慢性呼吸衰竭的诊断和治疗推荐.pptVIP

维持水电解质酸碱平衡 避免脱水，按需补液 补充足够的K、Ca、Mg、P 纠正代谢性酸中毒 纠正代谢性碱中毒 慢性呼吸衰竭治疗-防治并发症 慢性肺源性心脏病 右心功能不全 消化道出血，休克 多脏器功能衰竭 慢性呼吸衰竭治疗-营养支持 普遍存在营养不良： 摄入热量不足，吸收不良 气道阻塞，呼吸功增加 感染或机械通气时，分解代谢增加 营养不良造成： 机体免疫功能降低，感染不易控制 呼吸肌肉无力或疲劳，呼吸泵功能衰竭 ，病程延长 组织修复能力减低 慢性呼吸衰竭治疗-营养支持（2） 补充途径： 鼻饲 静脉高营养 补充内容： 高蛋白，高脂肪 低碳水化合物 多种维生素 慢性呼吸衰竭治疗-营养支持（3） 营养支持应达到基础能量消耗值 基础能耗（女）=665+9.6X体重（kg）+1.8X身高（cm）-4.7X年龄(岁) 基础消耗（男）= 66+13.7 X体重（kg）+50X身高（cm）-6.8X年龄(岁) 呼吸衰竭者，较上述增加20% 人工通气患者增加50% 三大能量要素比例： 碳水化合物 45-50%，蛋白质15-20%，脂肪30-35% 哮喘治疗的三个区域 ALL CLEAR -ASTHMA CONTROLLED- MINIMAL SYMPTOMS NO DISTURBANCE OF ACTIVITIES OR SLEEP PEFR 80% PREDICTED OR BEST- VARIABILITY 20% STEP DOWN AFTER 3 MONTHS? CAUTION- LACK OF ADEQUATE CONTROL - SYMPTOMS PRESENT - PEFR 60-80% - VARIABILITY 20-30% ACUTE EXACERBATION OR DETERIORATION? INCREASE MEDICATION MEDICAL ALERT - SYMPTOMS PRESENT AT REST PEFR 60% PREDICTED OR BEST IMMEDIATE ACTION REQUIRED Global Initiative for Asthma (1995) 哮喘急性发作的管理 - 家庭治疗 Global Initiative for Asthma (1995) Assess Severity PEF 80% personal best or predicted Clinical features: cough, breathlessness, wheeze,chest tightness, use of accessory muscles, andsuprasternal retractions Initial Treatment Inhaled short-acting beta2-agonistup to three treatments in 1 hour Incomplete Response Moderate Episode If PEF 60-80% predicted orpersonal best Add oral corticosteroid Continue beta2-agonist Consult clinician Poor Response Severe Episode If PEF 60-60% predicted orpersonal best Add oral corticosteroid Repeat beta2-agonist immediately Immediate transport to hospital emergency department, consider ambulance Good Response Mild Episode If PEF 80% predicted orpersonal best Response to beta-agonistsustained for 4 hours May continue beta2-agonist every 3-4 hours for 24-48 hours Contact clinician for follow-upinstructions Consult clinician urgently (thisday) for instructions To emergency departm