支气管扩张

null支气管扩张(bronchiectasis )支气管扩张(bronchiectasis )呼吸科 吕寒静何谓支气管扩张？何谓支气管扩张？支气管由于管壁的肌肉、软骨和弹性组织结构破坏引起官腔的扩张和变形。 Bronchiectasis Definition Bronchiectasis is a chronic inflammatory or degenerative condition of one or more bronchioles of the lungs marked by dilatation. null为什么会支气管扩张？为什么会支气管扩张？支气管感染：细菌、结核、曲霉菌 感染 阻塞 支扩 为什么会支气管扩张？为什么会支气管扩张？支气管被牵拉：结核后 支气管阻塞：感染、异物、肿瘤（内长、外压） 为什么会支气管扩张？为什么会支气管扩张？支气管先天发育障碍和遗传因素： 1. 巨大气管－支气管症（tracheobronchomegaly) 2. Kartagener综合征(不动纤毛综合征,immotile cilia syndrome) 3. 副鼻窦－支气管综合征（sinobronchial syndrome） The sinobronchial syndrome consists of chronic sinusitis and chronic nonspecific inflammation of the lower airways, typically chronic bronchitis, bronchiectasis and diffuse panbronchiolitis. This airway disease of unknown etiology is not related to smoking. It is common in Japan and is poorly described in western countries. We report a case in a non-Asian patient. The known efficacy of long-term low-dose erythromycin therapy justifies careful diagnosis of sinobronchial syndrome in patients of non-Asian ethnic origin. 4. 先天性软骨缺失症（congenital cartilage deficiency） 5. 支气管肺隔离症(bronchopulmanary sequestration) 支气管扩张有哪些病理特点？支气管扩张有哪些病理特点？ 支气管壁的肌肉、软骨和弹性组织结构 破坏引起管腔扩大。（柱状、囊状） 鳞状上皮取代纤毛柱状上皮。 杯状细胞、粘液细胞增生。 毛细血管扩张。 支气管扩张有哪些病生特点？支气管扩张有哪些病生特点？与病变范围有关 阻塞性通气功能障碍 阻塞为主的混合性通气功能障碍 V/Q比例失调 肺源性心脏病、右心衰竭 支气管扩张有哪些临床特点？支气管扩张有哪些临床特点？长期咳嗽、咳痰：痰液可分层 反复咯血 反复造成相应部位的肺炎 慢性感染中毒症状：类似慢性肺脓肿 固定部位持久的湿啰音 肺气肿、肺心病的现 杵状指（趾） Bronchiectasis symptomsBronchiectasis symptoms The most typical symptom is a chronic cough that produces thick, white or green sputum and may be the first symptom of bronchiectasis. Symptoms begin usually after a respiratory infection.The other bronchiectasis symptoms may include:The other bronchiectasis symptoms may include: coughing up blood shortness of breath Breathlessness Tiredness Anemia Wheezing weight loss fatigue Clubbing Morning cough Skin discoloration, bluish Paleness Chest pain Breath odor Paroxysmal coughing Some people with bronchiectasis also have pus-producing infection of the nasal sinuses 应做哪些辅助检查？应做哪些辅助检查？影像学：胸片、CT。确诊依据。 纤维支气管镜 肺功能 血常规 痰菌 其他 支气管扩张有哪些诊断依据？支气管扩张有哪些诊断依据？病史：童年时期反复呼吸道感染病史 临床特点:长期咳嗽、咳痰； 固定部位持久的湿啰音 影像学：囊状扩张-卷发样改变，液平 柱状扩张-轨道征 细菌学：铜绿假单胞菌、金葡菌、流感 嗜血杆菌、肺炎链球菌、卡他莫拉菌 纤维支气管镜：出血部位、阻塞？ nullnullnullnullnull支气管扩张应与哪些疾病鉴别？支气管扩张应与哪些疾病鉴别？慢性支气管炎 慢性肺脓肿 肺结核 先天性肺囊肿 弥漫性泛细支气管炎（diffuse panbronchiolitis)支气管扩张如何治疗？支气管扩张如何治疗？控制急性感染 保持呼吸道引流通畅：祛痰、扩张支气管、体位、纤维支气管镜 手术：大咯血危及生命 病变局限而全身状况好，心肺功 能良好null