环境保护管理文件汇编.ppt

SYMPTOMSofCHYESTDISORDERS（胸部疾病的症状）,Zhengcuixia,Cough(咳嗽),Aprotectivereflexthatuncommoninhealthypersonalcleansesecretion&foreignmaterialfromtheairwayInitiatedbymiscellaneousstimuliorbyvoluntaryexertion.Themostcommonrespiratorysymptom.,Coughreflex（咳嗽反射）,Afferentinform.from:ENT,trachea,bifurcationofthebronchi.skinofthefacepleuraIrritanttype:mechanical,chemical,inflammationAfferentfibers(vaguenerve)coughcenter.,Coughreflex（咳嗽反射）,Efferentsignalslarynx:glottiscloseoropenRelatingmuscles(diaphragm,chestwall,abdomen)Acoordinatedseriesofactiontoperformthecoughmovement.Deepinspirationexpirationeffortwithglottisclosed-glottisopenabruptlyhighvolocityofairflowbringsoutscreationsfromairways.,Influencingfactors（影响因素）,Supressedafferantorefferentnervefunction:coma,seniorageFailedglottisfunctionDiminishedmuscleforce:cachexy(恶液质）ObstructedairwayseeninsevereCOPDTracheaintubationChestorabdominalpainlimitcoughmovement,MainCauses（原因）,Airwayinfection&inflammationLungparenchymadisordersAirwaystimulationbychemicals&foreignmaterialPleural&chestwalldisordersCardiovascularabnormalitiesAfferentnervefiberOthercausesPsychiatriccough,Classification(分类）,Nonproduction(drycough，干咳)Expecteration(withsputum，咳痰),Clinicalappearanceincommondiseases（常见疾病中的临床表现）,AcuteinfectionorexasperationofchronicinfectiousillnesssNeoplasms：insidiouslyinitiationPleuraldiseaseCardiovasculardiseasesGeneraldiseaseaffectingtherespiratorysystem,Accompaniedsymptoms(伴随症状）,FeverChestpainDyspnea&wheezingSputumproduction,Complication（并发症）,CoughsyncopesyndromaFatigueFracturesduetoseverepersistentcoughPneumomediastinum,pneumothorax,andsubcutaneousemphysemaduetohighintrathoracicpressureduringcough.,Chroniccough(3weeks):,postualnasaldripsyndroma(鼻后滴漏综合征）coughtypeasthmasmokerPostURWinfectionGERD,Sputumexpecteration（咳痰）,Denoteairwaysecretionsbeingcoughedout.,Characters:mucoid,tenasious,purulent,bloodstained,withspecialodor,rusty,serousVolume:AccompaniedmanifestationSpecialconditions,Laboratoryexamination,RutineMicrobiologictest(includingculture&drugsensitivity)Cellular,Hemoptysis(咯血),Bloodoriginatebelowthelevelofthelarynxthatbeingcoughedout.UsuallybrightredDegrees:fromblood-tingedsputumtomassivegrossblood,evenleadingtoairwayocclusion(apnea)&shock.Thelatterismuchlessseen.,Commoncauses（常见原因）,Infectiousrespiratorydisease:bronchitis,bronchiectasis,TBNeoplasm:Cardiovasculardisease:MS,PE,PAH,deformityofbloodvesselsOtherlessseendiseaseleadingtohemoptysis：CTDs&hemologicdisorders.,Classification(分级),SmallamountModerateMassive(600ml/24hrs),Differentiatingfromhematemesis,Differentiatingfromupperairwaybleedingbyintenssiveinvestigationandexamination,PostnasalbleedingMouthandfarynxilmembranebleeding,Investigation,whethercoughedoutorvomittedoutVolume:howmuchTimedurationAnyaccompaniedappearances,investigation,Chestpain（胸痛）,Character（性质）Degree（强度）Location（部位）Reflection（牵涉痛）,Commoncauses,Cardiovascular&pulmonaryvascular(iscamic)PleuralChestwallEmanatingpainsofneighboringabnormalities,Cardiovascular（心血管）,LocationbluredpresslikediscomfortEradiationCardiavascular&pulmonaryvascularAngina,MI,aorticstenosis(ischemic),Myocarditis,pericarditis,(inflamation),Pleorial（胸膜