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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=1738901505-HYazqEuBNze1MvAYnSfgdzFyLfvXiUIx-0-6d169bf115b30f26953a1533877714d1)
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=1738901505-OqyROqr1KJcogy1oTU6LTS1L7y21yvTN-0-021d76f8d46e7e0b10600f2cfa27322f)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.2_1_59651.jpg?sign=1738901505-Q241VdSG7wAnhgsMcYBNoW85xnQFxgh5-0-8b8345971cbad1ea089fdabaac2f764f)
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=1738901505-E9HJF7Gv3D8DcpTzEEjVD8zCVOlVYF0I-0-1f98b29ec1f9e1383c8f02189c2ccaa8)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.3_1_59975.jpg?sign=1738901505-jlQVOqD1fkEVkg9a740mqPudIBDWQEqq-0-754fa1d20d75fe9365b59b4ac680ce84)
表13.4 AECOPD的通气支持
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.4_59976.jpg?sign=1738901505-nCd17KihExitgF6MQeJnDSHTtQ7rnwkm-0-208e7bfa3965c89df782e8081ba25d04)
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=1738901505-F8RgaJWz2cFX6mU5jmJOseHLUijuWqLY-0-c8f3fa6f60cf3b7355f9b0864fecf983)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.5_1_11145.jpg?sign=1738901505-PaRiRxRa04bbGFwyKWdu1Xm2joKxdI9x-0-8822f802a7e1969522b6b226cb52a790)
表13.6 可能的其他诊断
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.6_59977.jpg?sign=1738901505-nehgl02LGw37SAuVX3WzcHN9t1xczckB-0-611f090133c09eef3122ebaa5b39d9de)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.6_1_59978.jpg?sign=1738901505-zpEZBMsxVRTGupDhZsI3vhjvXKIgcSoe-0-b2ec4dbccf8d32fe009e49982bb7291e)