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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=1739241302-BCbuLmuwMKbwvoWhJXp6AxnAgGabjpUb-0-bbc4414ef03cc0232729ec3356fc74f6)
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=1739241302-NtwTa8x2KqOABjziV6RwhzqcvAKzYZCH-0-874a73aaee1b903efeb5a708b223d185)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.2_1_59651.jpg?sign=1739241302-d2yO9l1i5r48pDzOxVgI1rrjsWcmpDXM-0-cccd4743256238b7d4bbcfcebd276933)
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=1739241302-rsb87hs8qu5UHXTBW7rggHm00wvXEfjz-0-f127075f2e55f5fdd30dafe3852a7747)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.3_1_59975.jpg?sign=1739241302-Y4dlIfQCLL9ja8RjfHv63JftKGZJenEX-0-ad46604e0711df429133072376e6d098)
表13.4 AECOPD的通气支持
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.4_59976.jpg?sign=1739241302-BX5rNrCCyaggT4rDR1Kosninuj5cV89Y-0-0ae8634a8951f21362cf00ada2872dfc)
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=1739241302-fU9G2vtkSaNCVuPMwokM0scxsE1nYGda-0-305da6ffa04ded0f37508ce554c27c29)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.5_1_11145.jpg?sign=1739241302-yjAc5cjrzSTc6W7FskZI5Ane7Ji1yiXE-0-9926ccd38cfa0260d0bf9a31a8699510)
表13.6 可能的其他诊断
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.6_59977.jpg?sign=1739241302-bcgRs1cJc0sFrkekkTPSPYTE4Ioj38AU-0-c2b189aa9a60cc240403489473c074f5)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.6_1_59978.jpg?sign=1739241302-4kznYC7xMGpJ5t0IhNLE1HEth2xtXJ8e-0-4522ba80db834b4859d4b9eec092fa09)