慢性阻塞性肺疾病 - 浙江大学.ppt

* 社会负担 生活质量的恶化4,5 病情日益恶化6,7 住院的增加1,2 COPD 急性加重对病人意味着? 极大的焦虑3 肺功能下降1,2 1. Garcia-Aymerich J et al. 2001　　　2. Donaldson D et al. 2002　　3. Gore JM et al. 2000 4. Seemungal T et al. 1998　　　 5. Pauwels Pet al. 2001　　 6. Seemungal T et al. 2000 7. Garcia-Aymerich J et al. 2003　　　8. Anto JM et al. 2001 症状的增加 (如：呼吸困难)6 死亡率的增加 8 * 严重度分级 可参考以下标准： Ⅰ级（轻/中度），可在家治疗 П级（中/重度），需住院治疗 Ⅲ级（重度），为急性呼吸衰竭 * COPD急性加重的治疗 支气管扩张剂 糖皮质激素 抗生素 氧疗 辅助通气 其它治疗 * 慢性阻塞性肺疾病 持续气流受限为特征 气流受限多呈进行性发展， 气道和肺对有害颗粒或气体的慢性炎症反应。 吸入支气管扩张剂后肺功能FEV1/FVC＜70 % 急性加重和合并症影响患者整体疾病的严重程 度。 * 参考文献 Guidelines:Global Strategy for Diagnosis, Management, and Prevention of COPD. * 谢谢！ * * ? M Saetta * This provides a summary of the recommended treatment at each stage of COPD. * * Exacerbations of COPD are a major cause of morbidity, mortality and hospital admission.1,2 Some patients are particularly susceptible to developing frequent exacerbations, an important determinant in health-related quality of life.1–3 The downward spiral of more frequent exacerbations can lead to decline in lung function; greater anxiety; worsening quality of life; social withdrawal; more exacerbations and increased risk of hospitalisation.1-9 As frequent exacerbations are associated with a faster long-term decline in lung function, it has also been suggested that prevention of exacerbations might slow disease progression.9 In addition, a reduction in the frequency or severity of exacerbations offers an obvious means of reducing demand on the healthcare system. Patients who are prone to exacerbations have been found to have higher airway cytokine levels suggesting increased airway inflammation that could increase susceptibility to exacerbation.5 These patients are also prone to larger falls in FEV1 at exacerbations, prolonged and more frequent hospital admissions, more chronic respiratory symptoms and more severe exacerbations.4 Exacerbations that require hospital admission are associated with a high risk of mo