教学查房哮喘英文课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Teaching ward round,Asthma,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 ?,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,喘息,Wheezing,呼吸困难,Dyspnea,咳嗽,Cough,胸闷,Chest distress,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:病症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,symptoms,signs,recovered ways,except other cardiac and pulmonary diseases,lung function examinationuntypical asthma,Lung functions diagnosis of asthma,Obstructive ventilation insufficiency,and reversibility of airway obstruction,Variance 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 FEV1,FEV1improved rate, 100%,Pre FEV1,determinant standard:FEV1 improved rate,15(+),FEV1 improved rate,200,ml,Lung functions diagnosis of asthma(2),PEF ,80,pre and PEF variance rate,20,PEF max,PEF min,PEF 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 positive,therapeutic properties,forbid properties,methods drug induce:,methocholiner,histamine,exercise induce,阻塞性通气缺乏,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)防止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,-,agonist,theophylline bronchodilators,anticholinergic drug,non-steroid anti-inflammations,Drug therapy of asthma,快速缓解药物 长期预防药物,短效吸入 2-冲动剂,吸入抗胆碱药,短效口服 2-冲动剂,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-冲动剂,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,40320,Hydrocortison 100 20 11-ketone,1001000,dexamethason 5 0.75 11-ketone,10,30,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 5,mg200,oral,： 酮替酚、曲尼斯特,息思敏、开瑞坦等,LTs receptor inhibitor：,顺尔宁 10,mg5,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 emphysema, cor pulmonale,cardiopulmonary function not entire, prognosis is poor, need to control in a timely manner.,合理用药,可以减少攻击或愈合。大约一半的儿童或成人可以完成治疗后缓解。无法删除等因素诱发哮喘,哮喘发作,增加一次又一次。积状态,必须及时加强治疗,如并发肺气肿、肺心病、心肺功能不全,预后差,需要及时的控制。,Community Service,The resources,?第八版内科学?,2021GINA指南,?内科学?,Thank you!,