英文班肺心病慢性阻塞性肺病.ppt

General introduction COPD慢性阻塞性肺病 Chronic bronchitis慢性支气管炎、Emphysema肺气肿 Pulmonary hypertension肺动脉高压 Chronic Cor Pulmonale慢性肺源性心脏病 Spirometry: Normal and COPD 吸入装置 吸入装置 Diagnosis History of illness Clinical manifestationssigns Pulmonary function: airflow limitation, hyperinflation, increased residual volume(FEV1/FVC70%, TLC 120%, RV/TLC 40%, DLco 80%) Lung CT Therapy Same as COPD Definition Cor pulmonale is an enlargement of the right ventricle due to derangements in the structure or function of the respiratory system. The enlargement may represent progressive right ventricular hypertrophy, right ventricular dilation, and eventual cardiac decompensation Treatment Cardiopulmonary compensatory phase Cardiopulmonary decompensatory phase Treaatment  Cardiopulmonary compensatory phase Avoid triggers for acute exacerbation Treatment of primary disease Treatment  Cardiopulmonary decompensatory phase Respiratory failure Right ventricular failure Complications Supportive therapy Morbidity COPD：84％ SEVERE TB： 5.9% ASTHMA： 4.4% BRONCHIECTASIS： 2.8% OTHERS： ～3％ Clinical Features Cardio-pulmonary compensatory phase Symptoms：chronic cough,sputum,dyspnea, exertional palpation, fatigue, exercise tolerance Signs：emphysema barrel chest,hyperresonance, liver dullness, cardiac dullness, respiratory sound, pulmonary hypertension: P2, tricuspid valve SM, jugular vein distension Respiratory failure: after acute respiratory infection，dyspnea, headach, insomnia, altered consciousness. Right hear failure：dyspnea, palpation, oliguria/cyanosis, abdominal distension, loss of appetite,nausea and vomiting。 Signs：Jugular vein distension, gallop, tricuspid SM, arrythmia, hepatomegaly, hepatojajular reflux+, edema and ascites Cyanosis Clinical Features Cardio-pulmonary decompensatory phase ECG Clockwise rotation of the electric axis with a mean QRS axis +90 P-pulmonale pattern (an increase in P-wave amplitude in II,