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最后审阅: 30 Mar 2025
最后更新: 26 May 2021

小结

定义

病史和体格检查

关键诊断因素

  • 呼吸困难
  • 咳嗽
  • 喘鸣
  • 痰量/颜色/黏稠度的变化
  • 呼吸急促
  • 紫绀

其他诊断因素

  • 慢阻肺既往史
  • 吸烟
  • 既往胃食管反流和/或吞咽功能障碍病史
  • 不适感和疲劳
  • 胸闷
  • 肺心病的特征
  • 环境/职业暴露于污染物或粉尘
  • 精神状态改变
  • 发热
  • 辅助呼吸肌参与呼吸
  • 腹部矛盾运动

危险因素

  • 细菌感染
  • 胃食管反流和/或吞咽功能障碍
  • 病毒感染
  • 污染物
  • 非典型细菌感染
  • 天气变化

诊断性检查

首要检查

  • 脉搏血氧测定仪监测 SaO2
  • 胸部 X 线检查(CXR)
  • 心电图(ECG)
  • 动脉血气分析
  • 全血细胞计数,包括血小板
  • 电解质、尿素和肌酐

需考虑的检查

  • 痰培养 + 革兰染色
  • 呼吸道病毒诊断
  • 心肌肌钙蛋白
  • 胸部 CT 扫描

治疗流程

急症处理
持续性治疗

撰稿人

作者

Carolyn L. Rochester, MD

Associate Professor

Yale University School of Medicine

New Haven

VA Connecticut Healthcare System

West Haven

CT

利益声明

CLR serves on the COPD scientific advisory board for GlaxoSmithKline Pharmaceuticals but has no competing interests pertaining to this publication.

Richard A. Martinello, MD

Associate Professor

Yale University School of Medicine

New Haven

Veterans Health Administration

Office of Public Health

West Haven

CT

利益声明

RAM declares that he has no competing interests.

同行评议者

Sanjay Sethi, MD

Professor of Medicine

Division Chief

Pulmonary/Critical Care/Sleep Medicine

University at Buffalo

State University of New York

Section Chief

Pulmonary/Critical Care/Sleep Medicine

VA Western New York Healthcare System

Buffalo

NY

利益声明

SS declares that he has no competing interests.

Francis Thien, MD, FRACP, FCCP

Professor

Box Hill Hospital and Monash University

Victoria

Australia

利益声明

FT declares that he has no competing interests.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2021 report. 2021 [internet publication].全文

Hanania NA, Crater GD, Morris AN, et al. Benefits of adding fluticasone propionate/salmeterol to tiotropium in moderate to severe COPD. Respir Med. 2012;106:91-101. 摘要

British Thoracic Society. BTS guideline for oxygen use in healthcare and emergency settings. June 2017 [internet publication].全文

Vollenweider DJ, Frei A, Steurer-Stey CA, et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2018 Oct 29;(10):CD010257.全文  摘要

Puhan MA, Gimeno-Santos E, Cates CJ, et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2016 Dec 8;(12):CD005305.全文  摘要

Tang CY, Blackstock FC, Clarence M, et al. Early rehabilitation exercise program for inpatients during an acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial. J Cardiopulm Rehabil Prev. 2012;32:163-169. 摘要

参考文献

A full list of sources referenced in this topic is available here.

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