《慢阻肺诊断、治疗和预防全球倡议(GOLD)》2018版.pptxVIP

《慢阻肺诊断、治疗与预防全球倡议（GOLD）》2018版解读;要点概述;第一章：定义和概述;慢阻肺的病理生理学;;第二章：诊断和起始评估慢阻肺的诊断;2018版慢阻肺综合评估流程;急性加重风险的评估。;AECOPD的分级包括：;第三章：基于证据支持的预防及维持治疗戒烟与电子烟;药物治疗-支扩剂;药物治疗-PDE4抑制剂;药物治疗-抗生素;肺康复;氧疗和通气支持;3、目前对于住院后发生慢性呼吸衰竭急性发作的患者是否可以在家长期应用无创正压通气 (NPPV) 存在争议。近期一项前瞻性RCT研究纳入了116例出院2-4周后因急性加重出现持续高碳酸血症 (PaCO2? 53 mmHg) 的慢阻肺患者，比较家庭无创通气 (NIV) 联合氧疗与仅家庭氧疗对再次入院或死亡的影响。在排除BMI 35 kg/m2、阻塞性睡眠呼吸暂停综合征或其他呼吸衰竭诱因之后，2,021 例患者中仅 124 例 (6%) 符合条件。研究结果显示家庭NIV 联合氧疗显著延长12 个月内再次入院或死亡的发生时间。 Whether to use NPPV chronically at home to treat COPD patients with acute on chronic respiratory failure following hospitalization remains controversial. A recent multicenter (13 sites) prospective RCT of COPD patients (n=116) with persistent hypercapnia (PaCO2?53 mmHg) after 2-4 weeks of hospital discharge because an acute episode of exacerbation, compared the effects of home noninvasive ventilation (NIV) plus oxygen compared to home oxygen alone on time to readmission or death. (Murphy et al., 2017) Patients with body mass index 35 Kg/m2, obstructive sleep apnea syndrome, or other causes of respiratory failure were excluded. Of 2,021 patients screened, only 124 (6%) were eligible. Results showed that adding home NIV to oxygen therapy significantly prolonged the time to readmission or death within 12 months. (Murphy et al., 2017) ? 4、两项回顾性研究和三项RCT中的两项研究发现，出院后使用NPPV 可降低再次住院率并提高生存率。不同研究间结论的差异可能与患者选择不同、研究效能不足、NPPV设置不足以实现充分通气、以及NPPV依从性差相关。在应用NPPV时，应由熟悉设备和操作的人员进行指导和监测。 Two previous retrospective studies (Coughlin, Liang, Parthasarathy, 2015; Galli et al., 2014) and two of three RCTs (Casanova et al., 2000; Clini et al., 2002; Kohnlein et al., 2014; Struik et al., 2014) reported reductions in re-hospitalization and improved survival with using NPPV post-hospitalization. Several factors may account for discrepancies: differences in patient selection, underpowered studies, NPPV settings incapable of achieving adequate ventilation, and poor adherence with NPPV therapy.(White et al., 2015) NPPV when indicated