呼吸系统疾病-呼病总论教案

RespiratorydiseasesRespiratorydiseases2()()()()()()(100)1030153015Respiratorydiseases1992319984(14.08%)(24.26%)Pulmonaryneoplasms---Bronchogeniccarcinoma(Astham)(Chronicobstructivepulmonoarydisease)PulmonarytuberculosisInterstitiallungdisease,ILDIdiopathicpulmonaryfibrosis,IPFPneumoniaCDXX2cm13X1100237.512000L16m20/19mm/2m:Asthma2(pulmonarycirculation,lessercirculation)(1)1/322mmHg,8mmHg,13mmHg7mmHg14mmHg,2mmHg(2)450ml9200ml1000ml(3)7mmHg25mmHg,3CT4453CCU2X3.5cm1655SLEWegeners()atmoshericpollutong:------10195224000SO2Smoking2COPD4COPD83651015673600000030000/19791986COPD28.812.325.52.59.0501315COPD1.885COPD70Asthma,COPD()(Aspirationofallergen)()Community-acquiredpneumonia1/3250/(hospital-aquiredlunginfection)(nosocomialpneumonia)10.9-3.8%ICU749WHO19906902220/148/10465/101992195.9568322.9831999Richards19921997ICU181993319527860.5112642205019851987182613.145.218.0199884RICU5.883.3(70/80)94(79/84)17.9(15/85)17.9%(15/84)8.3(7/84)2G60%ESBLsG+20%MRSAAIDS()60106571990608.5%655.58COPD()(history)COPD()(sympton)(coughexpectorationg)(hemoptysis)(dyspnea)(chestpain)()623028COPD()1(bloodtest)(bloodroutine)WBC18.2G/LNEU86617537.2WBC9.6G/LNEU82%31bloodcultivation(erythrocytesedimentationrate)(tumormarkers)2(antigenskintest)3(smear)(cultivation+drugsensitivetest)(esfoliativecytologicexamination)4(pleuraleffusion)(biopsyofpleura)CEALDH5(imageanalyses)(1)X(2)CTMRI(3)(4)(conventionalpulmonaryangiongraphy,CPA)PE85%90%PEXa.b.c.()d.()0.5mmCPACPA410%0.5a.PEPECOPDb.(5)(digitalsubtractionangiongraphy,DSA)XDSACPA946(bronchoscopy)IgEbroncho-alveolarlavage7(radionuclidescanning)/(V/Q)PEPE92911995Teigen38V/QV/QPE2015299mTc-MAA()MAA10100m10m99mTc-MAACOPDPE70COPD302133XePECOPD2551280PEXPEPEPE()PET8(biopsy)XCTB9(diagnosticartificialpneumothorax)(pneumoperitoneum)10PE11(1)(2)(3)RV/TLC%(4)PEFR2.COPDFEV165FEV1%:38VC72TBFEV1%78VC628FEV167RV/TLC%5613040BAL90ARDSIPF1IPFplateletderivedgrowthfactor,PGDFBC-sis22IPFC-sismRNAC-sisPDGF4RbP533P905029094ICU2AsthmaCOPD4