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COPD,???????

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Title: COPD,???????


1
?????????
  • ??????

????????? COPD,???????
???????????? ?? ??
2
??????????
3
??????????
4
?????????
5
??????
1)?
2)?????????
3)??????????
6
????????????
??????? ??????????????????
7
(No Transcript)
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(No Transcript)
9
?????????
  • ????????????

10
???????
(760-47)0.21149.7
??????
???
11
??????
????!
12
?????????
??
????
???
13
????????
??!
?????????
0.75sec.
0.50sec.
0.0sec.
0.25sec.
PAO2
15Torr??
A-aDO2
PaO2
PaO2
80100Torr
14
???????
PaO2 ?60 Torr
??????
15
???????
?????
?????
?????
COPD
16
???????????
???????? ????????????
????? ?????????????????????????????
?????? CO2???????????
????? ???????????????????
??? ??????????
??? ?Na????????
?? ???????????(???)?????
???? ????????????????????????
17
??????????
????? ???? ?????COPD???????
????? ?????? ???????ARDS???????
????? ?????? ????????
????? ????? ??????
????? ????? ????
????? ???????????????ALS
????? ???????????
18
COPD???
19
???????COPD??????
2004?
20
GOLD
2003?
GOLD updated2003
21
(????)??????????
???
??????
????????????????????????????????????????2???????1?
????????3?????????????????????????????????????????
?????????????????????????????????????????????????
?????
?????
???????
22
GOLD?COPD???
??????????????????????????????????????????????????
??????????????????
GOLD
23
COPD???
????(??, ????, ??????)
COPD



???? ???? ???

?????????




GOLD
24
? ?
?????? ???? ?????
?????? ???????? ????????
????
GOLD
25
COPD???????????
???????
26
??????????????? 1998
?(?)
??
  • Heart Disease 724,269
  • Cancer 538,947
  • Cerebrovascular disease (stroke) 158,060
  • Respiratory Diseases (COPD) 114,381
  • Accidents 94,828
  • Pneumonia and influenza 93,207
  • Diabetes 64,574
  • Suicide 29,264
  • Nephritis 26,295
  • Chronic liver disease 24,936
  • All other causes of death 469,314

GOLD
27
??????????????????????
2001??????10? (10.4)
???????
28
COPD???
  • COPD????????????
  • ?????????4720?? (???28????23) ???????
  • WHO?????11??????????2025???16????????????????????
    ???????????????????

GOLD
29
COPD?HRCT
????????????? ?????? ???????
30
COPD???????
???
??
31
COPD???
? ?
???????????
?
???
?
??
????
?????????
è
????????
GOLD
32
???????????
  • ???(VC)
  • ??????(FVC)
  • 1??(FEV1.0)

FEV1.0
  • 1??

FVC
(FEV1.0)
??????????????
33
???????
100
??
???????
70
???????
1??
???????
100
80
0
???
34
1??(FEV1.0)
FEV1.0lt70COPD?
COPD???
35
1??(FEV1)
FEV1.0(???)
1??
FEV1.0(???)
COPD?FEV1??????????
36
???????????
37
COPD?F-V??
1??
FEV1
38
COPD??????
???? ?? 0 ????? ??????????? ???? (???)  I
?? FEV1/FVC lt 70 FEV1 ³ 80 ??(???)?????????
II ??? FEV1/FVC lt 70 50 FEV1 lt
80 ??(???)????????? III ?? FEV1/FVC lt 70
30 FEV1 lt 50 ??(????????)?????????
???? FEV1/FVC lt 70 FEV1 lt 30 ??? FEV1lt
50 ??????????????
GOLD
39
COPD??????????
????? ?? ??? ?? ???
Stage0 Stage? Stage? Stage? Stage?

FEV1
30
50
80
??????????????????????????
40
COPD????
  • ????????????
  • ?????????????????
  • ???????????
  • ???????????????
  • ??????????????????????????????????
  • ???????

41
????????
42
???????????
IPF ???????
NSIP ?????????
COP ????????
AIP ???????
DIP ????????
RBILD ??????????????
LIP ??????????
43
IPF(???????)
  • ????????????????
  • ??????????
  • HRCT??????????(???honeycomb)
  • ??????????????????5??HOT?

44
???????????????????
  • ???????
  • ??(?????????????)
  • AIP(???????)
  • ALI/ARDS
  • ?????
  • ????????

ALI Acute Lung Injury ARDS Acute Respiratory
Distress SyndromeAIP Acute Interstitial
Pneumonia
45
AIP(???????)
  1. ??X??CT???????????????,????????.
  2. ??,???????????????,?????????????.
  3. ???????????,CRP??,KL-6??????.
  4. ????????????ARDS?????????.
  5. ???Hamman-Rich???,???????????????????????????.

46
ALI/ARDS
  • ARDS????????????(ALIacute lung
    injury)???,ALI?????ARDS.
  • ALI?ARDS?????????????????????????????????PF?(PaO2
    /FIO2)??????.P/F300???ALI,200???ARDS

47
ARDS(?????????)
??????? ???????? PaO2/FiO2lt200
??????(???) ???????? ??????18mmHg??or?????????
(Bernard GR?,1994???)
48
ARDS???
49
ARDS???
???? ??????????PEEP 515cmH2O ???high
PEEP Permissive hypercapnia
???? ??? FOY?
???? ????? 10cmH2O?? ??????
?????? ????????? ??????????
50
????????????? ??????????????????? ????????????????
????? ??? ???????????????? ???????????????????? ??
??????? http//www.dobin.jp ?????????????????????
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? ????????????????????? ???? ?????????????????????
????? ??????????????Address???? ?????????????????
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