慢阻肺的科治疗 ppt课件.pptVIP

* COPD的病理生理变化包括气流受限和气体陷闭、气体交换异常、粘液高分泌、肺动脉高压。 * * Air trapping in COPD. During expiration small airways narrow but closure is prevented by the elasticity of alveolar attachments. In COPD patients there is a loss of elasticity with greater narrowing in small airways, which may close completely when there is loss of alveolar attachments as a result of emphysema. This results in air trapping and hyperinflation, leading to dyspnea and reduced exercise capacity. An example of how the CAT can be used – to get the total score which measures overall severity, but also to identify very quickly which areas are most affected. 虽然FEV1％预计值对反映COPD严重程度、健康状况及病死率有用，但FEV1并不能完全反映COPD复杂的严重情况 除FEV1以外，已证明体重指数(BMI)和呼吸困难分级在预测COPD生存率等方面有意义 * * 所有噻托溴铵试验均选择了目前应用较为广泛、可信度较高的圣-乔治呼吸问卷(SGRQ)作为健康状况的评估工具。 SGRQ是疾病特异性问卷调查工具，共由三部分组成，用以评价呼吸系统疾病对于健康状况各方面的影响。 总评分由三部分组成，评分范围为0至100；分值越高代表健康状况越差。 SGRQ总评分至少改变4分意味着具有临床意义。 * COPD的发病初期患者常无明显不适 当患者求医时，常常疾病已经进展到中度以上 无症状 轻中度COPD患者 管理缺失！ * COPD患者肺功能加速下降的特征。 FEV1持续下降将持续患者的一生，并随着年龄的增长略有加速。非吸烟和对吸烟不敏感的患者FEV1下降减慢，几乎没有发展到临床显著的气流阻塞。 与之形成显著对比的是，对吸烟敏感的患者发展到了不同程度的气流阻塞，最终致残或致死。在这些患者中，戒烟无法恢复FEV1，但可以使随后的FEV1成正常速率地下降 Fig. 1 Average central and peripheral airway retention curves of insoluble radio-labeled marker for chronic flow-limited COPD and healthy subjects. Regional analysis of mucociliary clearance evaluated by separating retention regions located during radio-gas ventilation scan into Central (inner, 30% of total region and centered over large central airways) and Peripheral (outer, remaining 70% of total region) Airways. The number of subjects studied as indicated and time zero was time of initial scan acquired immediately following inhalation and deposition of the radiomarker. The error bars represent standard error of the means. * 越来越多的研究表明：气道炎症发病的根本原因在于：各种原因导致MC系统功能障碍后，引起呼吸道内引流不畅、分泌物潴留等一系列病理变化，这些病理变化又进一步加重粘液纤毛系统的功能障碍，进而反复感染，致使炎症长期存在，疾病缠绵难愈。因此，在抗炎及抗菌治疗的同时，使用粘液纤毛清除系统功能恢复剂来恢复MC功能，实现通气引流，彻底打破炎症的恶性循环，成为眼下国内外学者关注的焦点。 都保装置（需要吸气流速60L/min) 支气管扩张剂 临床常用的支气管扩张剂有三类：β受体激动剂、抗胆碱能药物