Traditional Chinese subtitles for clip: File:Pneumonia.webm

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好，那來看看這傢伙，他
的肺看起來不賴，而且他是

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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

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這條大的通氣管，叫做氣管
氣管會再分成兩條

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分支，叫做支氣管，然後再分下去
到細支氣管，直到最後

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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

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這些肺泡們和一些
微血管彼此交織成網，而這時

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氧氣就能藉由肺泡擴散
進入微血管，很明顯的

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氧氣並非是唯一吸入人體的
物質，對吧？你一直持續的

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吸入一大堆東西，不論你
願不願意，像是微生物之類

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通常你的身體很快的能驅逐或消滅
這些不受歡迎的訪客

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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

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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

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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

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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 

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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 

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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？

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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

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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

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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、

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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?

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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?

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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

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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

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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

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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

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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

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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

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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,

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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.

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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

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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

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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?

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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

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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

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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

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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

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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

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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

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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

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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?

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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 

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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"

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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, 

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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

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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

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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

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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?

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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!

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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

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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

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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

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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

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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

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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

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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

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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"

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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~

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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

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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 !!

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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?

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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

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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

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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

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body’s inflammatory reaction 
in your lungs.
在肺裡的發炎反應

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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

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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

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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

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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

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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"!!

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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, 

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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

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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
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like scattered alveoli, we call that bronchopneumonia,
which is defined by these scattered or patchy

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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

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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

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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

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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

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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

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lobe. Speaking of lobes though, another way
though pneumonia can present itself is called
說到肺葉

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lobar pneumonia. Where bronchopneumonia was
all patchy and scattered, lobar pneumonia

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is this almost complete consolidation of a
whole lobe of the lung. Pretty much all cases,

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around 95%, of this are caused by the bacteria
streptococcus pneumoniae. Usually lobar pneumonia

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happens in steps or stages, though. The first
stage is called congestion, and lasts between

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1 and 2 days, this is where the vessels start
filling with fluid. The next stage is called

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red hepatization, between day 3 and 4, the
lobe starts to get reddish brown and firm,

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and starts to resemble liver tissue, which
is why we call it HEPAT-ization. It’s color

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is red because it’s a combination of red
blood cells, neutrophils and fibrin, which

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we can call an exudate, and this now becomes
more solid because this exudate is filling

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the air spaces. As the red blood cells break
down and degrade, we move into stage 3 around

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days 5 to 7, called the gray hepatization
stage, where it’s still firm but the color

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has changed because the cells begin to break
down. Finally, the last stage is called resolution,

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and this happens around day 8 and can continue
for 3 weeks. In this stage the exudate gets

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digested by enzymes and broken up, ingested
by macrophages, or coughed up. And those are

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major pieces of lobar pneumonia, but there’s
still one more, someone could have interstitial

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pneumonia, which is also just known as atypical
pneumonia which remember is this like walking

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pneumonia, and this type’s localized to
the tissue around alveoli, and usually there

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actually isn’t any exudate or fluid in the
alveolar spaces, and so essentially no consolidation,

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but there will be some mononuclear infiltrate,
like white blood cells that’ve infiltrated

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these interstitial spaces. This one, remember,
is more rare and symptoms are typically pretty

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mild, like low fever and not a lot of mucus,
similar to the flu. Since there’s not a

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ton of mucus, usually patients will have a
nonproductive cough along with chest pains.

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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

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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

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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

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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

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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

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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

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are more reticular because it’s affecting
the tissue outside the alveoli. Another way

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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

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00:14:01,670 --> 00:14:05,700
consolidation. Also though, you might be able
to feel more vibrations from the patient’s

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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

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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

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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

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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, 

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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

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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