GOLD03资料.ppt

正常人的肺泡排空 COPD患者的肺泡排空 正常人的呼吸 COPD患者的呼吸 COPD的诊断 诊断：任何患有呼吸困难、慢性咳嗽或多痰的患者，并有暴露于危险因素的病史，临床上需要考虑COPD的诊断。 COPD诊断：需要进行肺功能检查，吸入支气管扩张剂后FEV1/FVC 0.7 即明确存在气流受限，可诊断COPD。 COPD稳定期药物治疗-2013年 COPD全球策略　 AECOPD 的辅助检查 脉氧或动脉血气：用来监测和/或调整氧疗方案，必要时需要机械通气 胸片：有助于除外其他诊断 心电图：有助于诊断合并的心脏疾病 血常规：有助于发现RBC增多(HCT55%)，贫血或WBC增多 痰培养：初始抗生素治疗无效，需进行痰培养 生化检查：有助于发现电解质紊乱和血糖增高 AECOPD抗病毒治疗问题（1） 抗病毒药物治疗AECOPD的研究： 病毒（鼻病毒属）:AECOPD发病中起重要作用; 已尝试多种抗病毒制剂治疗鼻病毒属感染。 包括: 靶向细胞敏感性、病毒附着、受体阻断、病毒外膜、病毒RNA复制和病毒蛋白合成等类的药物。 除神经氨酶抑制剂（zanamivir，扎那米韦）和金刚烷胺治疗流感外，其他抗病毒制剂均无治疗效应，且出现明显副作用和缺乏耐受性。 AECOPD抗病毒治疗问题（2） 2011年欧洲呼吸学会（ERS）发布的下呼吸道感染处理指南特别指出： * AECOPD 通常不推荐经验性抗病毒治疗。 * 流感流行季节，怀疑流感的者；及流感流行季节时，流感高危者，如出现典型流感症状（发热、肌肉痛、全身乏力和呼吸道感染症状），且起病 2 天内，考虑抗病毒治疗。 * GOLD 2011 北京协和医院 蔡柏蔷 * * * The animation begins with the alveolus fully inflated. Over the course of a normal exhalation, the alveolus fully deflates. With inhalation, the alveolus re-inflates. In COPD, irreversible damage causes the alveolar walls and supports to lose elasticity compared with the normal condition. The airways are partly collapsed and occluded, an effect made worse by reversible cholinergic constriction.1 As a result, deflation is slower, and so the alveolus only partly deflates over the course of an exhalation. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO workshop report. 2001. /workshop/toc.html. Accessed: 14 November 2003. 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 p