呼吸科常见疾病及基本药物治疗讲解课件.ppt

慢性肺源性心脏病--诊断 病史 临床表现 X线改变 心电图 超声心动图 慢性肺源性心脏病--治疗 呼吸衰竭的治疗 心力衰竭的治疗 并发症的治疗：肺性脑病、心律失常\休克、肺部感染、消化道出血、DIC 五、慢性呼吸衰竭--概述 因多种原因引起的肺通气和换气功能严重障碍，导致低氧血症伴（或不伴）高碳酸血症，进而引起一系列病理生理改变和相应临床表现的综合征。 在海平面、静息状态、呼吸空气条件下，PO260mmHg,伴（或不伴）PaO250mmHg，并排除心内解剖分流和原发于心排血量降低等因素，可诊断为呼吸衰竭。 慢性呼吸衰竭--诊断 病史 动脉血气分析 Ⅰ型呼吸衰竭：PaO2 60mmHg Ⅱ型呼吸衰竭：PaO2 60mmHg，PaCO250mmHg 慢性呼吸衰竭--治疗 一. 畅通呼吸道： 1. 祛除呼吸道分泌物 2. 扩张支气管 3. 建立人工气道 慢性呼吸衰竭--治疗 二. 增加通气量 1. 机械通气 2. 呼吸兴奋剂 三 . 控制感染 四 . 纠正酸碱、电解质紊乱 谢谢！ * * * Diffuse bilateral air-space opacities consistent with pneumonia. Possible causative organisms include Pneumocystis carinii. 男性, 43岁，４-６周来气短 gay white man who presents to your office for the first time with a complaint of worsening shortness of breath over the past 4 to 6 weeks. Gary claims he received a positive result from an HIV test 7 years ago and has seen a doctor once or twice since then. He admits that he preferred to ignore his diagnosis and suspects that it may have been wrong because he has felt well. The doctors he saw in the interim pronounced him healthy, but he acknowledges that he withheld both his sexuality and the earlier HIV test results from them afebrile, with a heart rate of 90 beats per minute; respiratory rate, 18 breaths per minute; and blood pressure, 120/80 mm Hg. His oxygen saturation on room air is 92% His lactate dehydrogenase (LDH) level is 599 U/L, and his white blood cell count is 6.2 3 103/μL. His hemoglobin level is 12.1 g/dL and hematocrit is 35.4%. CD4 cell count is 25/μL * * * 根据哮喘的临床控制水平对患者进行评估，这样的评估既用于治疗开始前也用于开始后的监测，对于患者治疗方法的正确选择非常重要。 一般情况下经过治疗哮喘是可以完全控制的，哮喘管理的目标是在衡量治疗的安全性、药物的副作用和治疗费用的基础上达到和保持哮喘的长期控制。 * GINA是全球哮喘防治创仪的缩写,是最权威的哮喘治疗指南 * * * In treatment-na?ve patients with persistent asthma, treatment should be start at Step 2, or, if very symptomatic (uncontrolled), at step 3. All patients with persistent asthma require one or more regular controller medications (Steps 2 through 5). Step 2 is the initial treatment for most treatment-na?ve patients with persistent asthma symptoms. If