教学查房哮喘英文

TeachingwardroundAsthmaMainContentsCasereportChiefphysicianmakesupplementaryphysicianvisitsandmainchestexaminationforthepatientCorrectionofphysicianvisitsandexaminationintheexistingproblemsCasediscussionCasereport王钦平70yearsold379294主诉：反复发作性喘息14年，加重7天。肺功能：FEV1：31%，FEV1/FVC:96%CorrectionofphysicianvisitsandexaminationintheexistingproblemsCasediscussionTheDefinitionOfAsthma?TheDefinitionOfAsthmaAchronicinflammatorydiseaseoftherespiratorytract.Manycellsandcellularcomponents.Chronicinflammationinairwayofhighreactiveandrecurrentwheezingcough,chesttightness,andshortnessofbreath.Extensive,differentlevelsof,usuallyreversibleairflowlimitation.CasediscussionWhatcelebrityshaveasthma?Attheageof42,forasthma,diedinThailand,Chiangmai,OnMay8,in1995.CasediscussionThePathogenesisOfAsthma?PathogenesisAssociatedwithmanygenetic,andatthesametimebythedualeffectsofgeneticfactorsandenvironmentalfactors.吸入物：尘螨、花粉等感染：病毒、细菌等食物：鱼、虾、蛋、牛奶等药物：阿斯匹林与多基因遗传有关，同时受遗传因素和环境因素的双重影响等气候变化、运动ThePathogenesisOfAsthmaGeneticfactorsEnvironmentalfactors气道炎症气道炎症气道炎症气道炎症AirwayhyperresponsivenessAirflowobstructionRiskfactors(seizures)symptomsCasediscussionClinicalManifestations?ClinicalManifestationssymptomsSigns喘息Wheezing呼吸困难Dyspnea咳嗽Cough胸闷ChestdistressWheezingsoundChestistoomuchaircondition.severeasthmawithoutwheezingsoundsilence.SeriousHROrthopnea端坐呼吸andheartrateincreasefast,pulsusparadoxus奇脉,cyanosis紫绀ClinicalManifestationsNotthetypicalbronchialasthma:paroxysmalbosomfrowstyorrefractorycough.咳嗽变异性哮喘ClinicalManifestationsCriticalasthma(fatal):oftenreferredtoasstatusasthmaticus,characterizedbydifficultybreathing,violetpurple,sweat,coldlimbs,pulsefinevelocity,bothlungswithwheezingsound.Canbethreateningthelifeofthepatient.Sosevereasthmaattacksisasthmaisoneofthemostcommonemergency.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。CasediscussionDiagnosisstandardsofasthma？Diagnosisstandardsofasthmasymptomssignsrecoveredwaysexceptothercardiacandpulmonarydiseaseslungfunctionexamination→untypicalasthmaLungfunctionsdiagnosisofasthmaObstructiveventilationinsufficiencyandreversibilityofairwayobstructionVariancerateofpeakexpiredflow(PEF)in24hours≥20%BronchialchallengeispositiveLungfunctionsdiagnosisofasthma(1)FEV180%pre,FEV1/FVC%70%bronchialdilationtestispositivePostFEV1-PreFEV1FEV1improvedrate＝×100%PreFEV1determinantstandard:FEV1improvedrate≥15％(+)FEV1improvedrate≥200mlLungfunctionsdiagnosisofasthma(2)PEF80％preandPEFvariancerate≥20％PEFmax–PEFminPEFvariancerate＝×100%1/2(PEFmax+PEFmin)Determinantstandard：PEFvariancerate(24h)≥20%(+)Lungfunctionsdiagnosisofasthma(2)PEFmeterPEFpredictedvalueLungfunctionsdiagnosisofasthma(3)Bronchialchallengeispositivetherapeuticpropertiesforbidpropertiesmethodsdruginduce:methocholinerhistamineexerciseinduceCasediscussionTheDifferentialDiagnosis?TheDifferentialDiagnosisCardiacasthmaAhighheart,induction,rheumatichistory.Cough,pinkfoamsamplephlegm,widelydetectralesandwheezingsound.X-rayenlargedheartandpulmonaryedema.Lungfunction:restrictiveventilationdysfunction(ratherthantheairflowlimitation)Avoidusingepinephrine肾上腺素andmorphine吗啡.LungcancerBloodphlegmy,sputumfoundincancercells、Fiberlens,computedtomography(CT)Allergiclunginfiltrates.CasediscussionWhatisthetreatmentofbronchialasthma?DrugsfortreatingasthmaGlucocorticosteroid－anti-inflammationβ2-agonisttheophyllinebronchodilatorsanticholinergicdrugnon-steroidanti-inflammationsDrugtherapyofasthma快速缓解药物长期预防药物短效吸入β2-激动剂吸入抗胆碱药短效口服β2-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β2-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Steroidswithveininjectionmethylprednisonlone40411-hydroxide40～320Hydrocortison1002011-ketone100～1000dexamethason50.7511-ketone10～30steroiddose=dosecharacterdose/d(mg)(mg)(mg)ControlDrug-Long-ActingBronchodilatorsAnticholinergicmedicinesβ2-agonistsNon-steroidanti-inflammationdrugsAnti-histamine：inhaler：色甘酸钠5mg×200oral：酮替酚、曲尼斯特息思敏、开瑞坦等LTsreceptorinhibitor：顺尔宁10mg×5Classificationofβ2-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ThePrognosisOfAsthmaRationaldruguse,canreduceattackorheal.Abouthalfofthechildren,ortoadulthoodcancompleteremissionaftertreatment.Unabletoremovethefactorssuchasinducedasthma,asthmaattacksandincreaseagainandagain.Statusasthmaticus,suchasconcurrentemphysema,corpulmonale,cardiopulmonaryfunctionnotentire,prognosisispoor,needtocontrolinatimelymanner.CommunityServiceTheresources《第八版内科学》2014GINA指南《内科学》Thankyou!