医学交流课件：慢阻肺急性加重管理的探讨.pptx

慢阻肺急性加重管理的探讨发病机制疾病管理预测影响CONTENTS慢阻肺急性加重的定义一种急性起病的事件，其特征是患者呼吸系统症状恶化，超出日常变异，并导致需要调整药物治疗方案。 GOLD 20161 GOLD 20162 ERS 20143慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2014年修订版)感染是急性加重的诱发因素Bacteria, viruses and environmental agents account for the vast majority of episodes of exacerbation .In a recent study of patients admitted to hospital with severe exacerbations, 78% of patients had evidence of viral or bacterial infection . However, many patients suffer from exacerbations whereno specific causes can be identified.Papi A, Bellettato CM, Braccioni F, et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am J Respir Crit Care Med 2006; 173: 1114–1121细菌定植诱发因素病毒细菌污染COPD炎症性气道共同作用效果加剧的气道炎症反应急性加重症状慢阻肺急性加重的诱因和机制The Causes and Mechanisms of Acute Exacerbation of COPD慢性炎症基础上发生的急性炎症加重——慢阻肺急性加重机制The acute exacerbation of inflammation based on chronic inflammation -- mechanism of acute exacerbation of COPD慢阻肺气道炎症越严重，病理生理改变越明显，导致症状加重，使患者寻求医疗帮助，通常被诊断为急性加重。Patients are diagnosed with acute exacerbation when inflammatory airway of COPD is more severe, changes of pathological physiology are more obvious, aggrevated symptoms force patients to seek medical help. xx支气管狭窄；水肿；痰液全身性炎症呼气性气流受限心血管疾病动态性肺过度充气Wedzicha JA. Lancet 2007；370：786-796Antonio Anzueto. Proc Am Thorac Soc 2007；4：554–564发病机制疾病管理预测影响CONTENTS慢阻肺急性加重临床表现Clinical Manifestation of AECOPD症状和体征Symptoms and signs发热、不适、疲乏、嗜睡和意识障碍Fever, discomfort, fatigue drowsiness and disturbance of consciousness脓痰增加 Purulent sputum accumulation痰量增多Sputum accumulation呼吸困难加重、喘息和胸闷Aggravation of dyspnea, gasp and chest tightnessGlobal Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease ( Revised 2015）症状加重Aggravated symptoms肺功能减退Decrease of pulmonary function活动受限Limited mobility生活质量变差Deterioration in life quality与社会脱节Alienated from society进一步加重Further aggravated 极度焦虑Extreme anxiety 疾病负担沉重Heavy medical cost死亡率升高Increased mortality 住院风险增加Higher risk of hospitalizationGlo