慢性阻塞性气道病的处理-课件
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病因学
Cigarette smoke 吸烟
stimulate macrophages 刺激巨噬细胞
neutrophil release 噬中性粒细胞释放
Antiprotease抗蛋白酶 (elastase inhibitor)弹性蛋白
酶抑制
lysosomal elastase 溶酶体弹性蛋白酶
1-antitrypsin Deficiency
抗胰蛋白酶失效
destroys
lung tissue 破坏肺组织
10
Smokers lung
Non-smoker’s lung
11
Pink Puffers
intense dyspnoea重度呼吸困 难
Thin消瘦 small sputum volume少痰
rarely develop peripheral oedema (heart failure)极少周 围性水肿（心衰）
• hyperinflated chest 胸部过度充气
13
Chronic bronchitis – pathology
慢支病理
hypertrophy of mucous glands (large bronchi)粘液腺（大气管）增生
chronic inflammatory changes (small airways)慢性炎症改变（小气道） initial changes are in the small airways,
COPD慢性阻塞性肺疾病
Chronic Airflow Limitation
CAL慢性气流受限
2
Obstruction of the airway:
Intra-luminal
Obstruction 内腔阻塞
Smooth muscle
Constriction 平滑肌限制
reduced radial traction 管腔半径减小
塞
21
22
Common symptoms of COAD: 慢性阻塞性气道病常见症状
increasing shortness of breath over several years进行性呼吸困难数年
Management of patients with
Chronic Obstructive Airways Disease 慢性阻塞性气道病的处理
1
Chronic Obstructive Airways Disease 慢性阻塞性气道病
Also known as Chronic Obstructive Pulmonary Disease
West 2008 P52 3
Definition
A chronic condition of diffuse airway narrowing causing increased resistance to airflow呼吸道慢性弥漫狭窄导致气流阻力增加
emphysema肺气肿 chronic bronchitis慢性支气管炎 mixture of both混合性
near normal blood gases近正 常血气
Spirometry肺功能测定
severe airways obstruction 严重呼吸道阻塞
increased TLC肺总量增加
12
Pink Puffers
• long thin mediastinum瘦长纵 隔
• flattened diaphragm 膈扁平
then progress to the larger bronchi小气 道先改变，后进展为大气管
14
Chronic bronchitis – etiology
病因学
Causes cigarette smoking
吸烟 air pollution空气
污染
15
Blue bloaters
Develop a pattern of breathing which sets up a back pressure in the lungs. 发展成肺部回压的呼吸模式
症
congested lung fields肺野膨胀
20
Signs & symptoms (chronic bronchitis)
症状体征
chronic cough with expectoration for years慢性咳嗽伴咳痰数年
purulent sputum脓痰 high incidence of heart failure多发心衰 poor blood gases血气交换差 severe airways obstruction严重呼吸道阻
West 2008 p566
Alveolar wall destruction 肺泡壁破坏
surface area for gas exchange 气体交换的表面积减小
7
8
Emphysematous lung 肺气肿肺
Normal lung 正常肺
9
Emphysema – Etiology
Poor blood gases with low oxygenation and a high CO2
血气交换差，低氧，高二氧化碳
16
17
Chronic bronchitis – pathology
病理
Characterized by: Expectoration of sputum oBiblioteka Baidu most
days for at least 3 months in the year for 2 successive years连续2年一年中 至少3个月咳痰
18
Peripheral oedema周围性水肿
19
Blue bloaters
signs of
heart failure心衰 Inflammation炎
4
Pink Puffer - emphysema
Blue Bloater – chronic
bronchitis
5
Emphysema – pathology
肺气肿病理
Enlargement of air spaces distal to the terminal bronchiole with destruction of their walls终末细支气管壁破坏致空气 空间增大
Cigarette smoke 吸烟
stimulate macrophages 刺激巨噬细胞
neutrophil release 噬中性粒细胞释放
Antiprotease抗蛋白酶 (elastase inhibitor)弹性蛋白
酶抑制
lysosomal elastase 溶酶体弹性蛋白酶
1-antitrypsin Deficiency
抗胰蛋白酶失效
destroys
lung tissue 破坏肺组织
10
Smokers lung
Non-smoker’s lung
11
Pink Puffers
intense dyspnoea重度呼吸困 难
Thin消瘦 small sputum volume少痰
rarely develop peripheral oedema (heart failure)极少周 围性水肿（心衰）
• hyperinflated chest 胸部过度充气
13
Chronic bronchitis – pathology
慢支病理
hypertrophy of mucous glands (large bronchi)粘液腺（大气管）增生
chronic inflammatory changes (small airways)慢性炎症改变（小气道） initial changes are in the small airways,
COPD慢性阻塞性肺疾病
Chronic Airflow Limitation
CAL慢性气流受限
2
Obstruction of the airway:
Intra-luminal
Obstruction 内腔阻塞
Smooth muscle
Constriction 平滑肌限制
reduced radial traction 管腔半径减小
塞
21
22
Common symptoms of COAD: 慢性阻塞性气道病常见症状
increasing shortness of breath over several years进行性呼吸困难数年
Management of patients with
Chronic Obstructive Airways Disease 慢性阻塞性气道病的处理
1
Chronic Obstructive Airways Disease 慢性阻塞性气道病
Also known as Chronic Obstructive Pulmonary Disease
West 2008 P52 3
Definition
A chronic condition of diffuse airway narrowing causing increased resistance to airflow呼吸道慢性弥漫狭窄导致气流阻力增加
emphysema肺气肿 chronic bronchitis慢性支气管炎 mixture of both混合性
near normal blood gases近正 常血气
Spirometry肺功能测定
severe airways obstruction 严重呼吸道阻塞
increased TLC肺总量增加
12
Pink Puffers
• long thin mediastinum瘦长纵 隔
• flattened diaphragm 膈扁平
then progress to the larger bronchi小气 道先改变，后进展为大气管
14
Chronic bronchitis – etiology
病因学
Causes cigarette smoking
吸烟 air pollution空气
污染
15
Blue bloaters
Develop a pattern of breathing which sets up a back pressure in the lungs. 发展成肺部回压的呼吸模式
症
congested lung fields肺野膨胀
20
Signs & symptoms (chronic bronchitis)
症状体征
chronic cough with expectoration for years慢性咳嗽伴咳痰数年
purulent sputum脓痰 high incidence of heart failure多发心衰 poor blood gases血气交换差 severe airways obstruction严重呼吸道阻
West 2008 p566
Alveolar wall destruction 肺泡壁破坏
surface area for gas exchange 气体交换的表面积减小
7
8
Emphysematous lung 肺气肿肺
Normal lung 正常肺
9
Emphysema – Etiology
Poor blood gases with low oxygenation and a high CO2
血气交换差，低氧，高二氧化碳
16
17
Chronic bronchitis – pathology
病理
Characterized by: Expectoration of sputum oBiblioteka Baidu most
days for at least 3 months in the year for 2 successive years连续2年一年中 至少3个月咳痰
18
Peripheral oedema周围性水肿
19
Blue bloaters
signs of
heart failure心衰 Inflammation炎
4
Pink Puffer - emphysema
Blue Bloater – chronic
bronchitis
5
Emphysema – pathology
肺气肿病理
Enlargement of air spaces distal to the terminal bronchiole with destruction of their walls终末细支气管壁破坏致空气 空间增大