4COPD(黄静2014）.pptVIP

COPD的死亡率急剧上升 COPD的流行病学状况 COPD患者的肺泡排空 COPD实验室检查（胸片） COPD诊断方法 目的和要求 掌握：慢性支气管炎诊断。慢性阻塞性肺疾病的定义；临床表现；实验室检查（肺功能）；慢性阻塞性肺疾病的诊断与稳定期严重程度的分级 熟悉：慢性支气管炎的临床表现。慢性阻塞性肺疾病的病因及发病机制；病理生理；并发症；治疗 了解：慢性支气管炎病因与发病机制；病理；鉴别诊断和治疗。慢性阻塞性肺疾病的病理改变；预防；鉴别诊断 * These are pictures taken from smokers, the cilia are deformed, disorganised and beat in an irregular fashion and cannot ove mucus. Hence the first natural barrier to infection is destroyed. And this is the reason why smokers are more prone to infections and subsequent lung damage. It’s important to remember that COPD is essentially a man-made disease. * Saetta M, Turato G, Baraldo S, et al. Goblet Cell Hyperplasia and Epithelial Inflammation in Peripheral Airways of Smokers with Both Symptoms of Chronic Bronchitis and Chronic Airflow Limitation.Am J Respir Crit Care Med 2000; 161: 1016-1021. Official Journal of the American Thoracic Society ? American Lung Association 全球最新十大污染城市中国占八名，北京榜上有名 世界十大污染城市分别为:贵阳、重庆、太原、兰州、米兰（意大利）、淄博、北京、广州、墨西哥城、济南。 * 全球最新十大污染城市中国占八名，北京榜上有名 世界十大污染城市分别为:贵阳、重庆、太原、兰州、米兰（意大利）、淄博、北京、广州、墨西哥城、济南。 * 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. * 随着认识的深入，对于COPD的理解不再局限于气道和肺。关于COPD营养不良的研究越来越受到重视。并且，近年来国外文献里提出了一个新的概念，叫做COPD的全身效应（systemic effects），全身效应比营养不良更进了一步。这个概念包括营养不良，表现为体重下降、人体组成改变。全身效应还包括为全身炎症反应、和骨骼肌功能障碍等等，以及心血管、神经和骨骼系统改变等等。目前国际上关于COPD全身效应的研究非常多，从基础、到临床都做了广泛而深入的研究。 儿童或青少年期起病，发作性喘息为特征，发作时两肺布满哮鸣音，常有家庭或个人过敏史，症状经治疗后可缓解或自行缓解。哮喘的气流受限多为可逆性，其支气管舒张试验阳性。 * * * The MPOWER Package * The tobacco e