慢性阻塞性肺疾病COPD讲课研讨.ppt

* 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. * 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 patient to breathe in, which causes the sensation of breathlessness that typifies the disease. ODonnell DE, Webb K. The etiology of dyspnea during exercise in COPD. Pulmonary and Critical Care Update 14, Lesson 15./downloads/education/online/Vol14_13_18.pdf. Accessed 24 February 2004. * New * 随着认识的深入，对于COPD的理解不再局限于气道和肺。关于COPD营养不良的研究越来越受到重视。并且，近年来国外文献里提出了一个新的概念，叫做COPD的全身效应（systemic effects），全身效应比营养不良更进了一步。这个概念包括营养不良，表现为体重下降、人体组成改变。全身效应还包括为全身炎症反应、和骨骼肌功能障碍等等，以及心血管、神经和骨骼系统改变等等。目前国际上关于COPD全身效应的研究非常多，从基础、到临床都做了广泛而深入的研究。 * * * 血气分析: 轻、中度低氧血症，早期 COPD无高碳酸血症。病情进展，低氧血症加重，发生高碳酸血症。FEV１低于 1升时，高碳酸血症增加。 鉴别诊断-1： COPD 和支气管哮喘 COPD 支气管哮喘 中年起病 症状逐渐进展 长期吸烟史 运动后呼吸困难 气流受限大部分不可逆 发病年龄较轻(常在儿童期) 每日症状变化较大 症状好发于夜间和清晨 常伴有过敏、鼻炎和荨麻疹 哮喘家族史气流受限大部分可逆 （二）鉴别诊断 哮喘 致敏颗粒 COPD 毒性颗粒 哮喘性气道炎症 CD4+T淋巴细胞 嗜酸性粒细胞 COPD气道炎症 CD8+T淋巴细胞 巨噬细胞 嗜中性粒细胞 气流受限 完全可逆 不完全可逆 鉴别诊断-2：慢性阻塞性肺疾病和其他疾病 诊断 鉴别诊断要点 慢性阻塞性肺疾病 中年发病；症状缓慢