1、单击此处编辑母版标题样式单击添加署名或公司信息n慢性阻塞性肺疾病的护理内四科 刘秀明Page 2This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core compo
2、nents of the system are AT89C51 microcontroller and DS18B20 temperature sensor.慢性 阻塞性肺疾 病的概念n 定义：n COPD是一种常见的可以预防和可以治疗的疾病，其特征是 不 完全可逆 持续存在的气流受限 。气 流受限呈 进行性发展 ，伴有气道和肺对有害颗粒或气体的异常炎症反应有关。COPD急性加重期（ AECOPD)：指患者出现超越日常状况的持续恶化，并需改变基础 COPD的常规用药者，通常在疾病过程中，患者短期内咳嗽，咳痰，气短和喘息加重，痰量增多，可伴发热等。Page 3This paper mainly
3、introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temper
4、ature sensor.COPD 与慢性支气管炎和肺气肿的关系n 慢性支气管炎是指排除慢性咳嗽的n 其他已知原因后，患者每年咳嗽，n 咳痰 3个月以上，并且连续 2年者n 。肺气肿指肺部终末细支气管远端气腔出现异常持久的扩张，并伴有肺泡壁和细支气管的破坏而无明显纤维化。当慢支炎、肺气肿患者出现 气流受限而且不完全可逆 时即能诊断 COPD.无气流受限则不能诊断 COPD.哮喘是气流受限但是是可逆的，不属于COPD.单击此处编辑母版标题样式单击添加署名或公司信息研究人群 : 20,000 人，年龄 40 岁 以上COPD 的总体患病率为 8.2%，男性为 12.4% ，女性为 5.1%Zhon
5、g et al. AJRCCM 2007;176:753-760中国 COPD患病率 一 项 大型、基于人群的 调 研单击此处编辑母版标题样式单击添加署名或公司信息n 中国 COPD 死亡率 （ 2000年 : 近 128万 ）2008年 城市 居民主要疾病死亡构成 占总死亡数 (%) 农村 居民主要疾病死亡构成 占总死亡数 (%)1 恶性肿瘤 27.12 恶性肿瘤 25.392 脑血管病 19.65 脑血管病 21.733 心脏病 19.62 呼吸系统疾病 16.884 呼吸系统疾病 11.82 心脏病 14.115 损伤和中毒外部原因 5.08 损伤和中毒外部原因 8.596 消化系统疾病
6、 3.43 消化系统疾病 2.657 内分泌、营养和代谢问题 2.86 其他疾病 2.048 其他疾病 2.11 内分泌、营养和代谢问题 1.799 泌尿、生殖系统疾病 1.13 泌尿、生殖系统疾病 0.9210 神经系统疾病 1.03 神经系统疾病 0.71中国慢性病报告 . 中国疾病预防控制中心 . 2006. 中国卫生统计年鉴 2009. Page 6This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temp
7、erature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.发病原因一、外因1、吸烟2、感染因素3、理化因素4、气候5、过敏因素Page 7This paper mainly introduces the design of an int
8、elligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.内因1、呼吸道局部防御及免疫功能低下
9、2、自主神经功能失调3遗传因素Page 8This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT8
10、9C51 microcontroller and DS18B20 temperature sensor.病理生理1、 肺组织弹性日益减退，肺泡持续扩大，回缩障碍，肺泡周围毛细管受肺泡膨化的挤压而退化，致肺毛细血管大量减少，肺泡间的血流量减少，导致生理无效腔增大。2、 另外部分肺泡通气不能参与气体交换。因此产生通气 /血流比例失调，导致换气功能障碍。通气和换气功能障碍引起缺氧和二氧化碳潴留单击此处编辑母版标题样式单击添加署名或公司信息nCOPD发病机制 : 慢性炎症增强反应Barnes PJ. Chest 2000;117;10S-14S吸烟（其它刺激物）蛋白激酶 弹性蛋白酶组织蛋白酶金属基质蛋
11、白酶肺泡壁破坏 (肺气肿 ) 粘液高分泌CD8+ T淋巴细胞肺泡巨噬细胞上皮细胞纤维化(闭塞性细支气管炎 )成纤维细胞单核细胞中性粒细胞趋化因子单击此处编辑母版标题样式单击添加署名或公司信息COPD中气流受限的机制小气道疾病气道炎症气道纤维化，管腔黏液栓气道阻力升高肺实质破坏肺泡附着的消失弹性回缩力下降气流受限 GOLD 2011-P2单击此处编辑母版标题样式单击添加署名或公司信息COPD的典型症状是慢性和进行性呼吸困难、咳嗽和咳痰。 呼吸困难 ： 是 COPD标志性症状，早期为劳力时出现，后期加重，日常生活或休息时也出现。慢性咳嗽 ： 通常为首发症状慢性咳痰 ： 合并感染时痰量增多，常有脓性
12、痰。喘息和胸闷 ：不是 COPD特意性症状。全身症状：可出现体重下降，食欲减退等。COPD的症状GOLD 2011-P11Page 12This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomp
13、uter. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.体征n （ 1）视诊及触诊：桶状胸，腹上角增宽，呼吸浅快，重者辅助呼吸肌参与呼吸运动，甚至胸腹矛盾运动，低氧血症者出现发绀，右心衰可有下肢水肿，肝脏增大，颈静脉怒张，肝颈静脉回流征阳性。（ 2）叩诊：呈过清音。（ 3）听诊，两肺呼吸音减低，呼气相延长，心音遥远。Page 13This paper mainly introduces the design of an intelligent tempe
14、rature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.实验室检查1、 x线2肺功能 功能检查 金标准。3、血气分析4血
15、液检查单击此处编辑母版标题样式单击添加署名或公司信息症状慢性咳嗽气短危 险 因素暴露 烟草职业室内 /室外 污 染肺功能检查： 确诊 COPD的必需检查COPD的诊断咳痰 GOLD 2011-P10单击此处编辑母版标题样式单击添加署名或公司信息nCOPD急性加重期的处理Global Strategy for the Diagnosis, Management and Prevention ofChronic Obstructive Pulmonary Disease (Revised 2011).表 5.4 重度但非危及生命的急性加重的管理 * 评估症状的严重度、血气、胸片 吸氧治疗，获取系列
16、动脉血气分析结果 支气管扩张剂：- 增加剂量和 /或提高速效支气管扩张剂的使用频率- 速效 2-激动剂与抗胆碱能制剂联用- 使用储雾罐或空气驱动的雾化器 增加口服或静脉注射的激素 有细菌性感染的表现时，考虑使用抗生素（口服或偶尔静脉注射） 考虑无创机械通气 在任何时候都应：- 监测液体平衡和营养- 考虑皮下注射肝素或低分子量肝素- 识别并治疗相关状况（如心衰，心律失常）- 密切监测患者的病情Page 16This paper mainly introduces the design of an intelligent temperature control system which reali
17、zes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.护理诊断n1、气体交换受损 与通气减少 、通气 /血流比例失调有关n2、清理呼吸道无效 与分泌物增多、粘稠和无效咳嗽有关n3、营养
18、失调低于机体需要量 与食欲减低、呼吸困难、消耗增加有关n4活动无耐力 与呼吸困难，缺氧有关n5焦虑 与呼吸困难有关Page 17This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer
19、. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.护理n一、维持有效的气体交换n1、 注意观察病情 n2、 体位：取端坐位，或半坐卧位n n Page 18This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control
20、by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.n3、 遵医嘱予氧气吸入 n （ 1） 用氧注意事项 ：n 加强用氧管理 加强健康宣教 n 注意观察 注意湿化n （ 2）用氧副作 用氧疗可解除血氧过低，（正常动脉血氧含量为 80% 100%）但吸氧浓度 60%可引起氧 中毒 、肺不张、呼吸
21、道干燥及呼吸道分泌物聚集的危险。 Page 19This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are
22、AT89C51 microcontroller and DS18B20 temperature sensor.用氧副作n a、氧中毒n在常压下吸入 40%的氧是安全的，吸入纯氧不应超过 8 12h一般情况下连续吸纯氧 6小时后，或 60-70%氧浓度 1-2天会出现氧中毒。如需采用高压氧吸入时，更应严格控制氧压和使用时限，以防止氧中毒发生。氧中毒的程度主要取决于吸入气的氧分压及吸入时间。 n b、吸收性肺不张n C、呼吸道干燥n D、污染和导管堵塞张Page 20This paper mainly introduces the design of an intelligent temperat
23、ure control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.家庭用氧的指征n： 1、 PAO255mmhg,n或动脉血氧饱和度 8
24、8%。 2、PAO255-60mmhg,或动脉氧饱和度89%并伴有肺动脉高压，心力衰竭或红细胞增多症。n Page 21This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. Th
25、e core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.nCOPD为什么持续低流量吸氧Page 22This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital tempera
26、ture sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.一、维持有效的气体交换n4、做好药物治疗及护理 四类用药n5、维持气道通畅n6、呼吸功能锻炼n7、呼吸机支持Page 23This paper mainly introduces the design of an intelligent temperature control system which real
27、izes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.二保持呼吸道通畅1、观察痰液的性质、颜色，量等2、指导患者多饮水3、指导患者有效的咳嗽的方法和深呼吸 4、给予翻身，拍背Page
28、 24This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroll
29、er and DS18B20 temperature sensor.二保持呼吸道通畅5、遵医嘱给以雾化吸入 、 遵医嘱用药6、可采用震颤法使痰脱落，易于排出 7、对神志不清者，可进行机械吸痰 Page 25This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature senso
30、r DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.n8、 预防并发症n 长期剧咳时应适当n 给予镇咳药n ，防止发生晕厥、肋骨骨折、n 气胸等，但对湿性咳嗽n 不宜单独使用强效止咳药，n 尤其对年迈体弱者，n 以免造成窒息 Page 26This paper mainly introduces the design of an intelligent temperature co
31、ntrol system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.n9、 减轻或去除诱发及加重咳嗽的因素 ： 减少接触冷空气，寒冷季节或气候突变外出
32、时，应注意保暖，可用口罩和防寒具。劝病人戒烟并解释吸烟的危害，如吸烟可引起支气管上皮纤毛功能减退，分泌物增加，支气管痉挛，增加通气阻力，使痰不易排出。Page 27This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single
33、chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.三、呼吸功能锻炼n目的n 1、改变辅助呼吸肌参与的不合理的浅速呼吸方式n 2、有利于提高潮气容积，减少无效死腔，增加肺泡通气量n ，改善气体分布n 3、降低呼吸功耗n 4、缓解气促症状n 5、减轻焦虑 n 6、防止气道动态陷闭，有利于肺泡气的排出，改善通气 /血流比例失调Page 28This paper mainly introduces the design of a
34、n intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.呼吸功能锻炼的方法n缩唇呼
35、吸n腹式呼吸n全身性呼吸体操锻炼Page 29This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are A
36、T89C51 microcontroller and DS18B20 temperature sensor.呼吸功能锻炼注意事项n 1、 因人而异针对病人个体差异，为病人选择制定一套呼吸锻炼技术。n .2 循序渐进根据病情轻重程度， 为病人制定训练计划，开始训练时，应有医护人员在场，先做示范动作，再给予具体指导和及时纠正。开始训练时次数不宜过多，掌握方法后逐渐增加时间和次数。n 3 确保安全开始训练时，要密切观察病人的面色、神态及生命体征，如有不适，不宜强行训练，锻炼量以病人自觉稍累而无呼吸困难，心率较安静时增加 20 次 /min，呼吸增加 5 次 /min 为宜。Page 30This p
37、aper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.呼吸功能锻炼注意事项n 4 耐心宣教长期慢性病病人多有一定的心理障碍，体质差，让病人坚持长期呼吸功能锻炼有一定的困难，要求指导者高度的责任心，认真讲解训练方法、目的、作用机制及注意事项，做好耐心细致的说服教育，帮助病人树立信心。n .5 持之以恒呼吸功能锻炼要坚持长久，短时间的训练不会有明显成效，要指导病人坚持锻炼，尤其要做好病人出院指导，帮助病人制定持久的训练计划，定期电话随访，确保长期n 效 果。
