教学查房哮喘英文

TeachingwardroundAsthma MainContents CasereportChiefphysicianmakesupplementaryphysicianvisitsandmainchestexaminationforthepatientCorrectionofphysicianvisitsandexaminationintheexistingproblemsCasediscussion 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 Casediscussion TheDefinitionOfAsthma TheDefinitionOfAsthma Achronicinflammatorydiseaseoftherespiratorytract Manycellsandcellularcomponents Chronicinflammationinairwayofhighreactiveandrecurrentwheezingcough chesttightness andshortnessofbreath Extensive differentlevelsof usuallyreversibleairflowlimitation Casediscussion Whatcelebrityshaveasthma Attheageof42 forasthma diedinThailand Chiangmai OnMay8 in1995 Casediscussion ThePathogenesisOfAsthma Pathogenesis Associatedwithmanygenetic andatthesametimebythedualeffectsofgeneticfactorsandenvironmentalfactors ThePathogenesisOfAsthma GeneticfactorsEnvironmentalfactors Airwayhyperresponsiveness Airflowobstruction Riskfactors seizures symptoms Casediscussion ClinicalManifestations ClinicalManifestations symptoms Signs WheezingsoundChestistoomuchaircondition 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 Casediscussion Diagnosisstandardsofasthma Diagnosisstandardsofasthma symptomssignsrecoveredwaysexceptothercardiacandpulmonarydiseaseslungfunctionexamination untypicalasthma Lungfunctionsdiagnosisofasthma ObstructiveventilationinsufficiencyandreversibilityofairwayobstructionVariancerateofpeakexpiredflow 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 Casediscussion TheDifferentialDiagnosis TheDifferentialDiagnosis CardiacasthmaAhighheart 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 Casediscussion Whatisthetreatmentofbronchialasthma Drugsfortreatingasthma Glucocorticosteroid anti inflammation 2 agonisttheophyllinebronchodilatorsanticholinergicdrugnon steroidanti inflammations Drugtherapyofasthma快速缓解药物长期预防药物 短效吸入 2 激动剂吸入抗胆碱药短效口服 2 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 2 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 Steroidswithveininjection methylprednisonlone40411 hydroxide40 320Hydrocortison1002011 ketone100 1000dexamethason50 7511 ketone10 30 steroiddose dosecharacterdose d mg mg mg ControlDrug Long ActingBronchodilators Anticholinergicmedicines 2 agonists Non steroidanti inflammationdrugs Anti 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 Classificationof 2 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 ThePrognosisOfAsthma Rationaldruguse canreduceattackorheal Abouthalfofthechildren ortoadulthoodcancompleteremissionaftertreatment Unabletoremovethefactorssuchasinducedasthma asthmaattacksandincreaseagainandagain Statusasthmaticus suchasconcurrentemphysema