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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=1739227871-jQeKFcgEuKT3b4F5ngmpIrVtuQtxDIyl-0-7001e2143010868a651c8e8488cd7b5c)
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=1739227871-FdiS02cLaHawPTri8vLFL4PVtZ99cIZW-0-a21ecc1608120fdcb5ed125457347a6d)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.2_1_59651.jpg?sign=1739227871-kARrwPCk98wMONjjKT4PrhYPNIzqqZ4H-0-91d9cf6eb824b14550803133d8058239)
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=1739227871-oV9CYWjs5YNUyVAyqj0TdLFHrGBUnIIT-0-f79f419824fc17c0579b92a23c4ded2f)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.3_1_59975.jpg?sign=1739227871-rM3AB58v0an8U1NjvLSrwn5vMKqhKgYS-0-dde3d7cbed9c1ba0c2357980f097f10f)
表13.4 AECOPD的通气支持
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.4_59976.jpg?sign=1739227871-OK68Ky64esRrOACOSypUyGZnuqJBrtEq-0-07cff611b0b8b359aa9526231e62ebe3)
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=1739227871-jnYFoM65IFhQpYIpzI3eULyltt86aGOl-0-187371845485355a8d22e4b13245e14a)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.5_1_11145.jpg?sign=1739227871-TPOQ5pzGzRXcpRM8HFZZ7mLtcJEsL5Ez-0-7df62ae8f88e68b59a5b6f6ac52573f6)
表13.6 可能的其他诊断
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.6_59977.jpg?sign=1739227871-tPGpjce5v5Hrj7doUUMoqC6xI5EJFQhS-0-a7e973753fe46ee10b2e684d9429dd1d)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.6_1_59978.jpg?sign=1739227871-XxJQUnRiiTwasGyxjvQ9mTLxtSy1iCTb-0-a1a98cec7106b40d1a9465c7db681362)