重度哮喘诊治和机械通气.ppt

* * * * * * * * * * * * 本试验证实采用不同剂量的甲强龙来治疗成人哮喘患发现： 高剂量组（500mg/天）和中剂量组（160mg/天）治疗比低剂量组（60mg/天）显著改善患者的通气能力（FEV1）。 高剂量组（500mg/天）症状改善迅速，在治疗第1、2天即可显著改善FEV1达50％以上。 FEV1是1秒内呼气容积。 * * * * * Summary of Phase III Asthma Studies aSevere persistent asthma according to GINA 2002 classification; b28-week core study and 24-week extensionICS = inhaled corticosteroids 1. Humbert et al. Allergy 2004; 2. Ayres et al. Allergy 2004; 3. Vignola et al. Allergy 2004; 4. Busse et al. JACI 2001; 5. Lanier et al. AAAI 2003; 6. Solèr et al. ERJ 2001; 7. Buhl et al. ERJ 2002; 8. Holgate et al. Clin Exp Allergy 2004 Asthma Exacerbation Rates Across Studies 1. Humbert et al. Allergy 2004; 2. Ayres et al. Allergy 2004; 3. Vignola et al. Allergy 2004; 4. Busse et al. JACI 2001; 5. Lanier et al. AAAI 2003; 6. Solèr et al. ERJ 2001; 7. Buhl et al. ERJ 2002; 8. Holgate et al. Clin Exp Allergy 2004 6、抗 TNF-a Johnston SL et al., NEJM 2006;354:1589-1600 0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 Change in FEV1 from baseline (L) 0 11-14 28 (±3) 42 (±3) Day 0.63 0.60 0.54 0.51 0.50 0.34 Telithromycin Placebo P=0.001 Difficult to Treat Asthma Role for Antibiotic Treatment ? 危重症哮喘的治疗 哮喘急性发作的严重度判断 临床特点 重度 危重 气短 休息时 体位 端坐呼吸 讲话方式 单字 不能讲话 精神状态 常有焦虑、烦躁 嗜睡或意识模糊 出汗 大汗淋漓 呼吸频率 常30次/分 辅助呼吸肌活动及三凹征 常有 胸腹矛盾运动 哮鸣音 响亮、弥漫 减弱、乃至无 脉率 120次/分 脉率变慢或不规则 奇脉 常有，25mmHg 无，提示呼吸肌疲劳 使用β2激动剂后PEF占预计值比例或个人最佳值 60%或 100L/分或作用时间2h 动脉血氧分压 60mmHg 动脉血二氧化碳分压 45mmHg 氧饱和度 90% PH 降低 ????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? Figure 2-4. Lung taken at autopsy from a patient who died of asthma. Note that the lung is still expanded because of the presence of trapped air. Extensive plugging of airways by mucus is evident throughout the specimen. (Courtesy of Webb Waring Institute, Denver, CO.) Taking your breath away. Left: A normal lung is clear . Right: the molecule IL-13 m