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1、COPD病人的围术期处理复旦大学附属中山医院缪长虹COPD?goldGlobalinitiativeforchronicObstructiveLungDiseaseUnitedStatesUnitedKingdomArgentinaAustraliaBrazilAustriaCanadaCanadaChileBelgiumChinaDenmarkColumbiaCostaRicaCroatiaEgyptFranceGermanyGreeceIrelandItalyGuatemalaHongKongChinaJapanIcelandIndiaKoreaKyrgyzstan
2、LatviaLithuaniaMexicoMoldovaNepalMacedoniaMaltaNetherlandsNewZealandPolandNorwayPortugalRepublicofGeorgiaRomaniaRussiaSingaporeSlovakiaSloveniaSaudiArabiaSouthAfricaTatarstanRepublicSpainSwedenThailandTurkeySwitzerlandUkraineUnitedArabEmiratesTaiwanROCVenezuelaVietnamPeruYugoslaviaAlbani
3、aBangladeshCOPD?GOLD“apreventableandtreatablediseasestatecharacterizedbyairflowlimitationthatisnotfullyreversible.”-usuallyprogressive-abnormallunginflammatoryresponsetonoxiousparticlesorgases-definedbyhistoryplusSpirometryCOPD?不完全性可逆气流受限可逆的部分支气管内炎性细胞、粘液和血浆渗出物的积聚外周和中央气道平滑肌的收缩运动状态下气道的过
4、度充气不可逆的部分气道的纤维化与狭窄保持小气道开放的肺泡支撑作用消失肺泡结构破坏LeadingCausesofDeathsU.S.2001Allothercausesofdeath469,31410.Septicemia32,2759.Nephritis26,2958.Alzheimer’sdisease53,6797.Pneumoniaandinfluenza62,1236.Diabetes71,2525.Accidents97,7074.RespiratoryDiseases(COPD)123,9743.Cerebrovasculardisease(stroke)
5、163,6012.Cancer553,2511.CauseofDeathNumberHeartDisease699,697PercentChangeinAge-AdjustedDeathRates,U.S.,1965-199800.51.01.52.02.53.0Proportionof1965Rate1965-19981965-19981965-19981965-19981965-1998–59%–64%–35%+163%–7%CoronaryHeartDiseaseStrokeOtherCVDCOPDAllOtherCausesSource:NHLBI/NIH/DH
6、HSCOPDAge-AdjustedDeathRate,U.S.byyearandsex(CDC,DHHS)Age-AdjustedDeathRatesforCOPD,U.S.,1960-199860Deathsper100,00019601965197020001975198019851990199550403020100IschemicheartdiseaseCerebrovasculardiseaseLowerrespinfectionDiarrhealdiseasePerinataldisordersCOPDTuberculosisMeaslesRoadtraf
7、ficaccidentsLungcancerStomachCancerHIVSuicide6th3rdMurray&Lopez.Lancet1997FutureMortalityWorldwide19902020病因有害颗粒气体吸烟职业暴露空气污染ChronicObstructivePulmonaryDisease(COPD)Slide13.43Copyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsFigure13.13症状慢性咳嗽慢性咳痰呼吸困难有害颗粒与气体接触史