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1、上課名稱:心肺生理病理 阻塞性肺疾總論與慢性阻塞性肺疾(慢阻肺疾),高雄醫學大學 醫學院 呼吸治療學系 講師 附設中和紀念醫院 內科部 胸腔內科 主治醫師 王東衡 Phone: EXT. 5651 E-mail:。,時間地點:20120309 W1 1500-1650 CS601 對象:呼吸治療學系二年制在職專班3年級 課程:心肺病理生理學,Curriculum Title: Obstructive Pulmonary Diseases and Chronic Obstructive Pulmonary Diseases (COPD),上課名稱:心肺生理病理 阻塞性肺疾總論與慢性阻塞性肺疾(慢
2、阻肺疾),高雄醫學大學 醫學院 呼吸治療學系 講師 附設中和紀念醫院 內科部 胸腔內科 主治醫師 王東衡 Phone: EXT. 5651 E-mail:。,時間地點:20090313 W5 1300-1450 NB 116 對象:呼吸治療學系2年級 課程:心肺病理生理學,Curriculum Title: Obstructive Pulmonary Diseases and Chronic Obstructive Pulmonary Diseases (COPD),慢性阻塞性肺疾(慢阻肺疾) 症狀表徵 理學檢查 實驗室數據 影像學佐證 病理解剖實証 呼吸治療 肺量計檢查？ 支氣管擴張劑反應試
3、驗？,阻塞性肺疾總論：氣道阻塞 意義 種類 病理生理 呼吸治療的觀點,課程進度,學習目標study goals:,了解阻塞性肺疾與慢性阻塞性肺疾(慢阻肺疾)定義，介紹網路搜尋自學。了解阻塞性肺疾與慢性阻塞性肺疾(慢阻肺疾)病理解剖，病理生理變化。從構造層面了解阻塞性肺疾與慢性阻塞性肺疾(慢阻肺疾)病理解剖，病理生理變化。從發炎媒介質層面了解阻塞性肺疾與慢性阻塞性肺疾(慢阻肺疾)病理解剖，病理生理變化。從全身層面了解阻塞性肺疾與慢性阻塞性肺疾(慢阻肺疾)病理解剖，病理生理變化。鼓勵並回答提問，接受建議，當面溝通。,参考資料references:,CHAPTER 4: PATHOLOGY, PAT
4、HOGENESIS, AND PATHOPHYSIOLOGY GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR THE DIAGNOSIS, MANAGEMENT, AND PREVENTION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (2006) 2007年更新版慢性阻塞性肺病診治指引 台灣胸腔暨重症醫學會 Chronic obstructive pulmonary disease molecular and cellular mechanisms E
5、ur Respir J 2003 22 672 688 Airway dendritic cell phenotypes in inflammatory diseases of the human lung Eur Respir J 2007 30 878 886 Flow limitation and dynamic hyperinflation Eur Respir J 2005 25 186 199,KEY POINTS 1考試範圍:CHAPTER 4: PATHOLOGY, PATHOGENESIS, AND PATHOPHYSIOLOGY GLOBAL INITIATIVE FOR
6、CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR THE DIAGNOSIS, MANAGEMENT, AND PREVENTION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (2006) 2007年更新版慢性阻塞性肺病診治指引 台灣胸腔暨重症醫學會,Pathological changes characteristic of COPD are found in the proximal airways, peripheral airways, lung parenchyma, and pulmon
7、ary vasculature. These changes include chronic inflammation, and structural changes resulting from repeated injury and repair. COPD的病理變化特徵為呼吸道、肺實質以及肺血管慢性發炎以及反覆受傷和修補所造成之結構改變。 Inhaled cigarette smoke and other noxious particles cause lung inflammation, a normal response which appears to be amplified i
8、n patients who develop COPD. COPD病人對吸入香菸和有毒微粒所引起之炎性反應比常人嚴重。,KEY POINTS 2考試範圍:CHAPTER 4: PATHOLOGY, PATHOGENESIS, AND PATHOPHYSIOLOGY GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR THE DIAGNOSIS, MANAGEMENT, AND PREVENTION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (2006) 20
9、07年更新版慢性阻塞性肺病診治指引 台灣胸腔暨重症醫學會,There is a characteristic pattern of inflammation in the lungs of COPD patients, with increased numbers of neutrophils (in the airway lumen), macrophages (airway lumen, airway wall, and parenchyma), and CD8+ lymphocytes (airway wall and parenchyma). The pattern is differ
10、ent from that seen in asthma. COPD病人之炎性反應特徵是嗜中性球、巨噬細胞、CD8+淋巴球增加，其型態與哮喘不同。 Lung inflammation is further amplified by oxidative stress and an excess of proteases in the lung. 發炎氧化反應（oxidative stress）和過量蛋白酉每使肺部發炎更為嚴重。, Physiological changes characteristic of the disease include mucus hypersecretion, ai
11、rflow limitation and air trapping (leading to hyperinflation), gas exchange abnormalities, and cor pulmonale. COPD生理學變化特徵為黏液過度分泌、氣流受限、肺膨脹過度、氣體交換異常、肺心症(cor pulmonale)。 Systemic features of COPD, particularly in patients with severe disease, include cachexia, skeletal muscle wasting, increased risk of
12、 cardiovascular disease, anemia, osteoporosis, and depression. COPD之全身表現有惡體質（cachexia）、骨骼肌消耗、心血管疾病危險性增加、貧血、骨質疏鬆和憂鬱。 Exacerbations represent a further amplification of the inflammatory response in the airways of patients with COPD, and may be triggered by infection with bacteria or viruses or by envi
13、ronmental pollutants. COPD惡化可能由環境污染、細菌或病毒感染所引起，代表呼吸道發炎反應加劇。,KEY POINTS 3 考試範圍:CHAPTER 4: PATHOLOGY, PATHOGENESIS, AND PATHOPHYSIOLOGY GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR THE DIAGNOSIS, MANAGEMENT, AND PREVENTION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (2006) 2
14、007年更新版慢性阻塞性肺病診治指引 台灣胸腔暨重症醫學會,網路搜尋自學,網路搜尋自學,網路搜尋自學,網路搜尋自學,Figure 4. Small airway obstruction (A) Normal small airway. (B) Small airway containing plug of mucus with relatively few cells, which could have been produced in the glands of the larger airways and aspirated into the smaller airways. (C) Ac
15、utely inflamed airway with thickened wall in which the lumen is partly filled with an inflammatory exudate of mucus and cells, which has probably been produced in the small airway. (D) Airway surrounded by connective tissue, which appears as if it might restrict normal enlargement of the lumen and u
16、nfolding of the epithelial lining that occurs with lung inflation.,Pathophysiology of airflow limitation in chronic obstructive pulmonary disease Lancet 2004; 364: 70921,GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR THE DIAGNOSIS, MANAGEMENT, AND PREVENTION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (2006),GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR THE DIAGNOSIS, MANAGEMENT, AND PREVENTION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (2006),
