A: Patients with progressive lesions may have symptoms such as cough, expectoration, hemoptysis, shortness of breath, repeated pneumonia and pleurisy. The frequency of lung diseases and symptoms is about 2.6%-20%. Chest X-ray examination can show thickening of both lungs, strip shadow, patchy and mottled shadow, cystic change or cavity formation, which mostly involves both lungs. Clinically, it must be differentiated from tuberculosis, and sputum tuberculosis examination and tuberculin test are helpful for differentiation. Pulmonary function examination can show restrictive ventilation disorder or mixed ventilation disorder. Restrictive ventilation disorders mostly occur in cases with no pulmonary lesions and limited chest activity, and obstructive ventilation disorders are mostly caused by pulmonary fibrosis and other diseases. Lung function was measured in our hospital. In 30 cases, restrictive ventilation disorder accounted for 50% and mixed ventilation disorder accounted for 10%. The damage of lung function is reversible in a certain period of time.
2. Decreased function of small airway
A: Improve the general condition of patients. Every time the symptoms of emphysema patients are further aggravated by respiratory tract infection, the lung function is also more damaged. Therefore, it is very important to improve the body resistance and prevent colds and lower respiratory tract infections. Cold-resistant exercise, intramuscular injection of nuclear cheese or BCG can be done.
Treatment measures
Obstructive emphysema is mainly secondary to chronic bronchitis. There are many reasons for chronic bronchitis. Chemical plants should deal with harmful gases well, and factories that produce dust should improve their operation methods, such as adopting wet operation, sealing dust sources, strengthening ventilation and personal protection. These should be strictly implemented by the labor department. Quitting smoking is a practical way for individuals, and the health department should vigorously publicize the harm of smoking. After quitting smoking, cough and expectoration decreased, and the forced expiratory volume at the first 1 second decreased year by year, which was slower than before quitting smoking.
Patients with emphysema are prone to respiratory tract infection in winter, so antibiotics, expectorants and bronchodilators should be used as appropriate.
Patients with obstructive emphysema should still insist on treatment in remission stage, so as to relieve symptoms, prevent acute attack, reduce emergency and hospitalization times, maintain lung function and improve quality of life. Medical staff provide necessary education and guidance to family members and patients, and insist on outpatient or family follow-up. The specific content of treatment in remission period is as follows.
(1) Improve the general condition of patients. Every time the symptoms of emphysema patients are further aggravated by respiratory tract infection, the lung function is also more damaged. Therefore, it is very important to improve the body resistance and prevent colds and lower respiratory tract infections. Cold-resistant exercise, intramuscular injection of nuclear cheese or BCG can be done.
The respiratory load, respiratory function and energy consumption of patients with obstructive emphysema increased. However, due to shortness of breath, hypoxia, right heart failure or drug use, dietary intake can not be increased or even decreased, so malnutrition is often complicated. Malnutrition not only damages lung function and respiratory muscle function, but also weakens the immune mechanism of the body. Therefore, we should pay attention to the intake of nutrients and improve the nutritional status.
Full-body exercises, such as walking, pedaling, treadmill exercise, radio exercise and Tai Ji Chuan, can not only increase muscle activity, but also exercise respiratory and circulatory functions.
(2) Breathing training guides patients to do deep and slow abdominal breathing and exhale with contracted lips.
Patients with emphysema often have shallow breathing and poor breathing efficiency. Instruct patients to take deep and slow abdominal breathing to reduce respiratory resistance, increase tidal volume, reduce the ventilation ratio of dead space, make gas distribution uniform and improve the imbalance of ventilation/blood ratio.
In patients with emphysema, alveolar elasticity decreases, airway resistance increases, the isobaric point moves to the distal airway, and the airway closes earlier when exhaling, which leads to gas retention in the lungs and aggravates the imbalance of ventilation/blood flow ratio. Breathing with contracted lips increases the resistance of the external airway and moves the isobaric point to the central airway, which can prevent the premature closure of the airway.
(3) Respiratory muscle exercise Patients with emphysema have adverse effects on respiratory muscles due to factors such as over-inflation, malnutrition and hypoxia. In the case of lung infection, the respiratory load is further aggravated, which can cause respiratory muscle fatigue, which is one of the causes of respiratory failure. Respiratory muscle function can be improved by resistance breathing or hyperventilation with carbon dioxide.
(4) Patients whose arterial oxygen partial pressure is still below 7.33kPa(55mmHg) in remission after anti-infection, expectorant and bronchospasm treatment should be given home oxygen therapy. For emphysema patients with secondary polycythemia or intractable right heart failure, the indications of oxygen therapy can be relaxed appropriately. Oxygen therapy can improve patients' symptoms, improve work efficiency, increase activity intensity and expand the range of activities. It is better to insist on oxygen inhalation 15 hours every day than intermittent oxygen inhalation. In order to prevent the inhibitory effect of high concentration oxygen inhalation on ventilation, low flow oxygen inhalation should be adopted. Oxygen supply equipment has also been improved. Conventional compressed gas cylinders are inconvenient to be used at home because of their large size, heavy weight and inconvenient movement. The oxygen concentrator can concentrate oxygen in the air and is convenient to use. Liquid oxygen tank stores oxygen in liquid state at ultra-low temperature, so it is small in size and light in weight, which is its advantage. The synchronous oxygen inhalation device is triggered by the patient's inhalation to provide oxygen, and the expiratory phase does not provide oxygen, which can save oxygen. In recent years, it has been reported abroad that indwelling catheter absorbs oxygen through cricothyroid membrane.
(5) The development of other non-invasive mechanical ventilation provides conditions for home mechanical ventilation of patients with obstructive emphysema. Generally, nasal mask or nasal mask or ventilator is used for connection, and negative pressure ventilator can also be used. Intermittent mechanical ventilation at home can make respiratory muscles rest, relieve respiratory muscle fatigue and improve respiratory muscle function.
Amitriazine and magnesium glabrate vectarin can not only stimulate breathing to improve ventilation, but also improve the imbalance of ventilation/blood flow ratio and increase arterial oxygen partial pressure, which can be used for the treatment of obstructive emphysema in remission stage.
In recent years, lung transplantation has been carried out abroad to treat patients with advanced emphysema. Single lung transplantation is relatively simple, with low complications and mortality.
The treatment of acute attack and chronic delay should focus on controlling infection, eliminating phlegm and relieving cough; When accompanied by wheezing, add antispasmodic and antiasthmatic drugs.
⑴ Antibacterial treatment: General cases can be based on common pathogenic bacteria. You can choose compound sulfamethoxazole (SMZ) 2 tablets each time, twice a day; Amoxicillin 2 ~ 4g/d, taken orally for 3 ~ 4 times; Ampicillin 2 ~ 4g/d, taken orally for 4 times; Cefalexin 2 ~ 4g/d, or cefradine 1 ~ 2g/d, taken orally four times; Oral cefuroxime 1g/d or cefaclor 500mg ~ 1g/d, divided into 2 ~ 3 times. You can also choose a new generation of macrolide antibiotics, such as roxithromycin 0.3g/d, and take it orally twice. The course of antibacterial treatment is usually 7 ~ 10 days, and cases of repeated infection can be extended appropriately. After three days of treatment, if the condition does not improve, antibiotics should be selected according to the results of drug sensitivity test of sputum bacteria culture.
In case of severe infection, ampicillin, ciprofloxacin, ofloxacin, amikacin, netilmicin or cephalosporins can be given by combined intravenous drip. Please refer to "Antibacterial Therapy" for specific usage.
⑵ The expectorant and antitussive drugs can be given mucosolvan (bromocyclohexylamine hydrochloride) 30mg or expectorant tablets (carboxymethyl cysteine) 500mg orally, three times a day. Bromhexine (Bisuping) and ammonium chloride brown mixture have certain expectorant effect. When the sputum is thick and difficult to cough up, the secretions in the airway can be diluted by steam inhalation of loquat leaves or ultrasonic atomization.
⑶ Antispasmodic and antiasthmatic drugs are often used for asthmatic bronchitis, such as aminophylline 0. 1 ~ 0.2g, taken orally three times a day; Mei Chuanqing 50? G, oral twice a day, 2.5mg of bricanyl, 2 ~ 3 times a day, and compound Luchuan 1 tablet, 3 times a day. Patients with reversible obstruction of chronic bronchitis should be routinely treated with bronchodilators. Such as ipratropium bromide (ipratropium bromide) aerosol, bricanyl and other inhalation therapies. Paroxysmal cough is often accompanied by different degrees of bronchospasm. The use of bronchodilators can improve symptoms and help to clear phlegm.
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