慢性阻塞性肺疾病诊治指南.ppt

COPD急性加重期治疗 7．其他治疗措施：在出入量和血电解质监测下适当补充液体和电解质；注意维持液体和电解质平衡；注意补充营养，对不能进食者需经胃肠补充要素饮食或予静脉高营养；对卧床、红细胞增多症或脱水的患者，无论是否有血栓栓塞性疾病史，均需考虑使用肝素或低分子肝素；注意痰液引流，积极排痰治疗(如刺激咳嗽，叩击胸部，体位引流等方法)；识别并治疗伴随疾病(冠心病、糖尿病、高血压等)及合并症(休克、弥漫性血管内凝血、上消化道出血、胃功能不全等)。 * * * * ? M Saetta 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 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. COPD稳定期药物治疗支气管舒张剂： (1) β2受体激动剂：主要有沙丁胺醇、特布他林等，为短效定量雾化吸入剂，数分钟内开始起效，15～30min达到峰值，持续疗效4～5 h，每次剂量100～200μg(每喷100μg)，24h内不超过8～12喷。主要用于缓解症状，按需使用。福莫特罗(formoterol)为长效定量吸入剂，作用持续12 h以上，与短效β2受体激动剂相比，