copd基本认识与应用课件

ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 呼吸系统统的结结构 肺 气管 呼 吸 运 动 如 活 动 的 风 箱 气 管 ， 支 气 管 ， 肺 泡 好 像 枝 叶 繁 茂 的 大 树 ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 什么是COPD？ COPD定义义 是一种具有气流受限特征的肺部疾病； 气流受限不完全可逆、呈进进行性发发展; 与慢性支气管炎、肺气肿肿有密切关系。 （是导致COPD最常见的疾病） * 与肺部对香烟烟雾等有害气体或有害颗粒的 异常炎症反应有关； * 除肺脏外，也可引起全身不良反应。 ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” COPD的病理生理改变变 气道阻塞和气流受限，引起的阻塞性通气功能障碍 肺泡破坏，致使换换气功能障碍 缺氧，CO2 （低氧血症、高碳酸血症） 呼吸衰竭 肺源性心脏脏病 ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 咳嗽咳痰喘息 COPD主要症状表现现 进进行性加重 日积月累、病程漫长长 COPD标标志性症状：气短或呼吸困难难 ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” COPD对对健康生活的影响 反复发发作进进行性加重，整个病程花费费不亚亚于恶恶性肿肿 瘤； 疾病的进进行性发发展导导致肺功能破坏，稍有活动动就喘 憋加重；晚期，静息时时也可气促。严严重影响日常生活 ； 给给家庭和社会带带来不可估量的经济损经济损 失； COPD目前居全球死亡原因的第4位。 世界银行世界卫生组织 公布，至2020年， COPD将位居世界疾病经济负 担的第5位。 已引起政府卫生机构重视，纳入疾控慢病防控体系。 ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” COPD 卫卫生经济经济 学影响 ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” I级级 （轻轻度） F E V lF V C70 但F E V l80预计值预计值 级级 （中度） 50F E V 1 80预计值 级级 （重度） 30F E V 1 50预计值 级级 （极重度） F E V 130预计值 或F E V 150预计 值，伴有呼吸衰竭 COPD严严重程度分级级 肺功能检查检查 判断气流受限的客观观指标标 FEV1：第一秒用力呼气容积占预计值 百分比 FEV1/FVC：第一秒用力呼气容积占用力肺活量 百分比的降低（COPD的一项项敏感指标标） ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” COPD病程分期 COPD稳定期 COPD急性加重期 （ Acute Embittering Chronic Obstructive Pulmonary Disease，AECOPD） 家庭无创创通气 治疗疗的主要对对 象 引起COPD加重的最常见原因是： 感染 院内治疗疗：无创创通 气治疗疗的选择时选择时 机 ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” Global Strategy for the Diagnosis, Management, and Preventation of Chronic Obstructive Pulmonary Disease Gold Scientific Committee, NHLBI/WHO workshop summary, AJRCCM 2001 70% FEV1/FVC 30% 药药物治疗疗和肺康复 长长期氧疗疗 无创创机械通气 中度 气流受限加重 重度 严严重气流受限 轻轻度 轻轻度气流受限 随着疾病进展, 发生低氧血症和高碳酸血症. COPD治疗疗 ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” COPD稳稳定期治疗疗 治疗疗目的 患者咳嗽，咳痰 ，气短等症状稳 定或症状轻微。 4降低病死率 3改善活动能力 ，提高生活质量。 2缓解或阻止 肺功能下降。 1减轻症状 ，阻止病情发 展。 ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” COPD稳稳定期治疗疗 治疗疗方案 戒烟 防止粉尘烟雾有害气体吸入 抗胆碱药 2肾上腺素受体激动剂 茶碱类 祛痰药 环环境控制 提高生活质量和生存率，降低住院率 使用方法：流量1.0-2.0L/min，吸氧时间时间 15h/d 目的：SpO2 升至90%以上 支气管扩张药扩张药 不推荐长长期口服，建议议雾雾化吸入 长长期家庭氧疗疗（ LTOT） 目的：改善患者活动能力，提高生活质 量。 是稳定期重要的治疗手段 长长期吸入皮质质激素 康复治疗疗 均可使用 雾雾化器治疗疗 制氧机 ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 患者教育 提升信心；鼓励长期坚持治疗； 良好生活习惯；自我监测管理病情；定期随访 呼吸生理治疗 帮助咳嗽、清除分泌物 肌肉训练 适宜全身运动，呼吸操锻炼呼吸肌 长期无创通气 营养支持和心理指导 避免过高碳水化合物和过高热卡摄入 康复治疗疗 肺康复 ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 肺康复的定义义 美国NIH和康复医学研究中心： 对患者及其家庭能够继续实 施的 ，通过多种专业 的专家队伍协作，即 实施团队 医疗，为患者提供多方面的 医疗服务，目标是为患者在日常生活 中最大限度的自立，并最大限度的恢 复和维维持其社会活动动能力。 ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 肺康复治疗疗 呼吸运动训练动训练 法 : 体质弱者可在床上进行 ,体质较好者以立位锻炼为 好。 训练以腹式呼吸操为主：腹式呼吸是通过增强膈肌活动 ，增大通气 ，从而达 到改善肺功能的目的。患者可进行为期12周的康复锻炼,每周训练2次，锻炼结 束 前进行15min的放松训练。每次锻炼时间约为 0.5h。结束后进行评定。呼吸运动 宜在室外空气清新的处为好。 ( 1)卧位操 ：仰卧位 ，头部稍垫高 ，两手自然放于腹部。作腹式呼吸。吸气时力求胸部 不动而将腹部向前挺出 ；呼气时腹部尽量向内凹下。呼气用口 ，口唇缩起似吹口哨 状。 不用力地、缓慢地从齿缝 或唇间呼出 ，呼气要求比吸气长 1- 2倍 (即呼 :吸 =2- 3 1)。 (2)站立操 ：两手叉腰或双手置腹部 ，双足略向两侧开立。深呼气时两手压迫胸廓两侧 或压迫上腹部尽量使腹部凹陷 ，慢慢地将气呼出 ，吸气时头 向后微仰 ，两臂下垂 ，尽 量挺腹、吸气。 吸气时时鼓肚子呼气时瘪时瘪 肚子 ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 患者教育 提升信心；鼓励长期坚持治疗； 良好生活习惯；自我监测管理病情；定期随访 呼吸生理治疗 帮助咳嗽、清除分泌物 肌肉训练 适宜全身运动，呼吸操锻炼呼吸肌 长期无创通气 营养支持和心理指导 避免过高碳水化合物和过高热卡摄入 康复治疗疗 ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 长长期家庭无创创通气 哪些慢阻肺患者需要长期无创通气？ 无创通气能带来哪些好处？ 无创通气的治疗原理 如何选择 合适的呼吸机 进行家庭无创通气治疗时 ，应观 察哪些指标 如何选择 和佩戴合适鼻罩或面罩 呼吸机、鼻面罩及管道的使用保养 ConfidentialSector, MMMM dd, yyyy, Reference “This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it i