内科英文版PPT文件格式下载.ppt

内科英文版PPT文件格式下载.ppt

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BackgroundofasthmaPrevalence：

intheworld:

1.61.6hundredmillionhundredmillioninChina:

inChina:

1133ininShenyangShenyang:

1.24:

1.24（19991999）GINA:

GINA:

GGloballobalInInitiativeforitiativeforAAsthmasthma（19941994）WHO/HLBIWHO/HLBIBronchialasthmaticdiagnosisguideline（Bronchialasthmaticdiagnosisguideline（19971997）ChineseMedicalAcademyChineseMedicalAcademyDefinitionsofasthmaChronicairwayinflammationBroncho-hyperresponsiveness,BHRAirflowlimitationMechanism:

allergytheoryantigenantigenagainatopyIgEantibodymastcells,basophilshistamineinflammatorymediaLTsPAFECPimmediateasthmaticreaction,IARbronchialsmoothmusclespasmairwaynarrowMechanism:

never-receptordisordertheoryadrenergicandcholinergicneroussystems,ACnon-adrenergicandnon-cholinergicneroussystems,NANCAC:

1-receptor、M1-、M3-receptorsexcitementNANC：

PS-receptorbronchialsmoothmusclecontractionAC:

-receptor、M2-receptorexcitementNANC:

VIPreceptorbronchialsmoothmuscledilationasthmaticairway:

a1、M1、M3、PS/、M2、VIPMechanism:

airwayinflammationtheoryantigenallergicairwayinflammation,AAIECPMBPinflammatorycellsinflammatorymediaLTsEOSPAFneutrophilslateasthmaticreaction,LARTlymphocyte（Th1/Th2）Th2cytokineIL-3、4、5，GM-CSFIgEacuteacuteinflammationinflammationchronicchronicinflammationinflammationairwayairwayremodellingremodellinginflammationcellsepitheliuminjurybronchialcontractionmucousedemaairwaysecretionairwaynarrowBHRairwayreversibilitysymptomsexacerbationcellproliferationexcellularbaseDiffermechanismsinacuteandchronicasthmaDiffermechanismsinacuteandchronicasthmaOthermechanisms:

inducedfactorsAllergen:

pollen,acarusinfection:

virusormycoplasmalinfectionclimateandphysicalandchemicalfactorsdrugs:

aspirininducedasthma,AIA-receptorinhibitorheredityGastroesophagealrefluxdisease,GERDPsychological,incretionfactors,sportsDiagnosisstandardsofasthmasymptomssignsrecoveredwaysexceptothercardiacandpulmonarydiseaseslungfunctionexaminationuntypicalasthmaUntypicalasthmaCoughvariantasthma,CAVAsthmawithgastroesphgealrefluxExerciseinducedasthma,EIADruginducedasthma,DIAOccupationalasthma,OALungfunctionsdiagnosisofasthmaObstructiveventilationinsufficiencyandreversibilityofairwayobstructionVariancerateofpeakexpiredflow（PEF）in24hours20%BronchialchallengeispositiveLungfunctionsdiagnosisofasthma

（1）FEVFEV1180%80%pre,FEVpre,FEV11/FVC%70%/FVC%70%bronchialdilationtestispositivebronchialdilationtestispositivePostFEVPostFEV11-PreFEV-PreFEV11FEVFEV11improvedrateimprovedrate100%100%PreFEVPreFEV11determinantstandard:

FEVdeterminantstandard:

FEV11improvedrateimprovedrate1515（+）（+）FEVFEV11improvedrateimprovedrate200200mlmlLungfunctionsdiagnosisofasthma

（2）PEFmeterPEFpredictedvalueLungfunctionsdiagnosisofasthma

（2）PEFPEF8080preandPEFvarianceratepreandPEFvariancerate2020PEFmaxPEFminPEFmaxPEFminPEFvarianceratePEFvariancerate100%100%1/2（1/2（PEFmax+PEFmin）PEFmax+PEFmin）DeterminantstandardDeterminantstandard：

PEFvariancerate（24h）PEFvariancerate（24h）20%（+）20%（+）Lungfunctionsdiagnosisofasthma（3）Bronchialchallengeispositivetherapeuticpropertiesforbidpropertiesmethodsdruginduce:

methocholinerhistamineexerciseinduceThestepsofchronicpersistentasthma分级分级分度分度喘息发作喘息发作夜间发作夜间发作日常活动日常活动FEV1PEF变异率变异率或或PEF1间歇发作间歇发作1次次/w2次次/m不受限不受限80%2次次/m发作时受限发作时受限80%20%31次次/w发作时受限发作时受限6080%2030%54重度持续重度持续症状持续症状持续频繁频繁受限受限30%ThestepsofacuteexacerbationasthmaThestepsofacuteexacerbationasthma临床特点临床特点临床特点临床特点轻度轻度轻度轻度中度中度中度中度重度重度重度重度危重度危重度危重度危重度气短气短气短气短步行步行步行步行,上楼时上楼时上楼时上楼时稍活动稍活动稍活动稍活动休息时休息时休息时休息时体位体位体位体位可平卧可平卧可平卧可平卧喜坐位喜坐位喜坐位喜坐位前弓位前弓位前弓位前弓位谈话方式谈话方式谈话方式谈话方式连续成句连续成句连续成句连续成句字段字段字段字段单词单词单词单词不能讲话不能讲话不能讲话不能讲话精神状态精神状态精神状态精神状态尚安静尚安静尚安静尚安静时焦虑烦躁时焦虑烦躁时焦虑烦躁时焦虑烦躁常焦虑烦躁常焦虑烦躁常焦虑烦躁常焦虑烦躁嗜睡嗜睡嗜睡嗜睡,意识障碍意识障碍意识障碍意识障碍出汗出汗出汗出汗无无无无有有有有大汗淋漓大汗淋漓大汗淋漓大汗淋漓呼吸频率呼吸频率呼吸频率呼吸频率轻度增加轻度增加轻度增加轻度增加增加增加增加增加3030次次次次/分分分分三凹征三凹征三凹征三凹征常无常无常无常无可有可有可有可有常有常有常有常有胸腹矛盾运动胸腹矛盾运动胸腹矛盾运动胸腹矛盾运动喘鸣音喘鸣音喘鸣音喘鸣音呼吸末期散在呼吸末期散在呼吸末期散在呼吸末期散在响亮弥漫响亮弥漫响亮弥漫响亮弥漫响亮弥漫响亮弥漫响亮弥漫响亮弥漫减弱或无减弱或无减弱或无减弱或无脉率脉率脉率脉率100120120次次次次/分分分分120120次次次次/次次次次,不规则不规则不规则不规则奇脉奇脉奇脉奇脉无无无无,10,25,25mmHgmmHg无无无无,呼衰呼衰呼衰呼衰用用用用22后后后后PEF70%50PEF70%5070%50%70%50%或或或或100100L/minL/minPaOPaO22正常正常正常正常60608080mmHg60mmHgmmHg60mmHgPaCOPaCO2245mmHg45mmHgSaOSaO2295%9195%9195%90%95%90%pHpH降低降低降低降低DistinguishingdiagnosisofasthmaCardiacasthmaCOPDUpperairwayobstruction（lungcancer）PulmonaryeosiniphilinfiltrationCorrelationbetweenasthmaandCOPDDiscriminationbetweenasthmaandCOPDDiscriminationbetweenasthmaandCOPDAsthmaCOPDAsthmaCOPD症状症状症状症状喘息喘息喘息喘息咳嗽痰咳嗽痰咳嗽痰咳嗽痰呼吸困难呼吸困难呼吸困难呼吸困难（休息或运动休息或运动休息或运动休息或运动）呼吸困难呼吸困难呼吸困难呼吸困难（伴随运动伴随运动伴随运动伴随运动）胸闷胸闷胸闷胸闷喘息喘息喘息喘息咳嗽咳嗽咳嗽咳嗽胸闷胸闷胸闷胸闷经常出现夜间症状经常出现夜间症状经常出现夜间症状经常出现夜间症状很少夜间症