintest
phlegm
examinationpleuraleffusionthoracicopunctureradioexamination
RespiratorySystem(一)pandectbronchoscopyThoracoscopelungobiopsysupersonicinspectionrespiratoryfunctiontestPulmometry
目前五頁\總數(shù)五十七頁\編于十五點(diǎn)DefinitionPneumoniaisanacuteinfectionoftheparenchyma[p?'re?k?m?]ofthelung,肺炎是肺實(shí)質(zhì)的急性感染
,(lower-respiratorytract)下呼吸道causedbymicroorganism[ma?kr??'?:g?n?z?m]
由微生物引起,comeswithfever,focalchestsymptoms,shadowingonCXR(chestX-ray胸部x線檢查).伴隨發(fā)熱,局灶性胸部癥狀,胸片陰影。RespiratorySystem目前六頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18Defensemechanism[di'fens'mek?niz?m]oftherespiratorytract(呼吸道防御機(jī)制)
Filtration[fil'trei?n]anddeposition['dep?'z??n]
濾除及沉積(nasalfunction鼻功能)pathogens['p?θ?d??ns]intheupperairways上呼吸道病原體Coughreflex咳嗽反射Mucociliary[mju:k??'s?l??r?]clearance黏液纖毛清除macrophages['m?kr?fe?d?]巨噬細(xì)胞Humoral['hju:m?r?l]andcellular['selj?l?(r)]immunity體液及細(xì)胞的免疫Oxidative['?ks?de?t?v]metabolism[m??t?b?l?z?m]ofthe
neutrophils中性粒細(xì)胞的氧化代謝RespiratorySystem(二)、Pneumoniaingeneral目前七頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18
鼻炎咽炎耳炎扁桃體炎喉炎細(xì)支氣管炎R(shí)espiratorySystemSinus/-itis['sa?n?'sa?t?s]鼻竇炎Pharyng/-itis[.f?r?n'd?a?t?s]咽炎Laryng/-itis[l?r?n'd?a?t?s]喉炎Bronch/-itis[br??'ka?t?s]支氣管炎目前八頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18rootmeaningexamplePneum(o)-Lung,airpneumothorax[nju:m?'θ?:r?ks]氣胸pneumonia肺炎pneumatic[nu:'m?t?k]充氣的pneumocystis[n'ju?m?s?st?s]肺囊蟲pneumonectomy[nju:m?'nekt?m?]肺切除術(shù)pneumonrrhagia[nju:m?'rei:d???]肺出血pneumograph['nju:m?grɑ:f]呼吸描計(jì)議pneumocyte[nju:m?'s?t]肺細(xì)胞pneumatocele['nju:m?t??si:l]肺膨出Pulmo(o)-Pulmonary['p?lm?n?ri]肺的,肺病的Path(o)-pathologyPathobiology[p?θ?ba?'?l?d??]病理學(xué)Pathogen[‘p?θ?d??n]病原體Pathogenesis[p?θ?‘d?en?s?s]發(fā)病機(jī)理pathologist[p?’θ?l?d??st]病理學(xué)家Muc(o)-SlimeMucoid['mju:k??d]粘液樣的mucociliary[mju:k??'s?l??r?]黏液纖毛的mucositis[m'ju:k?sa?t?s]黏膜炎Myx(o)-Myxoma[m?ks'??m?]粘液瘤myxobacteria[m?ks?b?k't??r??]黏細(xì)菌myxiod粘液樣的Bronch(o)-bronchiBronchogenic[br?nk?d'?en?k]支氣管原的bronchoscopy[b'r?nt??sk?p?]支氣管鏡檢查術(shù)bronchitis[br??’ka?t?s]支氣管炎bronchospasm['br??k?sp?z?m]支氣管痙攣Bronchoconstriction[br?nt'???k?nstr?k?n]支氣管狹窄目前九頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18rootmeaningexampledys-有病的、不正常的、有障礙的dyspnea(呼吸困難)[d?s'pni:?]
、dyscrasia(惡病質(zhì))[d?s'kre?zj?]
、dysentry(痢疾)['d?sntr?]
、dysplasia(發(fā)育異常)[d?s'ple???]
pnea呼吸eupnea(呼吸正常)[ju:p'ni:?]
、tachypnea(呼吸急促)[t?k?p'ni:?]
hyper-超出、在······之上、高于、過度hyperadenosis(腺增大)[ha?p?r?d?'n??s?s]
、hyperaemia(充血)[ha?p?'ri:m??]
、hyperinsulinism(胰島素分泌過多)[ha?p?'?ns?l?n?z?m]
、hyperpiesia(血壓過高)[ha?p?(:)pa?'?zj?]
、hyperthyroid(甲狀腺功能亢進(jìn))[ha?p?'θa?r??d]
hypo-在······下、次于、不足hypothermia(低體溫)[ha?p?‘θ?:mi?]
、hypoglottis(舌下部)[ha?p?'gl?t?s]
、hypoacidity(胃)酸過少[h?p???'s?d?t?]
、hypocalcemia(低血鈣)[ha?p??k?l'si:m??]
、hypoglycemia(低血糖)[ha?p??gla?'si:m??]
RespiratorySystem目前十頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18Etiology病因Therearetwofactorsinvolvedintheformationofpneumonia,參與肺炎形成的兩個(gè)因素,includingpathogensandhostdefenses.包括病原體和宿主防御RespiratorySystem目前十一頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18Causativeorganisms致病微生物Bacteria細(xì)菌Mycobacteria分枝桿菌Chlamydiae衣原體Mycoplasma支原體Fungi真菌Parasites寄生蟲Viruses病毒rootmeaningexamplegerm-病菌germicide殺菌劑[’d??:m?sa?d]
bacteri-細(xì)菌bacteriology細(xì)菌學(xué)bacteriemia菌血癥[b?kt?'r??mj?]bactericide殺菌劑[b?k't??r?sa?d]
bacill-桿菌bacillemia桿菌血癥[b?s?'li:m??]
-coccus球菌diplococcus雙球菌[d?pl??'k?k?s]
、gonococcus淋球菌['g?n??'k?k?s]
strept-鏈streptococcus鏈球菌屬[strept?'k?k?s]
staphyl-葡萄staphylococcus葡萄球菌屬[st?f?l?'k?k?s]
、staphyloma葡萄腫[st?f?'l??m?]
monil-念珠菌moniliasis念珠菌病[m?n?'la??s?s]
fung-真菌fungoid似真菌的,狀的[f??g??d]
、fungicide殺真菌劑[f?ng?sa?d]
myc-霉菌mycoology霉菌學(xué),真菌學(xué)antimycotic抗真菌的目前十二頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18Classification分類Classificationofanatomy按解剖分類Classificationofpathogen按病原體分類Classificationofacquiredenvironment按患病環(huán)境分類RespiratorySystem目前十三頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18Classificationbyanatomy按解剖分類
Lobar大葉性
:Involvementofanentirelobe
一個(gè)完整的葉的參與Lobular小葉性
:Involvementofpartsofthelobeonly,segmentalorofalveolicontiguoustobronchi(bronchopneumonia支氣管肺炎).
只有部分的肺葉,節(jié)段性支氣管或相連的肺泡受累;Interstitial間質(zhì)性[?nt?’st??l]
:Involvementoftheinterstitialtissueofthelungs肺間質(zhì)組織參與
RespiratorySystem目前十四頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18Classificationbypathogen按病原體分類Pneumococcalpneumonia[,nju?m?'k?k?l]肺炎球菌肺炎Staphylococcalpneumoniast?f?l??'k?k?l]
葡萄球菌肺炎Mycoplasmalpneumonia肺炎支原體肺炎Chlamydiapneumonia[kl?’midi?]
肺炎衣原體肺炎Viralpneumonia病毒性肺炎Pulmonarycandidiasis{k?nd?'da??s?s]
肺念珠菌病Pulmonaryaspergillosis[?sp?d?i‘l?usis]
肺曲霉菌病klebsiellapneumonia[klebzi’el?]
克雷伯桿菌肺炎legionairesdisease[li:d??'ne?]
軍團(tuán)菌肺炎R(shí)espiratorySystem目前十五頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18Classificationsbyacquiredenvironment
按患病環(huán)境分類
Community-acquiredpneumonia:社區(qū)獲得性肺炎:。
Occurincommunitywithin48hour.在社區(qū)48小時(shí)內(nèi)發(fā)生
S.pneumoniaisthemostcommonCAPinpeopleolderthan60.Mostcommonduringwinterandspring.
60歲以上的老人中最常見肺炎鏈球菌肺炎,常發(fā)生在冬季和春季。
Hospital-acquiredpneumonia:醫(yī)院獲得性肺炎
CertainillnessmaypredisposeHAPbecauseof:Impaireddefensesorchronicillness;Coma昏迷,malnutrition營養(yǎng)不良,prolonghospitalization住院時(shí)間延長;Numerousintervention介入asendotrachealintubation
某些疾病導(dǎo)致醫(yī)院獲得性肺炎:受損的防御或慢性疾??;昏迷,營養(yǎng)不良住院時(shí)間延長;氣管插管等較多的介入治療。目前十六頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18Symptoms CoughDyspnea呼吸困難[d?s'pni:?]
Pleuritic肋膜炎的[pl??'r?t?k]
chestpain胸痛Feverorhypothermia發(fā)熱或低體溫Myalgias肌痛[ma?'?ld??]
Chills/Sweats發(fā)冷/出汗Fatigue疲勞[f?ti:ɡ]
HeadacheDiarrhea腹泄sinusitis鼻竇炎[sa?n?‘sa?t?s]
expectoration咳痰RespiratorySystem目前十七頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18全身怕冷濕冷發(fā)青痰痰短氣胸膜炎的[pl??'r?t?k]
胸痛咳血[h?'m?pt?s?s]
疲勞[f?'ti:ɡ]
食欲差情緒波動(dòng)血管的[v?skj?l?(r)]
惡心[n?:zi?]嘔吐
關(guān)節(jié)痛目前十八頁\總數(shù)五十七頁\編于十五點(diǎn)Pneumococcalpneumonia
肺炎鏈球菌肺炎ThepneumoniathatiscausedbyStreptococcuspneumoniaenearlyhalfofcommunity-acquiredpneumonia(CAP)由肺炎鏈球菌引起的肺炎近一半是社區(qū)獲得性肺炎.
Thediseaseonsetisacute起病急andcanbeserious,accompanied伴有byhighfever,chills寒戰(zhàn),cough,bloodysputum痰中帶血andchestpain.RespiratorySystem目前十九頁\總數(shù)五十七頁\編于十五點(diǎn)Thepathologicalchange病理變化isdividedintofourperiods,分為四個(gè)時(shí)期,i.e.congestivestage充血期,redhepatization紅色肝樣變,grayhepatization灰色肝樣變andresolution消散期.
121,dilatation擴(kuò)張[da?l?‘te??n]andcongestion充血[k?n’d?est??n]ofthecapillaries毛細(xì)血管['k?p?l?r?z]
2,
thefibrinous纖維蛋白[‘fa?br?n?s]exudate滲出物['eks?de?t]
RespiratorySystem目前二十頁\總數(shù)五十七頁\編于十五點(diǎn)Thisisnotedclinicallyasoedema水腫[?‘di:m?]andcongestion充血inlung,
alveolarexudate肺泡滲出,hematid['hem?t?d]infiltration紅細(xì)胞浸潤,leukocyte['lu:k?sa?t]infiltration白細(xì)胞浸潤.Thenthebacterium細(xì)菌willbeeliminated消除throughleukocyticphagocytosis白細(xì)胞吞噬作用.Atlast,thefibrousprotein纖維蛋白isbrokendownandabsorbed,thealveolarinflatesagain肺泡重新充氣.這是臨床表現(xiàn)為肺水腫和肺充血,肺泡滲出,紅細(xì)胞浸潤,白細(xì)胞浸潤。然后細(xì)菌通過白細(xì)胞吞噬作用將被淘汰消除。最后,纖維蛋白分解和吸收,肺泡重新充氣。RespiratorySystem目前二十一頁\總數(shù)五十七頁\編于十五點(diǎn)Infact,earlytreatmentbyusingantibacterial抗菌的drugcausehepatization肝樣變inpathologicalstagedoesnothavepreciselimits.Wehadrarelyseenthistypicalpathologicalstageinclinical.事實(shí)上,通過使用抗菌藥物引起肝病理階段早期治療沒有確切的界限。我們很少看到這種典型的臨床病理分期。RespiratorySystem目前二十二頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18Etiologyandpathogenesis
organismS.pneumoniaeDynamicbalance
目前二十三頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18S.pneumoniaeasthegram-positivebacillus,capsule,itsvirulencesizerelatedtothestructureandcontentofcapsularpolysaccharide,indryphlegmcansurviveformonths,butdirectsunlightfor1hour,heat52degrees10mincanbekilled.RespiratorySystem目前二十四頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18EtiologyandpathogenesisThebodykeepsadynamicequilbriumbetweentheorganismandS.pneumoniaeaswellastheinternalandexternalenvairoment,undernormalconditions,S.pneumoniaesentinthehunmanoralcavityandnasopharynx,theyarecalled“normalflora”.
RespiratorySystem目前二十五頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18EtiologyandpathogenesisthepathogenicityofS.pneumoniaeisduetothecapsuleinvadetheorganization,firstofall,causetohydropsofalveolarwalls,leukopedesis,overspreadingthelungsegmentandpulmonarylobe.RespiratorySystem目前二十六頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18Etiologyandpathogenesiswhenthebodyresistanceistooweakforthebodytoadapttoclimaticchange,whenS.pneumoniaeareexcessive,Whenthedynamicequilbriumisdamagedandcannotrestoredimmediately,S.pneumoniaewillbecomepathogenicfactorandleadtotheoccuranceofdisease.RespiratorySystem目前二十七頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18Streptococcuspneumoniaehigh-riskgroups:Smokers,dementia,ChronicBronchitis,bronchiectasis,cardiacfailure,chronicdisease,immunosuppressantsusers,theelderly,infantsandyoungchildren目前二十八頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18LaboratoryExaminations實(shí)驗(yàn)室檢查WBC(whitebloodcell)白細(xì)胞PaO2(動(dòng)脈血氧分壓Arterial動(dòng)脈的[ɑ:‘t??r??l]Partial部分的PressureofOxygen)PaCO2(肺泡二氧化碳分壓Alveolar肺泡的PartialPressureofCarbonDioxide)目前二十九頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/181.TheWBC:(10~30)x109/L,neutrophils中性粒細(xì)胞>80%;TheWBCcanbenormal,butneutrophilsmustbeincreased.2.TheBacteriologicalexamination細(xì)菌學(xué)檢查:directsmear直接涂片,
usesputumculture,
痰涂片
culturewithbloodorpleuraleffusion
血液或胸腔積液培養(yǎng).目前三十頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/183.Bloodgasanalysis血?dú)夥治?PaO2canbedecreased,PaCO2canbenormalordecreased,metabolicacidosis代謝性酸中毒[met?’b?lik‘?sid?usis]
.目前三十一頁\總數(shù)五十七頁\編于十五點(diǎn)Whatarepneumoniasymptomsandsigns?Initiallyhavesymptomsofacold(upperrespiratoryinfection,forexample,sneezing,sorethroat,cough),whicharethenfollowedbyahighfever(sometimesashighas104F),shakingchills,andacoughwithsputumproduction.Thesputumisusuallydiscoloredandsometimesbloody,shortnessofbreath.Theindividual’sskincolormaychangeandbecomedustyorpurplish(aconditionknownas“cyanosis”)duetotheirblood.目前三十二頁\總數(shù)五十七頁\編于十五點(diǎn)SymptomsThispainisusuallysharpandworsenwhentakingadeepbreathandisknownaspleuriticpainorpleurisy.Aworseningcough,headaches,andmuscleachesmaybetheonlysymptoms.Childrenandbabieswhodeveloppneumoniaoftendonothaveanyspecificsignsofachestinfectionbutdevelopafever,appearquiteill,andcanbecomelethargic.目前三十三頁\總數(shù)五十七頁\編于十五點(diǎn)Complications
Seriousandpotentiallylethal·Pleuraleffusionandempyema·Infectiveshock·Toxicmyocarditis·ARDS(AcuteRespiratoryDistressSyndrome)·Organizedpneumonia·Pleuritis·Meningocephalitis
目前三十四頁\總數(shù)五十七頁\編于十五點(diǎn)Howispneumoniadiagnosed?Coarsebreathingorcrackingsoundswithastethoscope.Wheezingorthesoundsofbreathingmaybefaintinaparticularareaofthechest.AchestX-rayisusuallyorderedtoconfirmthediagnosisofpneumonia.Thelungshavelobes,usuallytwoontheleftandthreeontheright.Whenthepneumoniaaffectsoneoftheselobes,itisoftenreferredtoaslobarpneumonia.目前三十五頁\總數(shù)五十七頁\編于十五點(diǎn)SputumSamplesSputumSamplescanbecollectedandexaminedunderthemicroscope.Pneumoniacausedbybacteriaorfungicanbedetectedbythisexamination.Aswehaveusedantibioticsinabroaderuncontrolledfashion,moreorganismsarebecomingresistanttothecommonlyusedantibiotics.Thesetypesofculturescanhelpindirectingmoreappropriatetherapy.目前三十六頁\總數(shù)五十七頁\編于十五點(diǎn)AbloodtestThatmeasureswhitebloodcellcount.Anindividual’swhitebloodcellcountcanoftengiveahintastotheseverityofthepneumoniaandwhetheritiscausedbybacteriaoravirus.Anincreasednumberofneutrophils,onetypeofWBC,isseeninmostbacterialinfections.Whereasanincreaseinlymphocytes,anothertypeofWBC,isseeninviralinfections,fungalinfections,andsomebacterialinfections.目前三十七頁\總數(shù)五十七頁\編于十五點(diǎn)HematologylaboratoryCompletebloodcount(CBC)Redbloodcellcount(RBC)Hemoglobin(Hgb)Hematocrit(Hct)Whitebloodcellcount(WBC)NeutrophilslymphocytesMonocytesPlateletcount,prothrombintimePartialthromboplastintimebloodglucose目前三十八頁\總數(shù)五十七頁\編于十五點(diǎn)BronchoscopyBronchoscopyisaprocedureinwhichathin,flexible,lightedviewingtubeisinsertedintothenoseormouthafteralocalanestheticisadministered.Usingthisdevice,thedoctorcandirectlyexaminethebreathingpassages(tracheaandbronchi).Simultaneously,samplesofsputumortissuefromtheinfectedpartofthelungcanbeobtained.目前三十九頁\總數(shù)五十七頁\編于十五點(diǎn)FluidcollectsSometimes,fluidcollectsinthepleuralspacearoundthelungasaresultoftheinflammationfrompneumonia.Thisfluidiscalledapleuraleffusion.Ifasignificantamountoffluiddevelops,itcanberemoved.Afternumbingtheskinwithlocalanestheticaneedleisinsertedintothechestcavityandfluidcanbewithdrawnandexaminedunderthemicroscope.Thisprocedureiscalledathoracentesis.目前四十頁\總數(shù)五十七頁\編于十五點(diǎn)Diagnosis1·PrecedinghistoryofcommoncoldorotherURI;2.Symptoms:abruptonset,
highfever,coughwitharustysputum,chestpain,dyspneaandcoughetc;3.Signs:remarkablemoistrale;
4.Bloodtest:leukocytosis;5.Radiologicstudy:Lobarconsolidation;6.Adefinitivediagnosisrequiresdemonstrationofpneumoniainsputumculture,blood,lungtissue.
Upperrespiratoryinfection目前四十一頁\總數(shù)五十七頁\編于十五點(diǎn)DiffuseinterstitialpneumoniaLobarpneumonia目前四十二頁\總數(shù)五十七頁\編于十五點(diǎn)Criteriaofseverepneumonia1.Respiratoryrate>30/min;2.Bloodpressure<90/60mmHg;3.Bloodgas:PaO2<60mmHg,
PaO2/FiO2
<300mmHg;4.BUN>7.1mmol/L(30mg/DL);5.X-ray:twolobesareinvolved;NeedforvasopressorsRenalFailure目前四十三頁\總數(shù)五十七頁\編于十五點(diǎn)Caseouspneumonia(lungtuberculosis)DifferentialdiagnosisApicallocationInsidiousonsetwithlowerfever,nightsweats,F(xiàn)atigueandweightlossNotrespondtoantibioticsSputumsmearfortuberclebacilli(+)目前四十四頁\總數(shù)五十七頁\編于十五點(diǎn)DifferentialdiagnosisLungabscessCopiouspurulentfoul-smellingsputum目前四十五頁\總數(shù)五十七頁\編于十五點(diǎn)DifferentialdiagnosisObstructivepneumoniasuperimposedhilarshadowrecurrentpneumoniaatthesamesitehappendedinpatientsover40,whichdoesnotrespondwelltotheantibiotictreatmentfiberopticbronchoscopy目前四十六頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18TreatmentAntiinfectioustherapySupportivetherapyTherapyofcomplications目前四十七頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18
TreatmentThemoreseriouspneumonia,requiresantibioticssuchaspenicillin.目前四十八頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18TreatmentAllpatientswithsuspectedpneumococcalpneumoniashouldbetreatedaspromptlyaspossiblewithpenicillinGThedoseandrouteofdeliverymayhavetobeonthebasisofpatientsstatus/adverserea-ctionorcomplicationthatoccur目前四十九頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18TreatmentForpatientswhoarebelievedtobeallergictopenicillin(青霉素),onemayselectthefirstorsecondgenerationcephalosporin(頭孢菌素)oradvancedmacrolide(大環(huán)內(nèi)酯物)+β
-lactam(β-內(nèi)酰胺)orrespiratoryfluoroquinolone(氟喹諾酮)alone.目前五十頁\總數(shù)五十七頁\編于十五點(diǎn)2023/5/18TreatmentInsomecases,vancomycinmaybeused.Treatmentwithanyeffectiveag
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