极光计划慢阻肺的定义诊断临.ppt

*****************************************************************************Thisslidehighlightsthefactthatbythetimemostpatientsreporttothedoctorwithsymptoms,慢阻肺canbequiteadvancedandsignificantdeteriorationinlungfunctionhasalreadyoccurred.Treatmentthereforecanoftenbestartedstraightaway.Thecourseof慢阻肺beginswithanasymptomaticphaseinwhichlungfunctiondeteriorateswithoutassociatedsymptoms.Symptomsgenerallydeveloponlyafterasignificantdeclineinforcedexpiratoryvolume(FEV1≤50%)hasoccurred,progressingaslungfunctiondeterioratesfurther.“Sincesubstantialdeteriorationinairflowhasalreadyoccurredbythetimemostpatientspresentwithsymptoms,itisreasonabletoconcludethatthedegreeofairflowlimitationisonlyoneofmanyfactorsthatgoverntheonsetofsymptoms”Reference:1.SutherlandERandCherniackRM.NewEnglJMed2004;350:2689-2697.***********Realizetheimportanceofhyperinflation.Barrel-shapedchest.EILV:吸气末肺容积，EELV（FRC,平静呼气末肺内残留的气体量）：呼气末肺容积RIV，inspiratoryreservevolum：补吸气容积,从平静吸气末开始进行最大吸气所能吸入的最大气体容量。SlideillustratesstatichyperinflationRepresentsincreaseinEELV(FRC),RVorairtrappingandTLCDuringavarietyofmaneuvers,e.g.exercise,ICcanbeusedtoassessEELVandquantitatethedegreeofhyperinflation***********诊断：对于临床上任何有呼吸困难、慢性咳嗽或多痰，和/或有危险因素接触史者，都应考虑慢阻肺的临床诊断。上述患者均应进行肺功能检查；吸入支气管扩张剂后FEV1/FVC70%表明存在气流受限，即可诊断为慢阻肺。但是根据2011GOLD的指导意见：现在对慢阻肺的诊断和分级，更多是根据患者具体的临床症状来区分的。等会我们后面会讲到。******指南修订根据肺功能，急性加重病史，症状评分将慢阻肺患者分为A、B、C和D4类。A肺功能分级（GOLD）Ⅰ-Ⅱ加重次数（每年）≤1mMRC≤1CAT10B肺功能分级（GOLD）Ⅰ-Ⅱ加重次数（每年）≤1mMRC1CAT≥10C肺功能分级（GOLD）Ⅲ-Ⅳ加重次数（每年）≥2mMRC≤1CAT10D肺功能分级（GOLD）Ⅲ-Ⅳ加重次数（每年）≥2mMRC1CAT≥10mMRC:呼吸困难量表,用于评估慢阻肺患者呼吸困难程度CAT:慢阻肺评估测试，主要用于对慢阻肺健康状况进行简便和可靠的评价*********