教学查房哮喘.英文.

Teaching ward roundAsthma,Main Contents,Case report Chief physician make supplementary physician visits and main chest examination for the patient Correction of physician visits and examination in the existing problems Case discussion,Case report,王钦平 70 years old 379294主诉：反复发作性喘息14年，加重7天。肺功能：FEV1：31%，FEV1/FVC:96%,Correction of physician visits and examination in the existing problems,Case discussion,The Definition Of Asthma ?,The Definition Of Asthma,A chronic inflammatory disease of the respiratory tract .Many cells and cellular components. Chronic inflammation in airway of high reactive and recurrent wheezing cough, chest tightness, and shortness of breath. Extensive, different levels of, usually reversible airflow limitation .,Case discussion,What celebritys have asthma ?,At the age of 42 , for asthma , died in Thailand, Chiang mai, On May 8, in 1995 .,Case discussion,The Pathogenesis Of Asthma ?,Pathogenesis,Associated with many genetic, and at the same time by the dual effects of genetic factors and environmental factors .,The Pathogenesis Of Asthma,Genetic factors Environmental factors,Airway hyper responsiveness,Airflow obstruction,Risk factors (seizures),symptoms,Case discussion,Clinical Manifestations ?,Clinical Manifestations,symptoms,Signs,Wheezing sound Chest is too much air condition .severe asthma without wheezing sound silence .Serious HR Orthopnea端坐呼吸 and heart rate increase fast, pulsus paradoxus奇脉, cyanosis 紫绀,Clinical Manifestations, The typical bronchial asthma: Attacks: recurrent of the breath difficulty breathing, there is seasonal, associated with exogenous inhaled allergens, and light night heavy day. Diffuse: acute onset, dual pulmonary diffuse wheezing sound, give priority to with expiratory phase. Reversible: the signs and symptoms can alleviate by oneself, from allergens or application after bronchodilators.,典型支气管哮喘:攻击:复发性的呼吸呼吸困难,有季节性,与外生吸入过敏原有关,轻夜重天。扩散:急性发作,双肺弥漫性喘息的声音,以呼气为主的阶段。可逆:症状和体征可以自行缓解,从支气管扩张剂后过敏原或应用程序。,Clinical Manifestations,Not the typical bronchial asthma: paroxysmal bosom frowsty or refractory cough .,咳嗽变异性哮喘,Clinical Manifestations, Critical asthma (fatal) : often referred to as status asthmaticus, characterized by difficulty breathing, violet purple, sweat, cold limbs, pulse fine velocity, both lungs with wheezing sound. Can be threatening the life of the patient. So severe asthma attacks is asthma is one of the most common emergency.,重要的哮喘(致命的):通常被称为“积状态,表现为呼吸困难,紫紫,汗,冰冷的四肢,脉冲速度,两肺与喘息的声音。可以威胁病人的生命。严重哮喘是哮喘是最常见的一种紧急情况。,Case discussion,Diagnosis standards of asthma？,Diagnosis standards of asthma,symptomssignsrecovered waysexcept other cardiac and pulmonary diseaseslung function examinationuntypical asthma,Lung functions diagnosis of asthma,Obstructive ventilation insufficiency and reversibility of airway obstructionVariance rate of peak expired flow (PEF) in 24 hours 20%Bronchial challenge is positive,Lung functions diagnosis of asthma(1),FEV1 80 % pre, FEV1/FVC% 70 % bronchial dilation test is positive Post FEV1 - Pre FEV1FEV1improved rate 100% Pre FEV1determinant standard:FEV1 improved rate15(+) FEV1 improved rate200ml,Lung functions diagnosis of asthma(2),PEF 80pre and PEF variance rate 20 PEF max PEF minPEF variance rate 100% 1/2( PEF max + PEF min )Determinant standard：PEF variance rate(24h) 20% (+),Lung functions diagnosis of asthma(2),PEF meter PEF predicted value,Lung functions diagnosis of asthma(3),Bronchial challenge is positivetherapeutic propertiesforbid propertiesmethods drug induce: methocholiner histamine exercise induce,阻塞性通气不足和气道阻塞的可逆性方差过期峰值流速(PEF)24小时内20%支气管的挑战是积极的,Case discussion,The Differential Diagnosis ?,The Differential Diagnosis,Cardiac asthma A high heart, induction, rheumatic history .Cough, pink foam sample phlegm, widely detect rales and wheezing sound . X-ray enlarged heart and pulmonary edema . Lung function: restrictive ventilation dysfunction (rather than the airflow limitation) Avoid using epinephrine肾上腺素 and morphine吗啡. Lung cancer Blood phlegmy, sputum found in cancer cells、Fiber lens, computed tomography (CT) Allergic lung infiltrates .,心脏哮喘高心,感应,风湿性历史。咳嗽,粉红色泡沫样痰,广泛湿罗音和喘息的声音。x光放大心脏和肺水肿。肺功能:限制性通气功能障碍(而非气流限制)避免使用肾上腺素和吗啡。肺癌血痰,痰中发现癌细胞,纤维透镜、计算机断层扫描(CT)过敏性肺部浸润,Case discussion,What is the treatment of bronchial asthma ?,Drugs for treating asthma,Glucocorticosteroid anti-inflammation 2-agonisttheophylline bronchodilatorsanticholinergic drugnon-steroid anti-inflammations,Drug therapy of asthma 快速缓解药物 长期预防药物,短效吸入 2-激动剂吸入抗胆碱药短效口服 2-激动剂全身性糖皮质激素短效茶碱,吸入型糖皮质激素长效吸入 2-激动剂白三烯受体拮抗剂缓释茶碱吸入色甘酸钠尼多克罗米酮替酚,Steroids with vein injection,methylprednisonlone 40 4 11-hydroxide 40320Hydrocortison 100 20 11-ketone 1001000dexamethason 5 0.75 11-ketone 1030,steroid dose =dose character dose/d (mg) (mg) (mg),Control Drug - Long-Acting Bronchodilators,Anticholinergic medicines 2- agonists,Non-steroid anti-inflammation drugs,Anti-histamine ：inhaler：色甘酸钠 5mg200 oral ： 酮替酚、曲尼斯特 息思敏、开瑞坦等LTs receptor inhibitor： 顺尔宁 10mg5,Classification of 2-agonsts (Politiek),3类起效慢 作用时间短口服型特布他林口服型沙丁胺醇口服型福美特罗,2类起效缓慢 作用时间长吸入型沙美特罗口服型班布特罗,4类起效快 作用时间短吸入型特布他林吸入型沙丁胺醇,1类起效快 作用时间长吸入型福美特罗,起效时间,快,慢,短 长 作用维持时间,快速缓解,维持治疗,哮喘药物各种吸入剂型,The Prognosis Of Asthma,Rational drug use, can reduce attack or heal. About half of the children, or to adulthood can complete remission after treatment. Unable to remove the factors such as induced asthma, asthma attacks and increase again and again.Status asthmaticus, such as concurrent e