教學(xué)查房哮喘英文

教學(xué)查房哮喘英文

MainContentsCasereportChiefphysicianmakesupplementaryphysicianvisitsandmainchestexaminationforthepatientCorrectionofphysicianvisitsandexaminationintheexistingproblemsCasediscussion

Casereport

王欽平70yearsold

379294主訴：反復(fù)發(fā)作性喘息14年，加重7天。肺功能：FEV1：31%，F(xiàn)EV1/FVC:96%Correctionofphysicianvisitsandexaminationintheexistingproblems

Casediscussion

TheDefinitionOfAsthma?TheDefinitionOfAsthma

Achronicinflammatorydiseaseoftherespiratorytract.Manycellsandcellularcomponents.

Chronicinflammationinairwayofhighreactiveandrecurrentwheezingcough,chesttightness,andshortnessofbreath.

Extensive,differentlevelsof,usuallyreversibleairflowlimitation.

Casediscussion

Whatcelebrityshaveasthma?Attheageof42,forasthma,diedinThailand,

Chiangmai,OnMay8,in1995.

Casediscussion

ThePathogenesisOfAsthma?

PathogenesisAssociatedwithmanygenetic,andatthesametimebythedualeffectsofgeneticfactorsandenvironmentalfactors.ThePathogenesisOfAsthma

Geneticfactors

EnvironmentalfactorsAirwayhyperresponsiveness

Airflowobstruction

Riskfactors(seizures)

symptoms

Casediscussion

ClinicalManifestations?

ClinicalManifestationssymptoms

Signs喘息Wheezing呼吸困難Dyspnea咳嗽Cough胸悶Chestdistress

WheezingsoundChestistoomuchaircondition.severeasthmawithoutwheezingsoundsilence.SeriousHROrthopnea端坐呼吸andheartrateincreasefast,pulsusparadoxus奇脈,cyanosis紫紺ClinicalManifestationsThetypicalbronchialasthma:

Attacks:recurrentofthebreathdifficultybreathing,thereisseasonal,associatedwithexogenousinhaledallergens,andlightnightheavyday.

Diffuse:acuteonset,dualpulmonarydiffusewheezingsound,giveprioritytowithexpiratoryphase.Reversible:thesignsandsymptomscanalleviatebyoneself,fromallergensorapplicationafterbronchodilators.

典型支氣管哮喘:攻擊:復(fù)發(fā)性的呼吸呼吸困難,有季節(jié)性,與外生吸入過敏原有關(guān),輕夜重天。擴(kuò)散:急性發(fā)作,雙肺彌漫性喘息的聲音,以呼氣為主的階段。可逆:癥狀和體征可以自行緩解,從支氣管擴(kuò)張劑后過敏原或應(yīng)用程序。ClinicalManifestationsNotthetypicalbronchialasthma:paroxysmalbosomfrowstyorrefractorycough.

咳嗽變異性哮喘ClinicalManifestationsCriticalasthma(fatal):oftenreferredtoas"statusasthmaticus,"characterizedbydifficultybreathing,violetpurple,sweat,coldlimbs,pulsefinevelocity,bothlungswithwheezingsound.Canbethreateningthelifeofthepatient.Sosevereasthmaattacksisasthmaisoneofthemostcommonemergency.重要的哮喘(致命的):通常被稱為“積狀態(tài),表現(xiàn)為呼吸困難,紫紫,汗,冰冷的四肢,脈沖速度,兩肺與喘息的聲音?？梢酝{病人的生命。嚴(yán)重哮喘是哮喘是最常見的一種緊急情況。

Casediscussion

Diagnosisstandardsofasthma？Diagnosisstandardsofasthmasymptomssignsrecoveredwaysexceptothercardiacandpulmonarydiseaseslungfunctionexamination→untypicalasthmaLungfunctionsdiagnosisofasthmaObstructiveventilationinsufficiencyandreversibilityofairwayobstructionVariancerateofpeakexpiredflow(PEF)in24hours≥20%BronchialchallengeispositiveLungfunctionsdiagnosisofasthma(1)FEV1<80%pre,FEV1/FVC%<70%

bronchialdilationtestispositive

PostFEV1-PreFEV1FEV1improvedrate＝×100%PreFEV1determinantstandard:FEV1improvedrate≥15％(+)

FEV1improvedrate≥200mlLungfunctionsdiagnosisofasthma(2)PEF<80％preandPEFvariancerate≥20％

PEFmax–PEFminPEFvariancerate＝×100%1/2(PEFmax+PEFmin)Determinantstandard：PEFvariancerate(24h)≥20%(+)Lungfunctionsdiagnosisofasthma(2)PEFmeter

PEFpredictedvalue

Lungfunctionsdiagnosisofasthma(3)Bronchialchallengeispositivetherapeuticpropertiesforbidpropertiesmethodsdruginduce:methocholinerhistamineexerciseinduce

阻塞性通氣不足和氣道阻塞的可逆性方差過期峰值流速(PEF)24小時(shí)內(nèi)≥20%支氣管的挑戰(zhàn)是積極的

Casediscussion

TheDifferentialDiagnosis?TheDifferentialDiagnosis

Cardiacasthma

Ahighheart,induction,rheumatichistory.Cough,pinkfoamsamplephlegm,widelydetectralesandwheezingsound.X-rayenlargedheartandpulmonaryedema.Lungfunction:restrictiveventilationdysfunction(ratherthantheairflowlimitation)Avoidusingepinephrine腎上腺素andmorphine嗎啡.

LungcancerBloodphlegmy,sputumfoundincancercells、Fiberlens,computedtomography(CT)

Allergiclunginfiltrates.心臟哮喘高心,感應(yīng),風(fēng)濕性歷史?？人?粉紅色泡沫樣痰,廣泛濕羅音和喘息的聲音。x光放大心臟和肺水腫。肺功能:限制性通氣功能障礙(而非氣流限制)避免使用腎上腺素和嗎啡。肺癌血痰,痰中發(fā)現(xiàn)癌細(xì)胞,纖維透鏡、計(jì)算機(jī)斷層掃描(CT)過敏性肺部浸潤(rùn)C(jī)asediscussion

Whatisthetreatmentofbronchialasthma?DrugsfortreatingasthmaGlucocorticosteroid－anti-inflammationβ2-agonisttheophyllinebronchodilatorsanticholinergicdrugnon-steroidanti-inflammationsDrugtherapyofasthma

快速緩解藥物長(zhǎng)期預(yù)防藥物短效吸入β2-激動(dòng)劑吸入抗膽堿藥短效口服β2-激動(dòng)劑全身性糖皮質(zhì)激素短效茶堿吸入型糖皮質(zhì)激素長(zhǎng)效吸入β2-激動(dòng)劑白三烯受體拮抗劑緩釋茶堿吸入色甘酸鈉尼多克羅米酮替酚Steroidswithveininjectionmethylprednisonlone40411-hydroxide40～320Hydrocortison1002011-ketone100～1000dexamethason50.7511-ketone10～30

steroiddose=dosecharacterdose/d(mg)(mg)(mg)ControlDrug-Long-ActingBronchodilators

Anticholinergicmedicines

β2-agonistsNon-steroidanti-inflammationdrugsAnti-histamine：inhaler：色甘酸鈉5mg×200oral：酮替酚、曲尼斯特息思敏、開瑞坦等LTsreceptorinhibitor：順爾寧10mg×5

Classificationofβ2-agonsts(Politiek)3類起效慢作用時(shí)間短口服型特布他林口服型沙丁胺醇口服型福美特羅2類起效緩慢作用時(shí)間長(zhǎng)吸入型沙美特羅口服型班布特羅4類起效快作用時(shí)間短吸入型特布他林吸入型沙丁胺醇1類起效快作用時(shí)間長(zhǎng)吸入型福美特羅起效時(shí)間快慢

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