1 COPD定义和诊断-10课件.pptVIP

* * * * * 2．病史特征： (1)吸烟史：多有长期较大量吸烟史。 (2)职业性、环境有害物质接触史： (3)家族史：COPD　有家族聚集倾向。 (4)发病年龄及好发季节：中年后发病，好发于秋冬寒冷季节，常有反复呼吸道感染及急性加重史。随病情进展，急性加重愈渐频繁。 (5)慢性肺原性心脏病史：后期出现低氧血症和(或)高碳酸血症，可并发慢性肺原性心脏病和右心衰竭。 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * COPD严重度分级是基于气流受限的程度，目前分为4级(表) 气流受限是诊断COPD的主要指标，也反映了病理改变的严重度 FEVl下降与气流受限有很好的相关性，FEVl的变化是严重度分级的主要依据 结合临床症状及合并症的程度 3. 病情分级 * 分级 特征 I：轻度COPD FEV1/FVC 70 % FEV1 ? 80%预计值 II：中度COPD FEV1/FVC 70% 50% ? FEV1 80%预计值 III：重度COPD FEV1/FVC 70% 30% ? FEV1 50%预计值 IV：非常严重COPD FEV1/FVC 70% FEV1 30% 预计值, 或FEV1%50%预计值合并慢性呼吸衰竭 COPD严重程度的肺功能分级 《2009GOLD》 * * * * * * * * * * * * * * * * * * * * * * 迷走神经分布于气道壁，其节后纤维终止于气道平滑肌和粘膜下腺。刺激迷走神经导致乙酰胆碱的释放，并与气道平滑肌细胞和粘膜下腺杯状细胞上的M3毒蕈碱受体相互作用。这继而导致平滑肌收缩和支气管狭窄以及粘液生成和分泌。 气道处于持续的低水平迷走神经刺激下，使得静息气道保持一定的“张力” 。 化学或机械刺激物的存在通过感觉性传入C-纤维会进一步刺激迷走神经。这些神经的刺激信号传输至CNS，并增强迷走神经刺激，从而导致支气管收缩和粘液分泌过多以防止刺激物深入到肺部。 * 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. * 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