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1、慢性阻塞性肺疾病,Chronic Obstructive Pulmonary Disease,主讲：昆医2008级,护理实习生,目录 Contents,Contents,7.Diagnostic Highlights,8.Treatment Points,9.Nursing Diagnosis and Measures,10.Health Education,6.Laboratory Exam,一、什么是慢性阻塞性肺疾病（）？ 哪种人群更容易患？ 作为医护人员，我们应该如何诊断、治疗？ 作为新时代的护士，我们应该如何提供护理？,？,一、定义,简称慢阻肺，是一种具有气流受限特征的可以预防和治疗的
2、疾病，气流受限不完全可逆、呈进行性发展，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。,慢性阻塞性肺疾病（）,Chronic obstructive pulmonary disease:“COPD“, is a kind of very limited characteristics of airflow prevention and treatment of disease can be limited, air is not completely reversible, a progressive development, and lung to cigarette smoke
3、and other harmful gases or harmful particles inflammation of the abnormal.,二、病案介绍,姓名：郭其文 Name: Qiwen Guo,性别：男,Gender: Male,年龄：,Age:,入院诊断：慢性阻塞性肺疾病 Admitting Diagnosis：,现病史,患者二十余年来反复出现咳嗽、咯痰，无咯血及胸痛，无低热、盗汗。两天前受凉后再发咳嗽、咯痰，痰量多，为黄色粘痰，畏寒，感咽痛声嘶。查体：T：36.4 P：80次/分 R：19次/分 BP：126/72mmHg（卧位）,横隔下移，双肺纹理增多、肋间隙增宽增粗，肢
4、端发绀，可见桶状胸，确诊为“慢性阻塞性肺病”，2011年8月14日为进一步诊治收住院。,History of Present Illness:,、Cough, cough up phlegm，No hemoptysis，Sputum volume of yellow sputum, stick、No low heat, night sweats，Chills, feeling sore throat screamed、Every move down the double lung texture, increased, rib widened the gap thick, acromegaly
5、 cyanosis, visible barrel shaped the chest,三、病因,至今尚未完全阐明，多认为其发生是多种因素共同作用的结果。引起慢支的各种因素均可引起阻塞性肺气肿，如吸烟、感染、大气污染、职业性粉尘和有害气体的长期吸入、过敏等，其中吸烟尤为重要，故慢性阻塞性肺气肿实际上属于慢性支气管炎的并发症。,A.,B.,D.,Has not yet been fully elucidated, many believe that its occurrence is the result of many factors. Cause a variety of factors ca
6、n cause chro-nic bronchitis emphysema, such as infection, smoking, air pollution, occupational dust and harmful gases long-term inhalation, allergies, etc., of which smoking is particularly important, it actually belongs to bronchitis.chronic obstructive pulmonary emphysema complications of chronic,
7、 Etiology,四、发病机制,1.吸烟 Smoking 2.弹性蛋白酶及其抑制因子的失衡 Elastase proteas and inhibitor imbalance 3.肺组织弹性减退Decreased lung tissue elasticity 4.小气管的不完全阻塞 Small airway obstruction is not completely,5.职业性粉尘和化学物质 6.空气污染 Air pollution7.感染 Infection8.其他 Other, Pathogenesis,Professional dust andchemical substance,五、临
8、床表现：症状,慢性咳嗽：晨间明显，白天较轻，睡眠时有阵咳或排痰,Chronic cough:The morning light, and the days are obvious, a cough or sleep in row sputum.,咳痰：为白色粘液或浆液性泡沫痰，偶可带血丝急性发作伴细菌感染时，痰量增多，可有脓性痰Sputum: It is white mucus or serous Frothy sputum, with blood occasionly. Acute attack with bacterial infections and sputum volume incr
9、eased.It can have a purulent sputum.,临床表现：症状,气短或呼吸困难：仅在体力劳动或上楼等活动时出现，病情重时日常活动也能感到气促是的标志症状Shortness of breath or breathing difficulties: Only in the physical labor or go upstairs and other activities when the illness weight daily activities, when also can feel shortness of breath which is the sign of
10、 COPD symptoms.,临床表现：症状,喘息和胸闷：重度病人或急性加重时出现喘息Breathing and chest tightness: serious patients or acute exacerbation when the breathing hard.,其他：晚期病人有体重下降，食欲减退等全身症状Other: Late patients have weight loss, systemic symptom such as anorexia.,临床表现：症状,What are the signs of COPD? The signs of COPD include:,六、
11、体征 Signs,、疾病中后期随疾病可出现：the disease can occur in the late with the disease: 视诊 桶状胸，呼吸浅快，严重者可有缩唇呼吸。 visual examination:barrel chest, rapid shallow breathing, severe cases may have reduced lip breathing,触诊：触觉语颤减弱或消失。 Palpation: Tactile fremitus weakened or disappeared,听诊：两肺呼吸音减弱，呼气延长，部分病人可闻及干性啰音和（或）湿性啰音
12、。 Auscultation: diminished breath sounds lungs, breath longer, some patients can be heard and dry La tone (or) moist rales.,体征,叩诊:呈过清音，心浊音界缩小，肺下界和肝浊界下降。Percussion: was too voiceless, voiced sector reduced heart, lung and liver cloud sector lower bound down.,体征,COPD严重程度分级,分级,0级：高危,级(中度),级(重度),IV(极重度)
13、,Grading,Zore:High-risk, level (moderate), grade (severe),IV (very severe),七、实验室检查,1、肺功能检查： （）FEV1下降（正常83%） （）FEV1/FVC下降（60）最敏感 （） RV升高 （）RV/TLC升高（40%）最有诊断价值,1、 Pulmonary function tests:,（） FEV1decreased ( normal 83%),（） FEV1 / FVC decreased ( 60 %) is the most sensitive,（）RV elevation,（） RV / TLC e
14、levated ( 40% ) have the most diagnostic value,2、 X线检查 X line check,慢阻肺早期X线胸片可无明显变化，以后出现肺纹理增多、紊乱等非特征性改变；,COPD early chest radiograph may be no obvious change, later increased lung markings, disorder and other non-characteristic changes;,实验室检查,3 、动脉血气分析,血气异常首先表现为轻、中度低氧血症。随疾病进展，低氧血症逐渐加重，并出现高碳酸血症，呼吸衰竭的
15、血气诊断标准为静息状态下海平面吸空气时动脉血氧分压（PaO2）60mm Hg伴或不伴动脉血二氧化碳分压（PaCO2）增高50mm Hg。,实验室检查,espiratory failure blood diagnostic criteria for resting state sea level suction air arterial partial pressure of oxygen ( PaO2 ) 50mm Hg.,arterial blood gas analysis：,COPD laboratory tests,4 、其他,并发感染时痰涂片可见大量中性粒细胞，痰培养可检出各种病原菌，常见者为肺炎链球菌、流感嗜血杆菌、卡他莫拉菌、肺炎克雷伯杆菌等。,实验室检查,The other：Complicated infection sputum smear revealed numerous neutrophils, sputum culture can be found in various pathogens, common for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella, pneumonia bacteria Mora Cray s bacillus,
