Traditional Chinese subtitles for clip: File:Pneumonia.webm
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1 00:00:01,839 --> 00:00:09,820 好,那來看看這傢伙,他 的肺看起來不賴,而且他是 2 00:00:09,820 --> 00:00:15,099 個蠻正常的人類,所以每次他呼吸時 他都會吸入一些氧氣,這些氧氣會掉到 3 00:00:15,099 --> 00:00:19,180 這條大的通氣管,叫做氣管 氣管會再分成兩條 4 00:00:19,180 --> 00:00:24,230 分支,叫做支氣管,然後再分下去 到細支氣管,直到最後 5 00:00:24,230 --> 00:00:30,380 分成這些微小的空間,稱作肺泡 看起來就像是一連串的葡萄 6 00:00:30,380 --> 00:00:35,120 這些肺泡們和一些 微血管彼此交織成網,而這時 7 00:00:35,120 --> 00:00:40,640 氧氣就能藉由肺泡擴散 進入微血管,很明顯的 8 00:00:40,640 --> 00:00:44,510 氧氣並非是唯一吸入人體的 物質,對吧?你一直持續的 9 00:00:44,510 --> 00:00:49,950 吸入一大堆東西,不論你 願不願意,像是微生物之類 10 00:00:49,950 --> 00:00:53,770 通常你的身體很快的能驅逐或消滅 這些不受歡迎的訪客 11 00:00:53,770 --> 00:00:59,760 驅逐方法很簡單,比如利用咳嗽來排除 或者讓身體的免疫系統 12 00:00:59,760 --> 00:01:05,850 來殲滅外來微生物。假如微生物非常頑強 仍然進入了人體,或者身體的防禦機能 13 00:01:05,850 --> 00:01:12,289 衰弱,微生物會開始複製並 感染肺部。當某種微生物已經成功的 14 00:01:12,289 --> 00:01:18,270 made your lungs their new home, like your bronchioles or alveoli, you’ve developed 把你的肺——包括細支氣管和肺泡—— 當作它的新家時,你已經得到了 15 00:01:18,270 --> 00:01:23,939 所謂的「肺炎」的疾病,這代表著肺部受到感染。 當這些微生物真的開始 16 00:01:23,939 --> 00:01:29,759 進行複製增生時,你的免疫系統會開始製造 免疫大軍來對付並殲滅這些不速之客,對吧? 17 00:01:29,759 --> 00:01:33,849 so things like white blood cells. These are great and all, because they’re trying to 免疫大軍像是白血球,最適合殲滅微生物的主力 由於白血球試著 18 00:01:33,849 --> 00:01:38,479 help, but what ends up happening is they cause inflammation in these areas where the organisms 要幫忙,會使得感染的區域開始進行發炎反應, 由於這些區域 19 00:01:38,479 --> 00:01:43,609 have set up camp, so they fill with white blood cells AND other things, like proteins, 累積了相當多的外來微生物,發炎的區域會累積許多白血球和 其他物質。像是蛋白質、 20 00:01:43,609 --> 00:01:49,689 fluid, and even red blood cells. These obviously take up valuable space in your airways, right? 體液、以及紅血球. 以上這些物質, 很明顯的 會佔據你的氣管中相當的體積, 對吧? 21 00:01:49,689 --> 00:01:54,039 So now this alveoli might be inflammed and filled with fluid, so when you breath in some 所以當肺泡因發炎而累積許多液體時, 當你吸入 22 00:01:54,039 --> 00:01:59,229 oxygen and it gets to these infected and inflammed airways, it’s gonna have a way harder time 氧氣進到這些受感染的並且正在發炎的氣管中時 氧氣擴散到微血管 23 00:01:59,229 --> 00:02:03,689 diffusing into the blood stream. So because you aren’t getting that oxygen into your 會變得更加困難。所以由於你的身體 比以前更難取得氧氣 24 00:02:03,689 --> 00:02:09,009 blood as easily, one common symptom is this like shortness of breath and this difficulty 到血液中, 一個常見的症狀就是 呼吸短促而且呼吸不順暢 25 00:02:09,009 --> 00:02:14,790 breathing, which is also called dyspnea. Also, like I mentioned, we cough to try and get 也可以稱作"呼吸困難", 而且就像我之前提到的 我們藉由咳嗽將 26 00:02:14,790 --> 00:02:18,959 things out of our lungs, so what do you think happens when we’ve got all this fluid and 這些微生物排除出肺外, 可想而知當 肺部全是積水和 27 00:02:18,959 --> 00:02:23,280 other things built up? Well we’re gonna try to cough it up and make some room for 其他體液時, 身體會更加利用咳嗽的方式 以騰出多餘的空間 28 00:02:23,280 --> 00:02:29,709 oxygen, so another big symptom is coughing. Also, sometimes patients experience chest 以利氧氣的交換, 所以肺炎的另一個症狀是咳嗽 另外, 有些病人也會經歷有 29 00:02:29,709 --> 00:02:35,319 pains, why might that be? Well there are definitely some pain receptors near these airways and 胸痛的情形, 為什麼呢? 因為在氣管和肺泡上 有一些疼痛感覺受器 30 00:02:35,319 --> 00:02:40,400 alveoli, so when they get inflamed, we can totally feel that! And finally, since your 當身體進行發炎反應時, 這些受器可以 "感受"到痛覺!! 而最後, 當 31 00:02:40,400 --> 00:02:44,450 immune system’s working to fight against some microbe, it’s also common to get a 免疫系統活躍運作以對抗細菌的時後, 容易感冒 32 00:02:44,450 --> 00:02:51,430 fever. Ok Ok, so notice that I’ve been pretty general about the culprit, this mysterious 也是很正常的. 好啦! 我知道我講得非常的概括和簡略 那為什麼我會一直以"微生物"來稱呼呢? 33 00:02:51,430 --> 00:02:56,370 microorganism, why so vague? Well, because there isn’t just one kind of microbe that 為什麼這麼的模糊? 因為事實上"不只一種" 微生物能造成 34 00:02:56,370 --> 00:03:01,400 causes pnemonia, it can actually be caused by all sorts of microbes. The most common 肺炎, 而是幾乎每一種微生物都能!! 最常見的有 35 00:03:01,400 --> 00:03:06,349 ones though are bacteria and viruses, but it can also extend to fungi as well and something 我們熟知的細菌和病毒, 但連一種真菌類的微生物 36 00:03:06,349 --> 00:03:12,670 called mycoplasma. Between viruses and Bacteria, though, bacteria wins out and is the most 叫做"黴漿菌"也能引起肺炎. 在細菌以及病毒感染造成肺炎的情形中 細菌感染而引發的 37 00:03:12,670 --> 00:03:18,590 common cause of pneumonia in adults, especially one called streptococcus pneumoniaie, also 成人肺炎占了大多數, 特別是稱為 "肺炎鏈球菌", 也被稱作 38 00:03:18,590 --> 00:03:23,480 sometimes known as pneumococcus, but just remember, it doesn’t necessarily have to 肺炎球菌, 但請記得 它並非是造成肺炎 39 00:03:23,480 --> 00:03:28,969 be caused by this one bacterium, other bacteria that may cause pnemonia are ones like haemophilus 唯一細菌, 其他種類的細菌 例如嗜血桿菌, 40 00:03:28,969 --> 00:03:37,239 influenzae, legionella pneumophila, and staphylococcus aureus. Aside from bacteria, viruses can also 退伍軍人肺炎菌, 以及黃金葡萄球菌皆可造成肺炎 除了細菌, 病毒也能引起肺炎 41 00:03:37,239 --> 00:03:42,349 be a bigtime contributor to pneumonia cases, influenza probably being the most common virus 由病毒引起的肺炎也不在少數 流感病毒大概是最常會造成 42 00:03:42,349 --> 00:03:48,049 that causes it, but it could also be caused by others. Fungi rarely cause pnemonia because 肺炎的病毒, 但也有可能是其他種類的病毒 真菌造成的肺炎案例非常少 43 00:03:48,049 --> 00:03:53,170 most of our immune systems fight them off...but for people with weakened immune systems, like 主要是因為免疫系統很容易殲滅他們 但是對於免疫不全/缺乏的病人 44 00:03:53,170 --> 00:03:59,659 with AIDS or cancer, pnemonia from fungi can become more of an issue. A common fungal culprit 像是愛滋病患以及癌症病患, 真菌造成的肺炎感染 就會是個大問題了. 常見的真菌感染源為 45 00:03:59,659 --> 00:04:05,340 is Pneumocystis jirovecii. Finally, these things called mycoplasma can also cause pnemonia 肺囊蟲. 最後, 黴漿菌在某些情況下 46 00:04:05,340 --> 00:04:10,209 in some cases. Mycoplasmas aren’t technically viruses or bacteria, but actually have traits 也能造成肺炎. 黴漿菌並非病毒也非細菌 但卻兼有以上兩者的表現 47 00:04:10,209 --> 00:04:15,590 in common with both! One important point is that they don’t have a cell wall, so common 最重要的是黴漿菌沒有 細胞壁, 所以有些常用的 48 00:04:15,590 --> 00:04:19,959 antibiotics like pennicillin that work by attacking cell walls, don’t work against 抗生素, 比如盤尼西林, 能攻擊細胞壁. 即無法抑制黴漿菌的生長 49 00:04:19,959 --> 00:04:24,560 these guys! Luckily though, they’re the smallest proportion that affects humans, and 幸運的是, 黴漿菌造成的肺炎只占全部肺炎的一小部分 而且通常 50 00:04:24,560 --> 00:04:31,389 often don’t cause serious complications and can clear up on their own. 不會造成嚴重的副作用 病通常會自行緩解. 51 00:04:31,389 --> 00:04:36,030 So we know that pneumonia is this infection of the lung tissue, and usually that infection’s 所以現在我們知道肺炎的原因是感染 肺部的組織, 而且感染源通常是 52 00:04:36,030 --> 00:04:42,180 caused by some bacteria or virus, but sometimes it’s fungal or caused by mycoplasma. At 細菌和病毒, 但有時候會是 真菌或者是黴漿菌 53 00:04:42,180 --> 00:04:47,610 this point the microbe’s already in the lungs, but how does it get there? Well just 在這種情形下, 這些微生物早已經進入肺中 但它們是怎麼進去的呢? 54 00:04:47,610 --> 00:04:51,720 like there being a ton of microbes that cause infection and pneumonia, there’s also a 恩~ 就像之前許多種造成肺部感染以及肺炎的情形 有許多方式 55 00:04:51,720 --> 00:04:57,110 ton of ways to actually contract these microbes, and we can categorize these. 能概略化這些細細菌的傳播方式 並且詳細分類 56 00:04:57,110 --> 00:05:02,330 K so the first category of pneumonia, and also the most common, is called community 第一種型態的肺炎, 也是 最常見的一種, 被稱作 57 00:05:02,330 --> 00:05:09,080 acquired pneumonia, sometimes just shortened to CAP. We can say that the pneumonia is community 社區型肺炎, 可以縮寫為"CAP" 得到這種肺炎的病患 58 00:05:09,080 --> 00:05:14,500 acquired when it happens outside of a hospital or other healthcare setting. Usually somebody 多半是在其所居住的非醫療場所或非健康照護場所 的地方得到肺炎, 通常 59 00:05:14,500 --> 00:05:19,500 gets this by breathing in microbes that live in your mouth, nose, or throat, and this one 病患藉由吸入居住於身體的其他位置的細菌, 比如 口腔, 鼻腔, 以及喉嚨等部位的細菌而產生肺炎 60 00:05:19,500 --> 00:05:23,050 most often happens in the winter when your immune system is weaker. 這種情況最常發生在冬季, 那時是身體免疫系統 較為脆弱的時刻 61 00:05:23,050 --> 00:05:27,569 But, now guess what we call it when you get pneumonia from a healthcare setting or hospital, 恩~ 那麼猜猜看當你在醫療場所或是健康照護場所 得到肺炎的時候, 我們會怎麼稱呼呢? 62 00:05:27,569 --> 00:05:34,080 yep, we call those healthcare-associated pneumonia and hospital-acquired pneumonia, respectively. 沒錯! 我們稱這種類型的肺炎 相對地叫做院內肺炎 63 00:05:34,080 --> 00:05:39,620 What’s the difference though? Well cases of hospital-acquired pneumonia, or nosocomial 這兩者有什麼不同呢? 案例像是 醫院型肺炎, 或者稱作"院內型肺炎" 64 00:05:39,620 --> 00:05:45,080 pneumonia, include those where patients were already hospitalized for something else, and 包含那些原本 因其他原因而住院的病人 65 00:05:45,080 --> 00:05:48,819 healthcare associated pneumonia just refers to those that are in frequent contact with 以及肺炎狀況相對不嚴重, 且經常出入接觸健康照護 66 00:05:48,819 --> 00:05:53,360 a healthcare setting, but aren’t necessarily hospitalized, so that could be like nursing 設施, 不需要住院而可以住進 看護之家或是 67 00:05:53,360 --> 00:05:59,150 homes or long-term care facilities. These two types tend to be more serious than community 健康照護之家的病人. 這兩種類型 的病人會使單純 68 00:05:59,150 --> 00:06:04,220 acquired pneumonia for a couple reasons. One reason is that the patients often have weakened 其中一個原因是病人的免疫系統已經被 69 00:06:04,220 --> 00:06:09,650 immune systems already, like for hospital-acquired, they’re there because they’re already 嚴重削弱殆盡, 像是院內型肺炎的病人 他們的體力已經 70 00:06:09,650 --> 00:06:13,940 sick right? Now throw a lung infection in there, you can imagine how that might make 夠衰弱了! 對吧? 但現在卻製造 一個肺部感染的情形, 你能想像 71 00:06:13,940 --> 00:06:18,909 things a little more complicated. The second reason is that the microbes in hospitals are 能讓情況多複雜嗎?第二個原因是 因為在醫院裡的微生物密度 72 00:06:18,909 --> 00:06:24,139 usually a more intense than in the ones floatin around in the community. Why’s that? Well, 通常比在開放空間 的社區還要高. 為什麼呢?這是因為 73 00:06:24,139 --> 00:06:29,240 although hospitals do a great job at treating and killing most bad microbes with antibiotics 即便醫院做好了相關消毒以及 用抗生素治療有感染性的微生物 74 00:06:29,240 --> 00:06:35,020 and other medicines, they also sometimes inadvertently become these like breeding grounds for microbes 也會不可避免的“篩選出”那些 對抗生素有抵抗性的微生物的繁殖 75 00:06:35,020 --> 00:06:40,300 that’re actually resistant to antibiotics, like Methicillin-resistant staphylococcus 這些對抗生素有抗性的微生物 比如抗甲氧西林金黃色葡萄球菌 76 00:06:40,300 --> 00:06:45,949 aureus, which maybe you recognize as MRSA. Normal staph can certainly cause pneumonia , 也可簡寫成“MRSA" 一般的葡萄球菌當然也能造成肺炎 77 00:06:45,949 --> 00:06:50,479 and other infections, but you can also kill normal staph using traditional antibiotics 或是其他的感染, 但我們能使用傳統的 抗生素治療來消滅這些細菌 78 00:06:50,479 --> 00:06:56,319 like penicillins. MRSA on the other hand, is like this mutant super staph that isn’t 比如盤尼西林. 但如果是“抗甲氧西林金黃色葡萄球菌” 的話, 他就像是超級無敵的細菌一樣 79 00:06:56,319 --> 00:07:02,189 affected by normal antibiotics, making it a lot harder to treat. Another important and 能抵禦抗生素的攻擊 使肺炎更難治療. 另一件很重要也 80 00:07:02,189 --> 00:07:07,949 more serious type of bacteria is pseudomonas aeruginosa, which also tends to be more resistant 很嚴肅的事情是 , 有一種名叫 " 綠膿桿菌"的細菌, 也越來越有呈現 81 00:07:07,949 --> 00:07:14,710 to traditional antibiotics. Alright and one other type that’s worth mentioning and is 對傳統抗生素有抵抗的趨勢. 好了, 另外一個值得提及並且 82 00:07:14,710 --> 00:07:19,990 along the same lines is called ventilator associated pneumonia. Sick patients often 非常重要的肺炎型態就叫做 「呼吸器相關肺炎」,一般來說重症患者都會 83 00:07:19,990 --> 00:07:25,580 need help breathing, so they’ll be connected to a ventilator. If microbes somehow get in 有呼吸器輔助呼吸。但萬一這些細菌 藉由這種方式 84 00:07:25,580 --> 00:07:31,069 through the tube, they’ll be sucked into the lungs, which can cause infection and pneumonia, 進入呼吸管, 他們會很容易被吸入 肺部, 並且造成感染以及肺炎, 85 00:07:31,069 --> 00:07:35,310 especially for these patients that’re already weak or sick. 這種情形尤其對那些已經很衰弱的病患 特別糟糕 86 00:07:35,310 --> 00:07:40,780 Alright, so besides breathing in some invisible microbe that you can’t even see, are there 好了! 除了藉由吸入 看不見得微生物而 87 00:07:40,780 --> 00:07:45,909 any other ways to get pneumonia? Well, consider this: you’re eating some french fries, instead 得到肺炎, 有沒有其他感染途徑呢? 想想這件事, 你正在吃一些薯條, 但是 88 00:07:45,909 --> 00:07:50,759 of swallowing one, you accidentally breath it in, informally we call that going down 你不小心把它們吸到氣管去了!! 好像進到不該進去的管子對吧? 89 00:07:50,759 --> 00:07:57,090 the wrong pipe right? Also though, we could say that you aspirated that french fry. OK 因為這樣, 我們可以說 你"吸入"了薯條! 90 00:07:57,090 --> 00:08:02,039 now what happens? Well normally you’d automatically gag and start coughing and it’d go flying 接下來會發生什麼事呢? 正常情況下, 你的 身體會自發性的有咽喉反射並開始咳嗽, 而咳出 91 00:08:02,039 --> 00:08:07,669 across the room, maybe not, but it wouldn’t stay in there. What if these gag reflexes 誤入歧途的薯條, 總而言之身體不會讓薯條留在 氣管中! 但萬一這些咽喉反射 92 00:08:07,669 --> 00:08:11,860 were compromised though? Meaning that they just don’t work like they should, which 不管用了呢? 代表著反射機制 已經失去了原本的能力 93 00:08:11,860 --> 00:08:16,669 is actually sometimes the case for patients with brain injury or swallowing issues, or 這種現象在腦創傷的病患中 以及噎到的案例, 或者 94 00:08:16,669 --> 00:08:21,830 even those that’ve abused drugs or alcohol. So bits of it might stick around in your lower 在毒癮或是過度酒精中毒的患者可見到 噎到的食物可能會 95 00:08:21,830 --> 00:08:25,729 airways...and you could imagine that that french fry probably isn’t the most sterile 卡在你的下消化道, 想像一下, 即使薯條不是世界上最骯髒的東西 96 00:08:25,729 --> 00:08:31,189 thing in the world, so it could be carrying some potentially infectious microbes. If that 依然帶有著許多有感染性的 微生物. 假如薯條上的 97 00:08:31,189 --> 00:08:36,720 microbe now infects the lungs and you get pneumonia, we would call this french fry pneumonia, 這些微生物感染了肺部並讓你得到了 肺炎, 我們叫可以稱你得到了"薯條性肺炎" 98 00:08:36,720 --> 00:08:41,670 just kidding, it’d be called aspiration pneumonia. And it doesn’t have to just be 開玩笑地!! 正式名稱是 "吸入型肺炎", 而且不限於噎到的食物喔~ 99 00:08:41,670 --> 00:08:48,360 bits of food though, it could also be drinks or other materials, or even gastric contents, 連飲料或者其他的物體, 甚至 連胃酸這些從胃內湧出的液體 100 00:08:48,360 --> 00:08:51,960 like things from your stomach that’ve come up one tube then gone back down the other 喔, 從胃底湧出經過食道並跑到 氣管裡 !! 101 00:08:51,960 --> 00:08:56,980 tube instead. Which can actually be pretty nasty; because what does your stomach have 聽起來就有點噁!! 對吧 想想你的胃裡有什麼東西? 102 00:08:56,980 --> 00:09:02,910 in it? Stomach or gastric acid. Now think about what might happen if that acid makes 就是胃酸! 現在想想 萬一胃酸 103 00:09:02,910 --> 00:09:09,170 it into your lungs? Nothing good, right? Nope definitely not. If you aspirate some of those 流入肺中會發生什麼事? 一定不是好事, 對吧? 絕對不是好事! 如果你吸入胃酸 104 00:09:09,170 --> 00:09:13,610 gastric contents into your airways you can get a chemical burn, which will initiate your 進入氣管的話, 會造成嚴重的化學灼傷 也會啟動 105 00:09:13,610 --> 00:09:32,310 body’s inflammatory reaction in your lungs. 在肺裡的發炎反應 106 00:09:32,310 --> 00:09:41,330 Finally, a quick an easy type of pneumonia is called atypical pneumonia. Atypical pneumonia 最後, 一個簡單而且快速的形容 叫做"非典型肺炎", 基本上被稱作非典型肺炎 107 00:09:41,330 --> 00:09:46,780 basically just means that it was caused by one of these organisms: chlamydophila pneumoniae, 是因為只有下列幾種感染源:衣原性肺炎 108 00:09:46,780 --> 00:09:53,440 legionella pneumophila, or mycoplasma pneumoniae. This type tends to be less serious than typical 退伍軍人肺炎, 或是黴漿菌肺炎, 以上這些肺炎的感染情形都比典型的 109 00:09:53,440 --> 00:09:58,010 pneumonia, and for that reason is sometimes referred to as “walking pneumonia”, because 肺炎症狀還要輕微, 因為某些原因 有時甚至被戲稱為"走路型肺炎", 因為 110 00:09:58,010 --> 00:10:03,000 sometimes people just go about their daily lives with it. 人們在生活中就和這種型態的肺炎"共存"!! 111 00:10:03,000 --> 00:10:07,400 Alright so by now we know there’s a ton of ways to classify pneumonia…and actually, 好了! 現在我們知道有許多方式 能分類肺炎的型態...而且事實上, 112 00:10:07,400 --> 00:10:12,140 that list keeps going! So another way that we can define a case of pneumonia is by where 這個清單還在一直成長!! 因此另一種方式 區分肺炎的型態是藉由 113 00:10:12,140 --> 00:10:17,710 the infection is. When the infection is super patchy, and maybe it’s only affecting these 感染的位置決定. 當感染位置在 肺上葉 114 00:10:17,710 --> 00:10:24,450 like scattered alveoli, we call that bronchopneumonia, which is defined by these scattered or patchy 115 00:10:24,450 --> 00:10:29,920 areas of consolidation. Consolidation just means the tissue has filled with fluid and 實質化的意思是 代表組織被體液充滿並 116 00:10:29,920 --> 00:10:36,660 has gotten all hard and swollen. These areas also usually have little tiny pockets of pus 變得堅硬和腫脹. 實質化的 區域通常有一些小小的 117 00:10:36,660 --> 00:10:42,120 or white blood cells, also known as microabscesses, since they’re so small you can only see 空間儲存著膿或是白血球, 也被稱作小型膿瘍 因為它們太小了以致於必須 118 00:10:42,120 --> 00:10:48,650 them under microscope. Along with being in various areas of one side, they can also be 使用顯微鏡才能看到. 肺炎的情形下 在肺臟的許多部分都能見到有 119 00:10:48,650 --> 00:10:55,480 bilateral, or on both sides. Usually it happens though in the lower lobes or the right middle 單側的部分感染, 但有時候會是雙側的感染 通常都好發於下肺葉或者是右中肺葉 120 00:10:55,480 --> 00:11:00,580 lobe. Speaking of lobes though, another way though pneumonia can present itself is called 說到肺葉 121 00:11:00,580 --> 00:11:05,920 lobar pneumonia. Where bronchopneumonia was all patchy and scattered, lobar pneumonia 122 00:11:05,920 --> 00:11:11,660 is this almost complete consolidation of a whole lobe of the lung. Pretty much all cases, 123 00:11:11,660 --> 00:11:19,550 around 95%, of this are caused by the bacteria streptococcus pneumoniae. Usually lobar pneumonia 124 00:11:19,550 --> 00:11:25,120 happens in steps or stages, though. The first stage is called congestion, and lasts between 125 00:11:25,120 --> 00:11:30,990 1 and 2 days, this is where the vessels start filling with fluid. The next stage is called 126 00:11:30,990 --> 00:11:37,490 red hepatization, between day 3 and 4, the lobe starts to get reddish brown and firm, 127 00:11:37,490 --> 00:11:43,610 and starts to resemble liver tissue, which is why we call it HEPAT-ization. It’s color 128 00:11:43,610 --> 00:11:48,920 is red because it’s a combination of red blood cells, neutrophils and fibrin, which 129 00:11:48,920 --> 00:11:54,770 we can call an exudate, and this now becomes more solid because this exudate is filling 130 00:11:54,770 --> 00:12:02,730 the air spaces. As the red blood cells break down and degrade, we move into stage 3 around 131 00:12:02,730 --> 00:12:08,110 days 5 to 7, called the gray hepatization stage, where it’s still firm but the color 132 00:12:08,110 --> 00:12:14,010 has changed because the cells begin to break down. Finally, the last stage is called resolution, 133 00:12:14,010 --> 00:12:19,450 and this happens around day 8 and can continue for 3 weeks. In this stage the exudate gets 134 00:12:19,450 --> 00:12:28,040 digested by enzymes and broken up, ingested by macrophages, or coughed up. And those are 135 00:12:28,040 --> 00:12:33,660 major pieces of lobar pneumonia, but there’s still one more, someone could have interstitial 136 00:12:33,660 --> 00:12:38,910 pneumonia, which is also just known as atypical pneumonia which remember is this like walking 137 00:12:38,910 --> 00:12:44,440 pneumonia, and this type’s localized to the tissue around alveoli, and usually there 138 00:12:44,440 --> 00:12:51,190 actually isn’t any exudate or fluid in the alveolar spaces, and so essentially no consolidation, 139 00:12:51,190 --> 00:12:56,350 but there will be some mononuclear infiltrate, like white blood cells that’ve infiltrated 140 00:12:56,350 --> 00:13:02,230 these interstitial spaces. This one, remember, is more rare and symptoms are typically pretty 141 00:13:02,230 --> 00:13:08,800 mild, like low fever and not a lot of mucus, similar to the flu. Since there’s not a 142 00:13:08,800 --> 00:13:13,660 ton of mucus, usually patients will have a nonproductive cough along with chest pains. 143 00:13:13,660 --> 00:13:19,140 Usually, in order to figure out how the pneumonia is characterized as bronchopneumonia, lobar 一般來說, 為了要細分肺炎為 氣管肺炎, 肺葉 144 00:13:19,140 --> 00:13:24,870 pneumonia, or interstitial pneumonia, we’d take a chest radiograph, and this is pretty 肺炎, 或是組織間隙肺炎 我們會建議病人照胸腔X光, 而這是一項 145 00:13:24,870 --> 00:13:29,700 much the gold standard. Here’s an x-ray of someone with lobar pneumonia, see how the 非常標準的黃金準則. 這是一張 有著肺葉肺炎的X光片, 看看 146 00:13:29,700 --> 00:13:35,190 fluid’s localized to the upper right lobe? Here’s one of bronchopneumonia, notice how 液體如何沉積在右上葉的部位 這是另一張有氣管肺炎的X光片, 注意 147 00:13:35,190 --> 00:13:40,220 the infected areas are spread out instead of being localized to a single lobe. And finally 受感染的部位是呈分散狀而非 聚積在單一處的肺葉. 最後 148 00:13:40,220 --> 00:13:44,310 here’s one of atypical or interstitial pneumonia, where you can see that the affected areas 這是一張非典型的組織間隙肺炎 149 00:13:44,310 --> 00:13:51,420 are more reticular because it’s affecting the tissue outside the alveoli. Another way 150 00:13:51,420 --> 00:13:56,760 one might be able to discern lobar pneumonia, where consolidation is a key factor, is by 151 00:13:56,760 --> 00:14:01,670 listening to various signs. For example, a dullness to percussion is often a sign of 152 00:14:01,670 --> 00:14:05,700 consolidation. Also though, you might be able to feel more vibrations from the patient’s 153 00:14:05,700 --> 00:14:11,700 chest or back after they repeat certain phrases, a procedure called tactile vocal fremitus. 154 00:14:11,700 --> 00:14:20,730 This is because the sound waves travel better through the fluid-filled or consolidated tissue. 155 00:14:20,730 --> 00:14:26,320 Late inspiratory crackles may also be heard, along with bronchial breath sounds, bronchophony 156 00:14:26,320 --> 00:14:31,730 and egophony. Finally, you might also use Laboratory findings to figure out if pneumonia 最後, 也能藉由實驗室檢測的發現 來判斷肺炎是否存在 157 00:14:31,730 --> 00:14:36,660 is present. The most useful lab finding is a positive gram stain, which is more useful 最常使用的實驗室發現是 陽性格蘭氏染色, 也更常應用於 158 00:14:36,660 --> 00:14:41,040 than blood cultures, even though cultures are still used and you might look for neutrophilic 血液培養, 159 00:14:41,040 --> 00:14:46,660 leukocytosis, or an abnormally high level of white blood cells in the blood, showing 白血球增多,或者異常增高 的血中白血球數量, 顯示 160 00:14:46,660 --> 00:14:54,050 that the body is likely fighting off infection of some kind. 身體正在與某種感染源進行戰鬥