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13. 慢性阻塞性肺疾病急性加重
概 述
慢性阻塞性肺疾病(COPD)是一组具有气流受限特征的疾病,气流受限不完全可逆,呈进行性发展,可分为慢性阻塞性肺疾病急性加重期(AECOPD)与稳定期。在疾病过程中,患者呼吸困难、咳嗽、咳痰症状在基线水平上急性加重,痰量增多,呈脓性或者黏液脓性,需要调整治疗方案时,称为COPD急性加重。急性加重的原因可以是感染性的或者非感染性的。
表13.1 AECOPD的紧急检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.1_10903.jpg?sign=1739251054-l3z50YGXmagicZhpElJj7QrdCpj6FWWR-0-820a32ddce7047b44860d0488faaf013)
表13.2 怀疑AECOPD的重点评估
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.2_10910.jpg?sign=1739251054-KwdveqarhcKvssQWDsWUjXp0Qt2Snf9c-0-e450314bdf8d8d78b930c5ed9e7d3e72)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.2_1_59651.jpg?sign=1739251054-bawGyDi9PXXBMIoYkWtDAYg1KQubN1AG-0-1f7d984d0c47a90e3697f2d2130a7131)
注:FEV 1,1秒用力呼气容量
表13.3 AECOPD的处理
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.3_59974.jpg?sign=1739251054-RbmPAhKdt3NqMfHkOZmjofjKl4DgRSy3-0-cebc9f13d8290cb4b1dfc1688a4e0c00)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.3_1_59975.jpg?sign=1739251054-lTSu7pBTe4s92beW5ULfjykD5tmhj3U9-0-0450cf4ec85fcf95921166c6694a6c43)
表13.4 AECOPD的通气支持
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.4_59976.jpg?sign=1739251054-yVuXWoFjK0ozRHp3d8IYreBQMW1kUB01-0-02eed011b9a8a9a5523f0320b95fc4a6)
注:NIV,无创正压通气
表13.5 AECOPD出院核对表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.5_11103.jpg?sign=1739251054-WMf7kkoPOeFUL6S1PrDLjC9Y5Ho41JTV-0-1f6451c643ef0500a9e5e224418f4103)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.5_1_11145.jpg?sign=1739251054-vp1gBkq4Bp1ylEnRj7AHXgxXdeZfB6kr-0-ffa5bfd290d2e881e66310d4a2c3e84b)
表13.6 可能的其他诊断
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.6_59977.jpg?sign=1739251054-O40jW5DqbuBikULbGtalqK6rZW8H2kMM-0-30e391939c99b373b1682e4d40fcc971)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.6_1_59978.jpg?sign=1739251054-FRdqB1Paoophhgjrst787pqNve0GLNRl-0-4283a7dfca19da723bfe8b143a3ba1ce)