GOLD及雾化吸入激素在AECOPD中的应用教案.pptVIP

AECOPD处理方案 根据症状、血气、X线胸片等评估病情的严重程度 控制性氧疗并于30-60分钟后复查血气 应用支气管舒张剂 加用口服或静脉糖皮质激素 考虑使用抗生素（口服或静脉）：当有细菌感染的临床表现时 整个治疗过程中应注意 ---监测液体平衡和营养状况 ---考虑使用皮下肝素注射 ---识别和处理相关的疾病（如心力衰竭、心律失常） ---对患者情况进行密切监测 考虑应用无创机械通气 急诊或住院的治疗方案 酸中毒的患者 非酸中毒的患者 使用雾化吸入激素治疗 雾化吸入激素部分替代或联合全身激素 GOLD 2011 * 小　结 糖皮质激素是COPD急性加重的重要治疗药物之一； 剂量和疗程：5天每日40mg激素对大部分患者是合适的； 雾化吸入布地奈德可以部份替代全身性激素治疗COPD急性加重；安全性好，减少激素不良反应； 仍需要认真审视全身激素使用问题，包括合适的患者亚群，使用激素的生物学指标。 * * * * * * * * * * * * * 雾化吸入的糖皮质激素药物能直接进入支气管和肺部，较少了全身药物得用量，并且无需特殊吸入技巧，能迅速发挥作用，副作用小，使用安全可靠成为治疗AECOPD的理想选择。 雾化糖皮质激素治疗非酸中毒AECOPD, 替代或减少全身激素的剂量；并减轻全身激素的副作用； * PERMISSION TO ADAPT TABLE TO BE REQUESTED UPON APPROVAL A total of 121 patients completed the study (BD only, n=39; BD + PRED, n=40; BD + BUD, n=42).Gunen et al 2007/4/4 The percentages of patients with relatively early and delayed discharge were not significantly different among the groups.Gunen et al 2007/6/4 Percentages of patients discharged at day 10 were 54%, 50%, and 45% for the BD only, BD + PRED, and BD + BUD groups, respectively.Gunen et al 2007/6/4 Discharge was delayed (15 days) in 10%, 10%, and 7% in the BD only, BD + PRED, and BD + BUD groups, respectively.Gunen et al 2007/6/4 There was a trend toward a significant difference in favor of the corticosteroid groups for exacerbations and re-hospitalization 1 month after discharge, but there were no significant differences across treatments.Gunen et al 2007/7/1 Within 1 month of discharge, there were 14, 8, and 9 exacerbations in the BD only, BD + PRED, and BD + BUD groups, respectively.Gunen et al 2007/6/5 These exacerbations resulted in 8, 4, and 5 hospitalizations in the BD only, BD + PRED, and BD + BUD groups, respectively, during the month after discharge.Gunen et al 2007/7/1 Gunen H, Hacievliyagil SS, Yetkin O, Gulbas G, Mutlu LC, In E. The role of nebulized budesonide in the treatment of exacerbations of COPD. Eur Respir J. 2007. Insert full citation when in print With regard to the absolute values of arterial blood gases and spirometric measu