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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=1739496846-34ePYCyn0MlUN9BkQBloF6HidgfHX81K-0-2600ffe47607bfde4f2d07dc7ed32678)
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=1739496846-siqzbe5ZPqWX3fNAOOoHLWML7PbrdVug-0-e932a43d32d2e39738f2767e9ad38bbf)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.2_1_59651.jpg?sign=1739496846-9517nm0IjCjqaDuHv6iDMLxcRfs6YoZj-0-c9e101d8170c374cddc189cec0fbcafa)
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=1739496846-zH9LccwWPQj5JvH6lsQfcsdsIO9aiwdW-0-50b54d02d98eeffc0eeb12e849ef315d)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.3_1_59975.jpg?sign=1739496846-LNfYl4ztt4Enrq15R177fq68bEd4Qv3n-0-4ffbbe42eec9693049fd79a735dc654c)
表13.4 AECOPD的通气支持
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.4_59976.jpg?sign=1739496846-IEqdOecOVacY8TZNAxLSpqapeux0Upus-0-ea8ad75f6bc03ff2df425f9f65b36279)
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=1739496846-frN3Y14tM7UNcil9dZi5UFgPe6feyXXg-0-01629ac2787d1a72b0e6b48c1b696825)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.5_1_11145.jpg?sign=1739496846-zlbiyeLR2imc05DffqAj9sUOprB9XfoE-0-0f9f4b342a062e43d832ef12527448f4)
表13.6 可能的其他诊断
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.6_59977.jpg?sign=1739496846-WuX2xGhd6qlTcCOOfC4Ru78vOmZtCWZK-0-62521baa9c92af274d383dd270e0c909)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T13.6_1_59978.jpg?sign=1739496846-OVWzidH9IXrwEpgHszQeXadwMIxVDAvz-0-6b23eccd83f74d5bcc344a61d91cd6d2)