教學(xué)查房哮喘英文

教學(xué)查房哮喘英文

MainContentsCasereportChiefphysicianmakesupplementaryphysicianvisitsandmainchestexaminationforthepatientCorrectionofphysicianvisitsandexaminationintheexistingproblemsCasediscussion

Casereport

王欽平70yearsold

379294主訴：反復(fù)發(fā)作性喘息14年，加重7天。肺功能：FEV1：31%，F(xiàn)EV1/FVC:96%Correctionofphysicianvisitsandexaminationintheexistingproblems

Casediscussion

TheDefinitionOfAsthma?TheDefinitionOfAsthma

Achronicinflammatorydiseaseoftherespiratorytract.Manycellsandcellularcomponents.

Chronicinflammationinairwayofhighreactiveandrecurrentwheezingcough,chesttightness,andshortnessofbreath.

Extensive,differentlevelsof,usuallyreversibleairflowlimitation.

Casediscussion

Whatcelebrityshaveasthma?Attheageof42,forasthma,diedinThailand,

Chiangmai,OnMay8,in1995.

Casediscussion

ThePathogenesisOfAsthma?

PathogenesisAssociatedwithmanygenetic,andatthesametimebythedualeffectsofgeneticfactorsandenvironmentalfactors.ThePathogenesisOfAsthma

Geneticfactors

EnvironmentalfactorsAirwayhyperresponsiveness

Airflowobstruction

Riskfactors(seizures)

symptoms

Casediscussion

ClinicalManifestations?

ClinicalManifestationssymptoms

Signs喘息Wheezing呼吸困難Dyspnea咳嗽Cough胸悶Chestdistress

WheezingsoundChestistoomuchaircondition.severeasthmawithoutwheezingsoundsilence.SeriousHROrthopnea端坐呼吸andheartrateincreasefast,pulsusparadoxus奇脈,cyanosis紫紺ClinicalManifestationsThetypicalbronchialasthma:

Attacks:recurrentofthebreathdifficultybreathing,thereisseasonal,associatedwithexogenousinhaledallergens,andlightnightheavyday.

Diffuse:acuteonset,dualpulmonarydiffusewheezingsound,giveprioritytowithexpiratoryphase.Reversible:thesignsandsymptomscanalleviatebyoneself,fromallergensorapplicationafterbronchodilators.

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,與外生吸入過敏原有關(guān),輕夜重天。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)張劑后過敏原或應(yīng)用程序。ClinicalManifestationsNotthetypicalbronchialasthma:paroxysmalbosomfrowstyorrefractorycough.

咳嗽變異性哮喘ClinicalManifestationsCriticalasthma(fatal):oftenreferredtoas"statusasthmaticus,"characterizedbydifficultybreathing,violetpurple,sweat,coldlimbs,pulsefinevelocity,bothlungswithwheezingsound.Canbethreateningthelifeofthepatient.Sosevereasthmaattacksisasthmaisoneofthemostcommonemergency.重要的哮喘(致命的):通常被稱為“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。可以威脅病人的生命。嚴(yán)重哮喘是哮喘是最常見的一種緊急情況。

Casediscussion

Diagnosisstandardsofasthma？Diagnosisstandardsofasthmasymptomssignsrecoveredwaysexceptothercardiacandpulmonarydiseaseslungfunctionexamination→untypicalasthmaLungfunctionsdiagnosisofasthmaObstructiveventilationinsufficiencyandreversibilityofairwayobstructionVariancerateofpeakexpiredflow(PEF)in24hours≥20%BronchialchallengeispositiveLungfunctionsdiagnosisofasthma(1)FEV1<80%pre,FEV1/FVC%<70%

bronchialdilationtestispositive

PostFEV1-PreFEV1FEV1improvedrate＝×100%PreFEV1determinantstandard:FEV1improvedrate≥15％(+)

FEV1improvedrate≥200mlLungfunctionsdiagnosisofasthma(2)PEF<80％preandPEFvariancerate≥20％

PEFmax–PEFminPEFvariancerate＝×100%1/2(PEFmax+PEFmin)Determinantstandard：PEFvariancerate(24h)≥20%(+)Lungfunctionsdiagnosisofasthma(2)PEFmeter

PEFpredictedvalue

Lungfunctionsdiagnosisofasthma(3)Bronchialchallengeispositivetherapeuticpropertiesforbidpropertiesmethodsdruginduce:methocholinerhistamineexerciseinduce

阻塞性通氣不足和氣道阻塞的可逆性方差過期峰值流速(PEF)24小時內(nèi)≥20%支氣管的挑戰(zhàn)是積極的

Casediscussion

TheDifferentialDiagnosis?TheDifferentialDiagnosis

Cardiacasthma

Ahighheart,induction,rheumatichistory.Cough,pinkfoamsamplephlegm,widelydetectralesandwheezingsound.X-rayenlargedheartandpulmonaryedema.Lungfunction:restrictiveventilationdysfunction(ratherthantheairflowlimitation)Avoidusingepinephrine腎上腺素andmorphine嗎啡.

LungcancerBloodphlegmy,sputumfoundincancercells、Fiberlens,computedtomography(CT)

Allergiclunginfiltrates.心臟哮喘高心,感應(yīng),風(fēng)濕性歷史?？人?粉紅色泡沫樣痰,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、計算機(jī)斷層掃描(CT)過敏性肺部浸潤C(jī)asediscussion

Whatisthetreatmentofbronchialasthma?DrugsfortreatingasthmaGlucocorticosteroid－anti-inflammationβ2-agonisttheophyllinebronchodilatorsanticholinergicdrugnon-steroidanti-inflammationsDrugtherapyofasthma

快速緩解藥物長期預(yù)防藥物短效吸入β2-激動劑吸入抗膽堿藥短效口服β2-激動劑全身性糖皮質(zhì)激素短效茶堿吸入型糖皮質(zhì)激素長效吸入β2-激動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Steroidswithveininjectionmethylprednisonlone40411-hydroxide40～320Hydrocortison1002011-ketone100～1000dexamethason50.7511-ketone10～30

steroiddose=dosecharacterdose/d(mg)(mg)(mg)ControlDrug-Long-ActingBronchodilators

Anticholinergicmedicines

β2-agonistsNon-steroidanti-inflammationdrugsAnti-histamine：inhaler：色甘酸鈉5mg×200oral：酮替酚、曲尼斯特息思敏、開瑞坦等LTsreceptorinhibitor：順爾寧10mg×5

Classificationofβ2-agonsts(Politiek)3類起效慢作用時間短口服型特布他林口服型沙丁胺醇口服型福美特羅2類起效緩慢作用時間長吸入型沙美特羅口服型班布特羅4類起效快作用時間短吸入型特布他林吸入型沙丁胺醇1類起效快作用時間長吸入型福美特羅起效時間快慢

短