肺气肿知识课件.pptVIP

肺 气 肿Pulmonary emphysema 定 义 肺气肿是指终末细支气管远端（呼吸细支气管、肺泡管、肺泡囊和肺泡）的气道弹性减退，过度膨胀、充气和肺容积增大或同时伴有气道壁破坏的病理状态。 支气管分支 类 型： 老年性肺气肿 间质性肺气肿 代偿性肺气肿 疤痕性肺气肿 α-抗胰蛋白酶缺乏性肺气肿 阻塞性肺气肿 ? 病因：同慢支 过敏 感染 全身或呼吸道局部防御及免疫功能减低 自主神经功能失调 慢性支气管炎 吸烟 理化 机 理 慢性炎症使管腔狭窄，肺泡残气过多 慢性炎症使支气管壁软骨破坏，肺泡残气过多 慢性炎症使蛋白分解酶增加，损害肺组织和肺泡壁 肺泡壁毛细血管受压，血供减少，肺泡壁弹性减退 弹性蛋白酶及其抑制因子失衡学说 炎症 小气道疾病 气道炎症 气道重建 肺实质破坏 肺泡牵拉作用消失 弹性回缩力下降 气流受限 正常肺实质 小叶中央型肺气肿 全小叶肺气肿 病理 临床表现 ①症状：气喘，其不同时期程度不同 ②体征： 望：桶状胸 触：语颤减弱或消失 叩：过清音，心浊音界缩小或叩不  出，肺下界、肝浊音界下降 听：呼吸音普遍减弱，呼气延长 ? Breathing in the Normal State Breathing in COPD ?? X 线 胸部C T 心 电 图 肺 功 能 FEV1/FVC (＜60%) RV 、RV/TLC （＞40%） * * 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.