만성 폐쇄성 폐질환chronic obstructive pulmonary disease

목차

Ⅰ. 정의 및 분류

Ⅱ. Simple chronic bronchitis

Ⅲ. Chronic asthmatic bronchitis (chronic persistent asthma)

Ⅳ. Chronic obstructive pulmonary disease

Ⅴ. Cor pulmonale

Ⅵ. Acute respiratory failure in COPD

Ⅶ. Miscellaneous diffuse obstructive syndrome

본문내용

90% 유지
PaO2 60-80 mmHg
O2 1-3L/ min via nasal prongs
7) Surgical therapy(esp. for emphysema)
(1) Bullectomy
(2) Lung volume reduction surgery
(3) Lung transplantation
(single lung transplant - 3 year survival : 75%)
8) Treatment of edema and cor pulmonale
(1) oxygen 투여
(2) small doses of diuretics (oral)
(3) digitalis for heart failure (Rt and Lt)
(4) phlebotomy - Hct > 60% 시 시행
Ⅴ. Cor pulmonale (肺性心)
1. 정의
enlargement (dilation and/or hypertrophy) of RV due to increased RV
afterload secondary to disease of lung, thorax or pulmonary circulation
Occ. RV failure
heart failure 의 20% → cor pulmonale
Cor pulmonale의 > 50% ← COPD
COPD 3 year survival 40%
heart failure 의 20% → cor pulmonale
Cor pulmonale의 > 50% ← COPD
COPD 3 year survival 40%
2. pulmonary hypertension
> 20mmHg(mean pressure) at midchest level
normal mean pressure : 13 4mmHg in young adult (< 18mmHg ,80%)
RV stroke volume :
pulmonary artery systolic pressure 30-40mmHg에서 떨어지기 시작하여
60-80mmHg - complete failure
3. Cor pulmonale in COPD
가장 흔한 원인
PAP (systolic) 40-50mmHg
FEV1 < 1.0L
PaO2 60mmHg
1) 원인
(1) generalized pulmonary vasoconstriction
alveolar hypoxia
acidemia
hypercapnia
(2) pulmonary vessel에 대한 high lung volume의 mechanical effect
(3) emphysema에서 loss of small vessels
(4) erythrocytosis에 의한 blood viscosity 증가
2) 치료
O2 투여 1-2.5L/min (25-35%)
SaO2 85-90%
PaO2 > 50mmHg 유지 (50-60 mmHg)
Ⅵ. Acute respiratory failure in COPD
1. Definition
1) a drop in PaO2 10-15mmHg
2) hypercapnia 와 arterial pH < 7.30
2. Precipitating factors
1) bronchopulmonary infection
2) sedative or narcotics
3) air pollution
4) pneumonia
5) thromboembolism
Lt. ventricular failure
pneumothorax
3. Acute exacerbation of COPD (Winnipeg criteria)
1) sputum volume ↑
2) sputum purulence ↑
3) dyspnea ↑
4. Treatment
1) management of hypoxia
: oxygenation 과 ventilation의 적정 level을 유지
2) control of infection, bronchoconstriction & secretion
: infection의 치료, removal of secretions, reversal of airway constriction
3) management of complication
: cardiac arrhythmia (multifocal supraventricular tachycardia)
Lt. ventricular failure, pulmonary embolism
GI hemorrhage from stress ulceration
4) mechanical ventilation
Ⅶ. Miscellaneous diffuse obstructive syndrome
1. acute bronchiolitis
2. constrictive bronchiolitis (bronchiolitis obliterans)
3. proliferative bronchiolitis (cryptogenic organizing pneumonia)
(bronchiolitis obliterans with organizing pneumonia)
4. diffuse panbronchiolitis
참 고 문 헌
1. Harrison's Principles of Internal Medicine 13th eds p1197-1206
2. Cecil. Textbook of Medicine 19th eds p.386-393
3. Murray Textbook of Respiratory Medicine 2nd eds p1331-1397
4. Fishman. Pulmonary Disease and Disorders 2nd eds p1159-1272
Chronic airway disease
Chronic obstructive lung disease(COLD)
Chronic obstructive pulmonary disease(COPD)
Chronic airflow obstruction(CAO)
1) simple chronic bronchitis
2) chronic asthmatic bronchitis
3) chronic obstructive bronchitis
4) emphysema
COPD
chronic bronchitis emphysema
simple asthmatic obstructive

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