Bronchitis 上海交通大学医学院课程慢性支气管炎上海交通大学医学院课程ppt课件.ppt

Oxygen Therapy Oxygen -- 15 h /d Long-term oxygen therapy (LTOT) improves survival,exercise,sleep and cognitive performance in patients with respiratory failure. The therapeutic goal is to maintain SaO2 ≥ 90% and PaO2 ≥ 60mmHg at sea level and rest . Long-term Oxygen therapy LTOT Indication: For patients with a PaO2 ≤ 55 mmHg or SaO2≤88% , with or without hypercapnia For patients with a PaO2 of 55~70（60）mmHg or SaO2≤89% as well as pulmonary hypertension / heart failure / polycythemia (hematocrit 55%) Pulmonary rehabilitation Nutrition Surgery: Bullectomy Lung volume reduction surgery(肺减容） Lung transplantation （肺移植） Manage exacerbation Identify the cause of exacerbation: Virus or Bacteria or Other uncertain reasons Assessment of severity: The proceeding history and disease must be considered and comparison is very important. Controlled oxygen therapy. Supplemental oxygen should be titrated to improve the patient’s hypoxemia. Adequate levels of oxygenation (PaO2 8.0 kPa, 60 mm Hg, or SaO2 90%) are easy to achieve in uncomplicated exacerbations, but CO2 retention can occur insidiously with little change in symptoms. Once oxygen is started, arterial rrr blood gases should be checked 30-60 minutes later to ensure satisfactory oxygenation without CO2 retention or acidosis. Oxygen therapy Bronchodilators : Increase dose and times properly Atomization and inhalation Glucocorticoids: Oral or intravenous glucocorticosteroids are recommended. Thirty to 40 mg of oral prednisolone daily for 7-10 days is effective and safe. Antibiotics Respiratory infection is the usual predisposing factor. It is advocated to select antibiotics according to culture of sputum and drug-sensitivity test. Mechanical Ventilation Noninvasive mechanical ventilation Invasive mechanical ventilation Others: Chronic Pulmonary Heart Disease Respiratory Department Renji Hospital DEFINITIONS Enlargemen