诊治的临床思维课件.ppt

* * * Fig. 1 Average central and peripheral airway retention curves of insoluble radio-labeled marker for chronic flow-limited COPD and healthy subjects. Regional analysis of mucociliary clearance evaluated by separating retention regions located during radio-gas ventilation scan into Central (inner, 30% of total region and centered over large central airways) and Peripheral (outer, remaining 70% of total region) Airways. The number of subjects studied as indicated and time zero was time of initial scan acquired immediately following inhalation and deposition of the radiomarker. The error bars represent standard error of the means. * 越来越多的研究表明：气道炎症发病的根本原因在于：各种原因导致MC系统功能障碍后，引起呼吸道内引流不畅、分泌物潴留等一系列病理变化，这些病理变化又进一步加重粘液纤毛系统的功能障碍，进而反复感染，致使炎症长期存在，疾病缠绵难愈。因此，在抗炎及抗菌治疗的同时，使用粘液纤毛清除系统功能恢复剂来恢复MC功能，实现通气引流，彻底打破炎症的恶性循环，成为眼下国内外学者关注的焦点。 采用什么方法进行物理治疗呢？有两个大类，一大类就是不需要仪器设备的，比如说：深呼吸的训练、拍背、震动背、体位的改变甚至让病人进行自主的引流。 * The NOTT1 and MRC studies2 included a total of 290 patients with COPD and a resting mean partial pressure of oxygen (PaO2) 60mmHg. Meta-analysis of these studies demonstrated an approximate 40% improvement in survival in patients given supplemental oxygen (relative risk [RR] for mortality=0.61; 95% confidence interval [CI]: 0.46, 0.82).3 In the NOTT study (n=203 patients), a significant (p=0.01) improvement in survival was observed for patients who received continuous oxygen therapy (mean 24-month mortality rate 22.4%) compared with those who received nocturnal oxygen therapy only (mean 24-month mortality rate 40.8%).1 The RR of death for patients receiving nocturnal oxygen therapy compared with those receiving continuous oxygen therapy was 1.94 (95% CI: 1.17, 3.24). In the MRC study (n=87 patients), there was a survival improvement over 5 years in those patients who received oxygen therapy compared with those who did not receive oxygen therapy.2 There was no difference in mortality for male patients in the oxygen therapy and control groups up to 500 days from start of treatment;