内科学支气管哮喘(中英文).ppt

抗胃食道反流治疗IPF 其它治疗 肺移植 氧疗与对症治疗 康复 中医中药 Nature History of IPF IPF小结 IPF是一种预后较差的疾病，病程各异 疾病恶化表现为呼吸道症状加重、肺功能下降、肺CT进行性肺纤维化、急性呼吸衰竭甚至死亡 临床表现为呼吸困难和肺部Velcro啰音 高分辨率肺CT（HRCT）是诊断重要手段 目前内科治疗有效的药物为： 吡非尼酮pirfenidone，尼达尼布Nintedanib Suggesting reading GINA REPORT, GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION. / An Official ATS/ERS/JRS/ALAT Clinical Practice Duideline: Treatment of Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med Vol 192(2). pp e3-e19, 2015 An Official American Thoracic Society/European Respiratory Society Statement: Update of the International Multidisciplinary Classification of the Idiopathic Interstitial Pneumonias. Am J Respir Crit Care Med Vol 188, Iss. 6, pp 733–748, Sep 15, 2013 * 新近由GINA出版的“全球哮喘疾病负担”的报告中指出中国的哮喘患者死亡率极高，约每100,000位哮喘患者中有36.7位患者会因哮喘死亡，而加拿大仅为1.6位哮喘患者。另外，中国农村地区哮喘患者死亡率是城市的2倍。 * * * * * 首先我们介绍“白三烯受体拮抗剂用于哮喘起始治疗”。 * * Bronchoalveolar Lavage肺泡灌洗 Normal：细胞总数5~10x106，巨噬细胞85~90%，L10~15%，N+E 1% Diagnosis: E25% eosinophilic pneumonia periodic acid–Schiff (PAS)+: alveolar proteinosis BAL lymphocytes ( 35%) sarcoidosis, HP,LIP,drug-induced ILD Response to therapy: lymphocytosis BAL-Alveolar proteinosis Physiologic Testing Restriction Diffusion defect Preservation of airflow Increase in P(A-a)O2 Exercise-induced hypoxaemia Hyperventilation PFT Lung Biopsy-definitive diagnosis The final step in the diagnostic evaluation of a patient with ILD is to decide whether it is necessary to obtain lung tissue. Tranbronchial Lung Biopsy经气管镜肺活检 Percutaneous lung biopsy经皮肺活检 Video-assited thoracosopic lung biopsy胸腔镜活检 Open lung biopsy开胸肺活检 Diagnosis Thyerapy Avoidance of exposure Steroid therapy Antifibrotic therapy Symptomatic therapy Others IDIOPATHIC PULMONARY FIBROSIS(IPF) 特发性肺纤维化 IDIOPATHIC INTERSTITIAL PNEUMONIA(IIP)特发性间质性肺炎 IIPs are a group of diffuse parenchymal lung diseases (DPLDs), a group also described as interstitial lung diseases The IIPs are a heterogeneous group of nonneoplastic disorders resulting from dam