COPD的诊治.pptVIP

一、定义、 流行病学和危险因素 COPD的患病率－中国COPD流行病学研究 COPD存在炎症表现(续)－即使在COPD早期，也存在炎症 炎症的严重程度与疾病严重程度的指标相关(续) －CD8+T淋巴细胞增加与肺功能恶化相关 炎症在COPD全身效应中有重要作用－炎症由肺部“溢出”至全身，引起全身炎症 COPD全身炎症的发病机制可能主要有： 肺部炎症是全身炎症的根源 肺部炎症细胞释放炎症细胞因子，并使氧化产物增多，这些促炎介质进入全身血循环，和/或在经过肺循环时，激活炎症细胞 吸烟或有害烟雾单独引起全身炎症 吸烟在没有COPD的情况下，可独立引起明显的肺外疾病，如冠心病 吸烟者存在全身血管内皮功能障碍和全身性氧化应激，可能引起全身炎症 COPD患者气道平滑肌增厚 正常人的肺泡排空 COPD患者的肺泡排空 正常人的呼吸 COPD患者的呼吸 炎症是COPD的重要因素，请问炎症存在于COPD的哪一期？ 炎症存在COPD的早期，即使轻、中度度的患者也存在炎症。 问题2：COPD诊断的金标准是什么？ 答案： 肺功能检查是诊断COPD的金标准。 应用支气管扩张剂后 FEVl／FVC%＜70％可确定为不完全可 逆性气流受限。 COPD急性加重期治疗 The animation begins with the alveolus fully inflated. Over the course of a normal exhalation, the alveolus fully deflates. With inhalation, the alveolus re-inflates. In COPD, irreversible damage causes the alveolar walls and supports to lose elasticity compared with the normal condition. The airways are partly collapsed and occluded, an effect made worse by reversible cholinergic constriction.1 As a result, deflation is slower, and so the alveolus only partly deflates over the course of an exhalation. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO workshop report. 2001. /workshop/toc.html. Accessed: 14 November 2003. In the normal state, inhalation is balanced by exhalation. There is no dynamic hyperinflation. COPD patients suffer from reduced expiratory flow. As a result, the lungs may not fully empty before the next breath begins. This is particularly likely if the patient has to breathe faster as a result of physical activity.1 Because the lungs do not fully empty, they become progressively over inflated with each breath. This process is known as air trapping, which leads to hyperinflation.1 Air trapping reduces the ability of the patient to breathe in, which causes the sensation of breathlessness