培训课件-COPD朱建波.pptVIP

有创机械通气： 严重呼吸困难，辅助呼吸肌参与呼吸， 呼吸频率﹥35次/min； 危及生命的低氧血症PaO2 40mmHg或PaO2 /FiO2 200mmHg； 严重的呼吸性酸中毒（pH 7.25）及高碳酸血症； 呼吸抑制或停止； 嗜睡，神志障碍；严重心血管系统并发症（低血压，休克，心力衰竭）； NIPPV失败或存在NIPPV的排除指征 外科治疗 肺大疱切除术 肺减容术 （LVRS） 肺移植 可缓解局部咯血、感染、胸痛等症状， 使周围受压肺组织重新充气膨胀 主要是通过切除部分肺组织，从而减少 肺充气过度，改善呼吸肌做功；还可以 增加肺弹性回缩力，改善呼气流速 手术适应症包括：FEV1 35%预计值； PaO2在55-60mmHg；PaCO2 50mmHg; 继发肺动脉高压 * 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. * 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 that typifies the disease. ODonnell DE, Webb K. The etiology of dyspnea during exercise in COPD. Pulmonary and Critical Care Update 14, Lesson 15./downloads/education/online/Vol14_13_18.pdf. Accessed 24 February 2004. * ? GlaxoSmithKline * 说明： COPD应用β2受体激动剂治疗，其支气管扩张作用稍差。 * 说明： COPD应用β2受体激动剂治疗，其支气管扩张作用稍差。 * 临床表现---症状 慢性咳嗽、咳痰 中心气道病变 气短、呼吸困难 外周气道、肺泡 临床表现—体征 视诊：桶状胸； 触诊：触觉语颤减弱； 叩诊：过清音，心浊音界缩小，肺下界和肝浊音界下移； 听诊：呼吸音普遍减弱，呼气延长，部分闻及干湿啰音。 辅助检查---X线 胸廓扩张，肋间隙增宽，肋骨平行，活动减弱，膈降低且变平，两肺野的透亮度增加。透亮度增高、肺大泡。肺血管纹理外带纤细、稀疏和变直；而内带的血管纹理可增粗和紊乱。心脏常呈垂直位，心影狭长。 用数字来定量呼吸困难有多重，机体是否存在呼吸衰竭，酸碱失衡和电解质紊