Treatment
of Lobar Pneumonia I. Introduction Lobar pneumonia is a common pulmonary infectious disease, mainly caused by bacterial infections such as Streptococcus pneumoniae, involving most or the whole lobe of the lung, which can seriously affect the respiratory function and health of patients. Timely and effective treatment is essential to alleviate the symptoms of patients and promote rehabilitation. This article will introduce the treatment of lobar pneumonia in detail, including general treatment, anti-infective treatment, symptomatic treatment and treatment of complications. 2. General treatment 1. Rest and diet • Patients should ensure adequate rest during illness. Rest helps the body to restore physical strength and enhance immunity, so as to better fight the disease. It is generally recommended that patients rest in bed and avoid overwork. • In terms of diet, patients should be given nutritious and easily digestible food. Increasing protein intake, such as lean meat, fish, eggs and beans, helps to maintain the normal metabolism of the body and repair damaged tissues. At the same time, we should ensure adequate vitamin intake and eat more fresh vegetables and fruits to enhance the body’s resistance. In addition, patients should drink more water to keep the respiratory tract moist, which is conducive to the discharge of sputum. 2. Environmental improvement • It is very important to maintain indoor air circulation. Every day, windows should be opened regularly to ventilate and change indoor air to reduce the growth of bacteria and viruses. Appropriate indoor temperature and humidity also contribute to the comfort and recovery of patients. Generally, the indoor temperature is kept at 18-22 C, and the humidity is 50% -60%. 3. Anti-infective treatment 1. Choice of antibiotics • Lobar pneumonia is mainly caused by bacterial infection, of which Streptococcus pneumoniae is the most common, so antibiotic treatment is the key. Penicillin antibiotics, such as penicillin G, are the first choice for young and middle-aged patients with community-acquired lobar pneumonia without underlying disease. If patients are allergic to penicillin, they can choose cephalosporins (such as cefazolin, cefuroxime, etc.), macrolides (such as erythromycin, azithromycin, etc.) Or quinolones (such as levofloxacin, moxifloxacin, etc.). • For the elderly, patients with underlying disease (such as chronic obstructive pulmonary disease, diabetes mellitus, heart disease, etc.), or suspected drug-resistant bacterial infections, appropriate antibiotics should be selected according to the results of pathogenic bacteria culture and drug sensitivity test. Broad-spectrum antibiotics, such as third-generation cephalosporins (such as ceftriaxone, cefotaxime, etc.) combined with macrolides, can be used empirically to cover possible pathogens before the results of drug sensitivity test come out. 2. Course of medication • Generally speaking, the course of antibiotic treatment is usually 7-14 days. However, the specific course of treatment should be determined according to the severity of the patient’s condition, recovery and the type of pathogenic bacteria. In the course of treatment, the patient’s symptoms, signs and laboratory results should be closely observed, such as whether the body temperature returns to normal, whether the white blood cell count drops to the normal range, whether the pulmonary rales disappear, etc., to determine the effect of antibiotic treatment and determine whether the course of treatment needs to be adjusted. 4. Symptomatic treatment 1. Fever treatment • Patients with lobar pneumonia are often accompanied by fever symptoms. Hyperthermia can cause discomfort to patients, and may even affect the function of other organs of the body. When the body temperature is below 38.5 ℃, physical cooling methods can be used, such as wiping the forehead, neck, armpit, groin and other parts of the patient with a wet towel, or using antipyretic paste. • When the body temperature exceeds 38.5 ℃, in addition to physical cooling, antipyretic analgesics, such as acetaminophen and ibuprofen, can be given to lower the body temperature and relieve the patient’s fever symptoms. However, when using these drugs, attention should be paid to observe the reaction of patients to avoid adverse reactions. 2. Cough and expectoration treatment • Cough and expectoration are common symptoms in patients with lobar pneumonia, which is conducive to the discharge of sputum and pathogens from the lungs, but too severe cough can affect the rest and quality of life of patients. For mild cough, no special treatment is generally required, and patients can be encouraged to drink more water to dilute sputum and facilitate coughing. • For patients with severe cough, cough and expectorant drugs, such as ambroxol and ammonium chloride, can be given to relieve cough symptoms and promote sputum discharge. If the patient’s sputum is sticky and not easy to cough up, atomization inhalation can also be used to turn the drug into tiny particles, directly acting on the respiratory tract, making the sputum thinner and easier to cough up. 3. Management of expiratory dyspnoea • Some patients with lobar pneumonia may have symptoms of expiratory dyspnoea, which may be due to pulmonary inflammation leading to pulmonary ventilation and ventilation dysfunction. For patients with mild expiratory dyspnoea, semi-reclining or high pillow position can be adopted to facilitate breathing. • When the expiratory dyspnoea is serious, oxygen therapy should be given in time to improve the patient’s oxygen saturation and alleviate the symptoms of expiratory dyspnoea. If the symptoms do not improve after oxygen inhalation, further respiratory support may be needed, such as non-invasive positive pressure ventilation or invasive positive pressure ventilation. 5. Treatment of complications 1. Treatment of pleural effusion • Patients with lobar pneumonia sometimes have complications of pleural effusion during the development of the disease. A small amount of pleural effusion can be absorbed spontaneously after pneumonia is cured without special treatment. • For more than moderate pleural effusion, it may compress the lungs and affect the respiratory function. At this time, thoracentesis or closed thoracic drainage is needed to discharge the pleural effusion, relieve the compression on the lungs and promote the recovery of respiratory function. 2. Treatment of septic shock • a small number of patients with lobar pneumonia may be complicated by septic shock, which is a very serious complication that can endanger the lives of patients. Once patients are found to have symptoms of septic shock such as decreased blood pressure, accelerated heart rate and clammy skin, anti-shock treatment should be carried out immediately. It includes rapid fluid replacement, correction of water and electrolyte disorders, use of vasoactive drugs (such as dopamine, epinephrine, etc.) To maintain blood pressure, and administration of strong antibiotics to control infection. 6. Rehabilitation and prevention 1. Rehabilitation guidance • After the patient’s condition improves and leaves the hospital, it still needs a period of rehabilitation. During this period, patients should continue to maintain good living habits, such as reasonable diet, moderate exercise, adequate rest and so on. Avoid overwork and cold to prevent recurrence of pneumonia. According to their own physical condition, gradually increase the amount of exercise, such as walking, Tai Chi, etc., to enhance physical fitness and improve immunity. 2. Preventive measure • The key to prevent lobar pneumonia is to enhance the body’s resistance and avoid source of infection. Maintain good personal hygiene habits, wash hands frequently, avoid touching the mouth and nose with hands, in order to reduce the spread of bacteria. Exercise, develop regular living habits, ensure adequate sleep and eat properly, all of which help to improve the body’s resistance. In addition, influenza vaccine or pneumonia vaccine can be considered to reduce the risk of infection during the influenza season or the season of high incidence of pneumonia. 7. Conclusion The treatment of lobar pneumonia is a comprehensive process, which needs to start with general treatment, anti-infective treatment, symptomatic treatment and complication treatment. Through timely and effective treatment, most patients can recover. At the same time, in daily life, taking effective preventive measure can reduce the risk of lobar pneumonia and protect people’s health. For patients, understanding the treatment and prevention of lobar pneumonia is helpful to better cooperate with doctors and promote their own rehabilitation.
