极光计划慢阻肺急性加重的管理与资料课件.ppt

* * * * * Other Treatment Options for AECB More as a preventative measure, local irritants such as dust, pollutants, or cigarette smoke should be removed. Symptomatic therapy for exacerbations in chronic bronchitis include bronchodilator therapy which may slow the decline of lung function in those 慢阻肺 patients who are bronchodilator responsive. Inhaled anticholinergic agents appear to produce greater bronchodilatation than inhaled ?-agonists. The role of long-acting inhaled ?-agonists is unclear but preliminary reports suggest that mild symptomatic improvement and small increases in pulmonary function are associated with their use (Balter and Grossman, 1997). Low-flow oxygen therapy should be administered if hypoxemia is present. It is important not to administer excess oxygen which may lead to progressive hypercapnia. The use of oral or IV corticosteroids is recommended for most patients with chronic bronchitis and demonstrable airflow obstruction during exacerbations. Although the optimal dose of corticosteroids is unknown, most clinicians prescribe prednisone in a daily dose of 30 to 40 mg, decreasing the dose to zero over the next 7 to 10 days. Theophylline products have less bronchodilator effect than ?2-agonists or anticholinergic agents (Balter and Grossman, 1997). * * * * 单用SABA或联用SAMA是临床上最常用的治疗方法（C类证据） 尚无临床研究评价单用LABA或联用ICS在AE慢阻肺中的作用 使用定量吸入装置（用或不用储雾罐）和雾化器对患者FEV1无显著差异，但后者可能对于重症患者来说使用更方便 静脉使用茶碱为二线用药，只用于短效支气管扩张剂疗效不佳的患者（B类证据） * 3％～5％的AE慢阻肺患者是由肺炎衣原体所致，AE慢阻肺 患者的肺炎衣原体感染率为60．9％，显著高于对照组(15．9％)，而慢阻肺稳定期患者的感染率为22．9％ 3％～5％的AE慢阻肺患者是由肺炎衣原体所致，AE慢阻肺 患者的肺炎衣原体感染率为60．9％，显著高于对照组(15．9％)，而慢阻肺稳定期患者的感染率为22．9％ 严重呼吸困难且具有呼吸肌疲劳或呼吸功增加的临床征象，或二者皆存在，如辅助呼吸肌的使用、腹部矛盾运动或肋间凹陷 * * * * * * * * 不推荐使用呼吸兴奋剂 * 机械通气支持 * .BMJ 2003;326:185. Am J Respir Crit Care Med 2000;161:1450-8. Am J Respir Crit Care Med 2001;163(1):283-91. 有创机械通气 （通过经口气管插管或气管切开） 无创通气 （通过鼻或面罩） 具有下列至少一项 呼吸性酸中毒（动脉pH≤7.35和/或PaCO2≥45 mmHg） 严重呼吸困难且具有呼吸肌疲劳或呼吸功增加的临床征象，或二者皆存在。 不能耐受NIV或NIV失败 呼吸或心跳骤停 呼吸暂停导致意识丧失或窒息 意识模糊、镇静无效