慢性阻塞性肺疾病诊治指南讲解课件.ppt

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急性加重期有创性机械通气 有创性机械通气在慢性阻塞性肺疾病加重期的应用指征 严重呼吸困难，辅助呼吸肌参与呼吸，并出现胸腹矛盾呼吸 呼吸频率35次／min 危及生命的低氧血症(PaO240mmHg或PaO2／FiO2200mmHg) 严重的呼吸性酸中毒(pH7.25)及高碳酸血症 呼吸抑制或停止 嗜睡，意识障碍 严重心血管系统并发症(低血压、休克、心力衰竭) 其他并发症(代谢紊乱、脓毒血症、肺炎、肺血栓栓塞症、气压伤、大量胸腔积液) COPD急性加重期有创性机械通气 使用最广泛的3种通气模式包括辅助控制通气(A-CMV)，压力支持通气(PSV)或同步间歇强制通气(SIMV)与PSV联合模式(SIMV+PSV)。因COPD患者广泛存在内源性呼气末正压(PEEPi)，为减少因PEEPi所致吸气功耗增加和人机不协调，可常规加用一适度水平(约为PEEPi的70％～80％) 的外源性呼气末正压(PEEP)。COPD的撤机可能会遇到困难，需设计和实施一周密方