Acute exacerbations and respiratory failure in chronic obstructive pulmonary disease.
Acute exacerbations and respiratory failure in chronic obstructive pulmonary disease.
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DOI：
10.1513/pats.200707-088et
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发表时间：
2008-05-01
期刊：
影响因子：
--
通讯作者：
Huang, Yuh Chin
中科院分区：
文献类型：
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作者：
MacIntyre, Neil;Huang, Yuh Chin
慢性阻塞性肺疾病急性加重（AECOPD）是指COPD患者气道功能和呼吸道症状突然恶化的现象。这些恶化的范围可以从自限性疾病到需要机械通气的呼吸衰竭发作。COPD患者平均每年经历两次这样的发作，并且它们占卫生保健资源的显著消耗。虽然细菌感染是AECOPD最常见的原因，但病毒感染和环境压力也涉及其中。AECOPD发作可由其他合并症触发或并发，如心脏病、其他肺部疾病（例如，肺栓塞、吸入、气胸）或全身过程。药物治疗包括支气管扩张剂、皮质类固醇和大多数患者的抗生素。氧气、物理治疗、粘液溶解剂和气道清除装置可能对选定的患者有用。在高碳酸血症性呼吸衰竭中，无创正压通气可以为其他治疗提供时间，从而避免气管插管。如果患者需要有创机械通气，重点应放在避免呼吸机引起的肺损伤和尽量减少内源性呼气末正压。这些可能需要限制通气和“允许性高碳酸血症”。“虽然AECOPD的轻度发作通常是可逆的，但更严重的呼吸衰竭形式与幸存者的大量死亡率和长期残疾有关。
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) describe the phenomenon of sudden worsening in airway function and respiratory symptoms in patients with COPD. These exacerbations can range from self-limited diseases to episodes of florid respiratory failure requiring mechanical ventilation. The average patient with COPD experiences two such episodes annually, and they account for significant consumption of health care resources. Although bacterial infections are the most common causes of AECOPD, viral infections and environmental stresses are also implicated. AECOPD episodes can be triggered or complicated by other comorbidities, such as heart disease, other lung diseases (e.g., pulmonary emboli, aspiration, pneumothorax), or systemic processes. Pharmacologic management includes bronchodilators, corticosteroids, and antibiotics in most patients. Oxygen, physical therapy, mucolytics, and airway clearance devices may be useful in selected patients. In hypercapneic respiratory failure, noninvasive positive pressure ventilation may allow time for other therapies to work and thus avoid endotracheal intubation. If the patient requires invasive mechanical ventilation, the focus should be on avoiding ventilator-induced lung injury and minimizing intrinsic positive end-expiratory pressure. These may require limiting ventilation and "permissive hypercapnia." Although mild episodes of AECOPD are generally reversible, more severe forms of respiratory failure are associated with a substantial mortality and a prolonged period of disability in survivors.