哮喘的急诊处理-.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Shanghai Childrens Medical Center,哮喘的急诊处理,哮喘背景知识,儿童最常见的慢性疾病,患病率,030%,患病率呈上升趋势,死亡率呈上升趋势,Shanghai Childrens Medical Center,哮喘定义,一种气道高反应性和慢性炎症的疾患,表现为反复发作的呼气相喘鸣、呼吸困难、胸闷和咳嗽，特别是夜间和清晨出现。,常伴有广泛的气道阻塞，可自行缓解或经治疗后缓解,Shanghai Childrens Medical Center,病理,急性支气管痉挛,气道壁肿胀,慢性粘液栓形成,气道壁重塑,Shanghai Childrens Medical Center,哮喘的诱发因素,病毒感染（,RSV,、流感、副流感）,气侯变化,吸烟及吸入过敏原（尘螨、花粉、动物变应原）,运动,冷空气,精神压力及情绪波动,药物（阿司匹林）,Shanghai Childrens Medical Center,喘鸣的鉴别诊断,Shanghai Childrens Medical Center,先天性疾病,肺囊性纤维化,肺叶气肿,气管支气管软化,气管狭窄,支气管狭窄,横膈疝,气管食管瘘,纤毛不动综合征,血管环,Shanghai Childrens Medical Center,感染性疾病,毛细支气管炎,肺炎,Shanghai Childrens Medical Center,过敏性疾病,哮喘,过敏反应,过敏性肺曲霉菌病,Shanghai Childrens Medical Center,获得性疾病,异物吸入,支气管肺发育不良,纵隔占位,Shanghai Childrens Medical Center,心脏疾病,充血性心衰,肺水肿,Shanghai Childrens Medical Center,哮喘严重度分类,Shanghai Childrens Medical Center,Shanghai Childrens Medical Center,轻度,中度,重度,PEFR,80%,预计值,60%80%,预计值,93%90%93%,6,岁,5mg QN po/D,，,15,岁,10mg QN po/D,。,可减少激素的用量。,Shanghai Childrens Medical Center,药物治疗（六）,抗组织胺,第一代抗组胺药物：酮替芬,第二代抗组胺药物：仙特明，开瑞坦等,Shanghai Childrens Medical Center,药物治疗（七）,特异性免疫治疗（,SIT,）,对花粉或尘螨过敏者可采用相应变应原提取物作脱敏治疗,指征,持续严重的呼吸困难,呼吸音减低至几乎听不到哮鸣音及呼吸音,因过度通气和呼吸肌疲劳而使胸廓运动受限,意识障碍、昏迷,吸氧状态下紫绀进行性加重,PaCO,2,65mmHg,Shanghai Childrens Medical Center,辅助机械通气,吸入装置简介,雾化治疗室的建立,氧驱动雾化吸入器,氧气,雾化溶液,Shanghai Childrens Medical Center,吸入疗法的重要性,迅速起效，副作用小，免注射。,急诊处理时首选吸入疗法,氧驱动雾化吸入为首选,预防治疗同样重要,掌握正确的使用方法,Shanghai Childrens Medical Center,重症哮喘的预防,积极治疗缓解期病人,急诊室开展雾化吸入疗法,Shanghai Childrens Medical Center,缓解期病人的治疗,轻度间歇 吸入激素,100200,微克,/,天,轻度持续 吸入激素,100,400,微克,/,天,中度持续 吸入激素,200,400,微克,/,天,重度持续 吸入激素,400,800,微克,/,天,Shanghai Childrens Medical Center,儿童哮喘处理要点,急性发作时的处理,缓解期的治疗计划,疗效评估,儿童支气管哮喘防治常规,中华儿科杂志,2004,年,2,月第,42,卷第,2,期,Shanghai Childrens Medical Center,