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COPD课程教案、知识点、字幕

空气污染引起呼吸道炎症反应

长期会造成慢性阻塞性肺疾病

即COPD

COPD是一组疾病

它是当前全球第4位死亡原因

已构成影响公共健康的重大问题

2000年WHO估计全世界有

274万人死于COPD

据世界卫生组织统计

1990年

COPD在疾病造成的负担中

位居第12位

预计到2020年

将达到疾病负担第五位

并成为第三大死亡原因

美国的死亡率

年龄调整的百分比变化分析

1965-1998年期间

因COPD死亡的人数

呈现直线上升趋势

我国50岁以上

COPD的患病率为15%

为城市居民第四大死因

农村居民的第一大死因

我们为什么如此关注COPD

其原因是它的发病率高

死亡率也高

发病率呈现不断的上涨趋势

并给社会带来很大的负担

统计发现

COPD的发病与空气污染

和吸烟有绝对的相关性

那究竟什么是COPD呢

它是以不完全的

可逆的气道阻塞

气流受限为特征

它包括慢性支气管炎

肺气肿 哮喘

有些人把支气管扩张

也纳入到COPD范畴中

科学家提出的三环理论

清晰地显现出COPD

与慢性支气管炎 肺气肿

哮喘的关系

图中蓝色部分

是属于COPD的范畴

也就是老年性慢性支气管炎

肺气肿 哮喘的病变引起气流受限

并且不能完全可逆时

就被视为COPD

那什么是老百姓熟称的

“老慢支”呢

它是老年性慢性支气管炎的简称

是指气管 支气管粘膜

及其周围组织的慢性

非特异性炎症

临床上以咳嗽 咳痰

伴喘息为主要症状

简称“咳 痰 喘”

而且发病每年持续至少3个月

连续2年或更长时间发病

并排除心肺其他疾病的患者

我们就可以诊断他为老慢支

另一种疾病肺气肿

是指终末细支气管远端的

气腔弹性减退

过度膨胀

肺容积增大

并伴有肺泡壁和细支气管的破坏

但没有出现明显肺纤维化的病理状态

COPD特征性的病理学改变

存在于中央气道 外周气道

肺实质和肺的血管系统

气管 支气管

以及内径>2~4 mm的

细支气管称为中央气道

中央气道出现炎症

细胞浸润表层上皮

黏液分泌腺增大

和杯状细胞增多

使黏液分泌增加

纤毛功能失调

内径<2 mm的小支气管

和细支气管称为外周气道

在外周气道引起慢性炎症

导致气道壁损伤和修复过程

反复循环发生

修复过程导致气道壁结构重塑

胶原含量增加及瘢痕组织形成

这些病理改变造成气腔狭窄

引起固定性气道阻塞

COPD患者典型的肺实质破坏

可引起肺泡不正常的永久性扩大

伴有肺泡壁的破坏

导致肺过度充气

气体交换异常

形成肺气肿

气肿的肺泡融合一起

可形成肺大疱

容易破裂引起气胸

COPD肺血管的改变

以血管壁的增厚为特征

这种增厚始于疾病的早期

内膜增厚是最早的结构改变

血管内膜增生

某些血管发生纤维化和闭塞

造成肺循环的结构重组

接着出现平滑肌增加

和血管壁炎症细胞浸润

COPD晚期出现的肺动脉高压

是其重要的心血管并发症

并进而产生慢性肺心病

及右心衰竭

提示预后不良

COPD患者临床表现

为呼气性呼吸困难

长期反复的咳嗽 咳痰

并伴有胸痛 喘息等现象

听诊肺部可听到干湿罗音

伴有哮鸣音

同时伴有肺气肿时

呼吸更加困难

并且患者胸廓的前后径增宽

肋间隙增大

剑突下胸骨下角增宽

呈现桶状胸

触诊双侧语颤减弱

胸部叩诊呈现过轻音

听诊呼吸音也降低

X线肺部呈现极度膨胀状态

除了出现不同程度的以上症状

要确诊COPD

必须进行肺功能检查

患者根据病情的轻重

进行必要的药物治疗

比如说采用支气管舒张药 如沙丁胺醇 还有化痰药 比如说氨溴索

还可辅助高压负离子氧疗和理疗

必要的时候呢

可应用抗生素和糖皮质激素

进行治疗

同时

饮食和心理精神上也要进行调节

Gateway to Medicine: An Introduction to the Field of Medicine课程列表:

CH01 Smog and Lung Diseases

-01-The basic condition of the air

--The basic condition of the air

-02-What is smog and its influence to the body

--What is smog and its influence to the body

-03-The structure and the function of human respiratory system

--The structure and the function of human respiratory system

-04-How the smog cause the human respiratory system disease

--How the smog cause the human respiratory system disease

-05-Asthma

--Asthma

-Exercise 01

-06-COPD

--COPD

-07-Lung cancer Ⅰ

--Lung cancer Ⅰ

-08-Lung cancer Ⅱ

--Lung cancer Ⅱ

-Exercise 02

CH02 Pregnancy and Delivery

-01 Dissection of genital organs

--Dissection of genital organs

-Exercise 01

-02 The formation of embryo and fetal appendage

--The formation of embryo and fetal appendage

-Exercise 02

-03 Characteristic of embryonic and fetal development

--Characteristic of embryonic and fetal development

-04 Maternal changes during pregnancy

--Maternal changes during pregnancy

-05 Four factors that affect childbirth

--Four factors that affect childbirth

-06 Mechanism of labor

--Mechanism of labor

CH03 Children’s nutrition requirement and infant feeding

-01 The energy requirement and the metabolic characteristics of kids

--The energy requirement and the metabolic characteristics of kids

-02 Need of the nutrition and metabolism of kids Ⅰ

--Need of the nutrition and metabolism of kids Ⅰ

-Exercise 01

-03 Need of the nutrition and metabolism of kids Ⅱ

--Need of the nutrition and metabolism of kids Ⅱ

-Exercise 02

-04 Guided feeding of infant Ⅰ

--Guided feeding of infant Ⅰ

-Exercise 03

-05 Guided feeding of infant Ⅱ

--Guided feeding of infant Ⅱ

-06 Guided feeding of infant Ⅲ

--Guided feeding of infant Ⅲ

CH04 Get to know about tumor

-01 Introduction

--Introduction

-02 What is tumor

--What is tumor

-03 The general shape of tumor

--The general shape of tumor

-04 The atypia of the tumor

--The atypia of the tumor

-05 Name and classification of the tumor

--Name and classification of the tumor

-Exercise 01

-06 The growing type of the tumor

--The growing type of the tumor

-07 Spread of tumor

--Spread of tumor

-Exercise 02

-08 The grading and staging of tumors and the effects to the body

--The grading and staging of tumors and the effects to the body

-09 The difference between benign and malignant tumors

--The difference between benign and malignant tumors

-10 The environmental causes of cancer

--The environmental causes of cancer

-11 Heredity and tumor

--Heredity and tumor

CH05 Emergency (Cardiopulmonary resuscitation) and Disaster Medicine

-01 Overview

--Overview

-02 Sudden cardiac arrest

--Sudden cardiac arrest

-Exercise 01

-03 Non-professional life support

--Non-professional life support

-Exercise 02

-04 Professional life support

--Professional life support

-Exercise 03

-05 Adult advanced life support Ⅰ

--Adult advanced life support Ⅰ

-Exercise 04

-06 Adult advanced life support Ⅱ

--Adult advanced life support Ⅱ

-Exercise 05

-07 Electric defibrillation

--Electric defibrillation

CH06 Cardiovascular disease (Atherosclerosis and hypertension)

-01 Introduction

--Introduction

-02 Risk factors and pathogenesis of atherosclerosis

--Risk factors and pathogenesis of atherosclerosis

-03 Pathological changes of atherosclerosis

--Pathological changes of atherosclerosis

-Exercise 01

-04 Atherosclerosis of vital organs

--Atherosclerosis of vital organs

-05 Coronary atherosclerotic heart disease

--Coronary atherosclerotic heart disease

-Tips 03

--Tips 03

-06 Primary hypertension

--Primary hypertension

-Exercise 02

-07 The etiology and pathogenesis of hypertension

--The etiology and pathogenesis of hypertension

-08 The types and pathologic changes of essential hypertension

--The types and pathologic changes of essential hypertension

-Exercise 03

CH07 The war that never ends——Human versus virus

-01 Overview Ⅰ

--Overview Ⅰ

-02 Overview Ⅱ

--Overview Ⅱ

-03 What is virus

--What is virus

-Exercise 01

-04 The structure and functions of influenza viruses

--The structure and functions of influenza viruses

-Exercise 02

-05 Different type of influenza viruses

--Different type of influenza viruses

-Exercise 03

-06 Bird flu

--Bird flu

-Exercise 04

-07 Street virus

--Street virus

-Exercie 05

CH08 The germs that gastric acid can't kill——Helicobacter pylori and Gastric diseases

-01 Introduction

--Introduction

-02 Chronic gastritis caused by helicobacter pylori infection

--Chronic gastritis caused by helicobacter pylori infection

-Exercise 01

-03 Helicobacter pylori causes peptic ulcer

--Helicobacter pylori causes peptic ulcer

-Exercise 02

-04 Pathological changes of peptic ulcer

--Pathological changes of peptic ulcer

-Exercise 03

-05 Gastric cancer

--Gastric cancer

CH09 The movement and injury of human body——The motor function of human body

-01 The evolution of biological motion

--The evolution of biological motion

-02 Biomechanics of human motion

--Biomechanics of human motion

-Exercise 01

-03 The perfect unity of function and structure

--The perfect unity of function and structure

-Exercise 02

-04 A brief history of trauma orthopedic development Ⅰ

--A brief history of trauma orthopedic development Ⅰ

-05 A brief history of trauma orthopedic development Ⅱ

--A brief history of trauma orthopedic development Ⅱ

-Exercise 03

-06 Sprain and fracture of the ankle joint

--Sprain and fracture of the ankle joint

-Exercise 04

-07 Ankle sprain

--Ankle sprain

-Exercise 05

-08 Prevention of ankle sprain

--Prevention of ankle sprain

Final Exam

-Final Exam

COPD笔记与讨论

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