教學(xué)查房哮喘

1、TeachingwardroundAsthmaMainContentsCasereptChiefphysicianmakesupplementaryphysicianvisitsmainchestexaminationfthepatientCrectionofphysicianvisitsexaminationintheexistingproblemsCasediscussionCaserept王欽平70yearsold379294主訴

2、：反復(fù)發(fā)作性喘息14年，加重7天。肺功能：FEV1：31%，F(xiàn)EV1FVC:96%CrectionofphysicianvisitsexaminationintheexistingproblemsCasediscussionTheDefinitionOfAsthmaTheDefinitionOfAsthmaAchronicinflammatydiseaseoftherespiratytract.Manycellscellularcomp

3、onents.Chronicinflammationinairwayofhighreactiverecurrentwheezingcoughchesttightnessshtnessofbreath.Extensivedifferentlevelsofusuallyreversibleairflowlimitation.CasediscussionWhatcelebrityshaveasthmaAttheageof42fasthmadi

4、edinThailChiangmaiOnMay8in1995.CasediscussionThePathogenesisOfAsthmaPathogenesisAssociatedwithmanygeicatthesametimebythedualeffectsofgeicfactsenvironmentalfacts.ThePathogenesisOfAsthmaGeicfactsEnvironmentalfactsAirwayhyp

5、erresponsivenessAirflowobstructionRiskfacts(seizures)symptomsCasediscussionClinicalManifestationsClinicalManifestationssymptomsSignsWheezingsoundChestistoomuchaircondition.severeasthmawithoutwheezingsoundsilence.SeriousH

6、Rthopnea端坐呼吸heartrateincreasefastpulsusparadoxus奇脈cyanosis紫紺ClinicalManifestations?Thetypicalbronchialasthma:Attacks:recurrentofthebreathdifficultybreathingthereisseasonalassociatedwithexogenousinhaledallergenslightnight

7、heavyday.Diffuse:acuteonsetdualpulmonarydiffusewheezingsoundgivepriitytowithexpiratyphase.Reversible:thesignssymptomscanalleviatebyoneselffromallergensapplicationafterbronchodilats.?典型支氣管哮喘:攻擊:復(fù)發(fā)性的呼吸呼吸困難有季節(jié)性與外生吸入過(guò)敏原有關(guān)輕夜重

8、天。擴(kuò)散:急性發(fā)作雙肺彌漫性喘息的聲音以呼氣為主的階段。可逆:癥狀和體征可以自行緩解從支氣管擴(kuò)張劑后過(guò)敏原或應(yīng)用程序。ClinicalManifestations?Notthetypicalbronchialasthma:paroxysmalbosomfrowstyrefractycough.咳嗽變異性哮喘ClinicalManifestations?Criticalasthma(fatal):oftenreferredtoasstat

9、usasthmaticusacterizedbydifficultybreathingvioletpurplesweatcoldlimbspulsefinevelocitybothlungswithwheezingsound.Canbethreateningthelifeofthepatient.Sosevereasthmaattacksisasthmaisoneofthemostcommonemergency.重要的哮喘(致命的):通

10、常被稱為“積狀態(tài)表現(xiàn)為呼吸困難紫紫汗冰冷的四肢脈沖速度兩肺與喘息的聲音?？梢酝{病人的生命。嚴(yán)重哮喘是哮喘是最常見的一種緊急情況。CasediscussionDiagnosisstardsofasthma？Diagnosisstardsofasthmasymptomssignsrecoveredwaysexceptothercardiacpulmonarydiseaseslungfunctionexamination→untypical

11、asthmaLungfunctionsdiagnosisofasthmaObstructiveventilationinsufficiencyreversibilityofairwayobstructionVariancerateofpeakexpiredflow(PEF)in24hours≥20%BronchialchallengeispositiveLungfunctionsdiagnosisofasthma(1)FEV180%pr

12、eFEV1FVC%70%bronchialdilationtestispositivePostFEV1PreFEV1FEV1improvedrate＝100%PreFEV1determinantstard:FEV1improvedrate≥15％()FEV1improvedrate≥200mlLungfunctionsdiagnosisofasthma(2)PEF80％prePEFvariancerate≥20％PEFmax–PEFmi

13、nPEFvariancerate＝100%12(PEFmaxPEFmin)Determinantstard：PEFvariancerate(24h)≥20%()Lungfunctionsdiagnosisofasthma(2)PEFmeterPEFpredictedvalueLungfunctionsdiagnosisofasthma(3)Bronchialchallengeispositivetherapeuticproperties

14、fbidpropertiesmethodsdruginduce:methocholinerhistamineexerciseinduce阻塞性通氣不足和氣道阻塞的可逆性方差過(guò)期峰值流速(PEF)24小時(shí)內(nèi)≥20%支氣管的挑戰(zhàn)是積極的CasediscussionTheDifferentialDiagnosisTheDifferentialDiagnosisCardiacasthmaAhighheartinductionrheumatich

15、isty.Coughpinkfoamsamplephlegmwidelydetectraleswheezingsound.Xrayenlargedheartpulmonaryedema.Lungfunction:restrictiveventilationdysfunction(ratherthantheairflowlimitation)Avoidusingepinephrine腎上腺素mphine嗎啡.LungcancerBlood

16、phlegmysputumfoundincancercells、Fiberlenscomputedtomography(CT)Allergiclunginfiltrates.心臟哮喘高心感應(yīng)風(fēng)濕性歷史?？人苑奂t色泡沫樣痰廣泛濕羅音和喘息的聲音。x光放大心臟和肺水腫。肺功能:限制性通氣功能障礙(而非氣流限制)避免使用腎上腺素和嗎啡。肺癌血痰痰中發(fā)現(xiàn)癌細(xì)胞纖維透鏡、計(jì)算機(jī)斷層掃描(CT)過(guò)敏性肺部浸潤(rùn)C(jī)asediscussionWhatis

17、thetreatmentofbronchialasthmaDrugsftreatingasthmaGlucocticosteroid－antiinflammationβ2agonisttheophyllinebronchodilatsanticholinergicdrugnonsteroidantiinflammationsDrugtherapyofasthma快速緩解藥物長(zhǎng)期預(yù)防藥物短效吸入β2激動(dòng)劑吸入抗膽堿藥短效口服β2激動(dòng)劑全身

18、性糖皮質(zhì)激素短效茶堿吸入型糖皮質(zhì)激素長(zhǎng)效吸入β2激動(dòng)劑白三烯受體拮抗劑緩釋茶堿吸入色甘酸鈉尼多克羅米酮替酚Steroidswithveininjectionmethylprednisonlone40411hydroxide40～320Hydroctison1002011ketone100～1000dexamethason50.7511ketone10～30steroiddose=doseacterdosed(mg)(mg)(mg)Con

19、trolDrugLongActingBronchodilatsAnticholinergicmedicinesβ2agonistsNonsteroidantiinflammationdrugsAntihistamine：inhaler：色甘酸鈉5mg200al：酮替酚、曲尼斯特息思敏、開瑞坦等LTsreceptinhibit：順爾寧10mg5Classificationofβ2agonsts(Politiek)3類起效慢作用時(shí)間短口服型

20、特布他林口服型沙丁胺醇口服型福美特羅2類起效緩慢作用時(shí)間長(zhǎng)吸入型沙美特羅口服型班布特羅4類起效快作用時(shí)間短吸入型特布他林吸入型沙丁胺醇1類起效快作用時(shí)間長(zhǎng)吸入型福美特羅起效時(shí)間快慢短長(zhǎng)作用維持時(shí)間快速緩解維持治療哮喘藥物各種吸入劑型ThePrognosisOfAsthmaRationaldrugusecanreduceattackheal.Abouthalfofthechildrentoadulthoodcancompleteremis

21、sionaftertreatment.Unabletoremovethefactssuchasinducedasthmaasthmaattacksincreaseagainagain.Statusasthmaticussuchasconcurrentemphysemacpulmonalecardiopulmonaryfunctionnotentireprognosisisponeedtocontrolinatimelymanner.合理