教学查房哮喘.英文PPT课件 46页

TeachingwardroundAsthma MainContentsCasereportChiefphysicianmakesupplementaryphysicianvisitsandmainchestexaminationforthepatientCorrectionofphysicianvisitsandexaminationintheexistingproblemsCasediscussion Casereport王钦平70yearsold379294主诉：反复发作性喘息14年，加重7天。肺功能：FEV1：31%，FEV1/FVC:96% Correctionofphysicianvisitsandexaminationintheexistingproblems CasediscussionTheDefinitionOfAsthma? Attheageof42,forasthma,diedinThailand,Chiangmai,OnMay8,in1995. CasediscussionThePathogenesisOfAsthma? PathogenesisAssociatedwithmanygenetic,andatthesametimebythedualeffectsofgeneticfactorsandenvironmentalfactors. ThePathogenesisOfAsthmaGeneticfactorsEnvironmentalfactorsAirwayhyperresponsivenessAirflowobstructionRiskfactors(seizures)symptoms CasediscussionClinicalManifestations? ClinicalManifestationssymptomsSigns喘息Wheezing呼吸困难Dyspnea咳嗽Cough胸闷ChestdistressWheezingsoundChestistoomuchaircondition.severeasthmawithoutwheezingsoundsilence.SeriousHROrthopnea端坐呼吸andheartrateincreasefast,pulsusparadoxus奇脉,cyanosis紫绀 ClinicalManifestationsThetypicalbronchialasthma:Attacks:recurrentofthebreathdifficultybreathing,thereisseasonal,associatedwithexogenousinhaledallergens,andlightnightheavyday.Diffuse:acuteonset,dualpulmonarydiffusewheezingsound,giveprioritytowithexpiratoryphase.Reversible:thesignsandsymptomscanalleviatebyoneself,fromallergensorapplicationafterbronchodilators. 典型支气管哮喘:攻击:复发性的呼吸呼吸困难,有季节性,与外生吸入过敏原有关,轻夜重天。扩散:急性发作,双肺弥漫性喘息的声音,以呼气为主的阶段。可逆:症状和体征可以自行缓解,从支气管扩张剂后过敏原或应用程序。 ClinicalManifestationsNotthetypicalbronchialasthma:paroxysmalbosomfrowstyorrefractorycough.咳嗽变异性哮喘 ClinicalManifestationsCriticalasthma(fatal):oftenreferredtoas"statusasthmaticus,"characterizedbydifficultybreathing,violetpurple,sweat,coldlimbs,pulsefinevelocity,bothlungswithwheezingsound.Canbethreateningthelifeofthepatient.Sosevereasthmaattacksisasthmaisoneofthemostcommonemergency. 重要的哮喘(致命的):通常被称为“积状态,表现为呼吸困难,紫紫,汗,冰冷的四肢,脉冲速度,两肺与喘息的声音。可以威胁病人的生命。严重哮喘是哮喘是最常见的一种紧急情况。 CasediscussionDiagnosisstandardsofasthma？ Diagnosisstandardsofasthmasymptomssignsrecoveredwaysexceptothercardiacandpulmonarydiseaseslungfunctionexamination→untypicalasthma LungfunctionsdiagnosisofasthmaObstructiveventilationinsufficiencyandreversibilityofairwayobstructionVariancerateofpeakexpiredflow(PEF)in24hours≥20%Bronchialchallengeispositive Lungfunctionsdiagnosisofasthma(1)FEV1<80%pre,FEV1/FVC%<70%bronchialdilationtestispositivePostFEV1-PreFEV1FEV1improvedrate＝×100%PreFEV1determinantstandard:FEV1improvedrate≥15％(+)FEV1improvedrate≥200ml Lungfunctionsdiagnosisofasthma(2)PEF<80％preandPEFvariancerate≥20％PEFmax–PEFminPEFvariancerate＝×100%1/2(PEFmax+PEFmin)Determinantstandard：PEFvariancerate(24h)≥20%(+) Lungfunctionsdiagnosisofasthma(2)PEFmeterPEFpredictedvalue Lungfunctionsdiagnosisofasthma(3)Bronchialchallengeispositivetherapeuticpropertiesforbidpropertiesmethodsdruginduce:methocholinerhistamineexerciseinduce 阻塞性通气不足和气道阻塞的可逆性方差过期峰值流速(PEF)24小时内≥20%支气管的挑战是积极的 CasediscussionTheDifferentialDiagnosis? TheDifferentialDiagnosisCardiacasthmaAhighheart,induction,rheumatichistory.Cough,pinkfoamsamplephlegm,widelydetectralesandwheezingsound.X-rayenlargedheartandpulmonaryedema.Lungfunction:restrictiveventilationdysfunction(ratherthantheairflowlimitation)Avoidusingepinephrine肾上腺素andmorphine吗啡.LungcancerBloodphlegmy,sputumfoundincancercells、Fiberlens,computedtomography(CT)Allergiclunginfiltrates. 心脏哮喘高心,感应,风湿性历史。咳嗽,粉红色泡沫样痰,广泛湿罗音和喘息的声音。x光放大心脏和肺水肿。肺功能:限制性通气功能障碍(而非气流限制)避免使用肾上腺素和吗啡。肺癌血痰,痰中发现癌细胞,纤维透镜、计算机断层扫描(CT)过敏性肺部浸润 CasediscussionWhatisthetreatmentofbronchialasthma? DrugsfortreatingasthmaGlucocorticosteroid－anti-inflammationβ2-agonisttheophyllinebronchodilatorsanticholinergicdrugnon-steroidanti-inflammations Drugtherapyofasthma快速缓解药物长期预防药物短效吸入β2-激动剂吸入抗胆碱药短效口服β2-激动剂全身性糖皮质激素短效茶碱吸入型糖皮质激素长效吸入β2-激动剂白三烯受体拮抗剂缓释茶碱吸入色甘酸钠尼多克罗米酮替酚 Steroidswithveininjectionmethylprednisonlone40411-hydroxide40～320Hydrocortison1002011-ketone100～1000dexamethason50.7511-ketone10～30steroiddose=dosecharacterdose/d(mg)(mg)(mg) ControlDrug-Long-ActingBronchodilatorsAnticholinergicmedicinesβ2-agonists Non-steroidanti-inflammationdrugsAnti-histamine：inhaler：色甘酸钠5mg×200oral：酮替酚、曲尼斯特息思敏、开瑞坦等LTsreceptorinhibitor：顺尔宁10mg×5 Classificationofβ2-agonsts(Politiek)3类起效慢作用时间短口服型特布他林口服型沙丁胺醇口服型福美特罗2类起效缓慢作用时间长吸入型沙美特罗口服型班布特罗4类起效快作用时间短吸入型特布他林吸入型沙丁胺醇1类起效快作用时间长吸入型福美特罗起效时间快慢短长作用维持时间快速缓解维持治疗 哮喘药物各种吸入剂型 ThePrognosisOfAsthmaRationaldruguse,canreduceattackorheal.Abouthalfofthechildren,ortoadulthoodcancompleteremissionaftertreatment.Unabletoremovethefactorssuchasinducedasthma,asthmaattacksandincreaseagainandagain.Statusasthmaticus,suchasconcurrentemphysema,corpulmonale,cardiopulmonaryfunctionnotentire,prognosisispoor,needtocontrolinatimelymanner. 合理用药,可以减少攻击或愈合。大约一半的儿童或成人可以完成治疗后缓解。无法删除等因素诱发哮喘,哮喘发作,增加一次又一次。积状态,必须及时加强治疗,如并发肺气肿、肺心病、心肺功能不全,预后差,需要及时的控制。 CommunityService Theresources《第八版内科学》2014GINA指南《内科学》 Thankyou!