第二十一篇慢支炎呼.ppt

第二节 慢性阻塞性肺病肺实质 小气道受损— 慢性 不可逆 气道 肺功能
一 慢性支气管炎 chronic bronchitis
1 概述 标准 咳嗽 咳痰 （喘） 3个月 2年
---
周围型 --- 扩张
全小叶型 扩张 扩张
肺大泡: 气肿 > 1cm 破坏小叶间隔
The dilated airspaces with emphysema are seen. Although there tends to be some scarring with time because of superimposed infections, the emphysematous process is one of loss of lung parenchyma, not fibrosis. The former involves primarily the upper lobes while the latter involves all lung fields, particularly the bases. Centrilobular emphysema occurs with loss of the respiratory bronchioles in the proximal portion of the acinus, with sparing of distal alveoli. This pattern is most typical for smokers. Panacinar emphysema occurs with loss of all portions of the acinus from the respiratory bronchiole to the alveoli. This pattern is typical for alpha-1-antitrypsin deficiency.
The chest cavity is opened at autopsy to reveal numerous large bullae apparent on the surface of the lungs in a patient dying with are large dilated is characterized by airspaces that bulge out from beneath the a loss of lung parenchyma by destruction of alveoli so that there is permanent dilation of airspaces.
4 临床病理联系及并发症
临床: 气短 呼吸困难 紫绀 桶状胸
并发症：
肺心病
肺大泡破裂—自发性气胸
呼吸衰竭
肺性脑病
四 慢性肺源性心脏病 chronic cor pulmonale
1 概念 慢性肺部疾病— 肺动脉高压 — 右心室
2 病因和发病机理
（1）慢性阻塞性肺疾病
（2）限制性肺疾病
胸廓 胸膜粘连 畸形等— 胸廓运动受限
— 肺通气障碍，血管扭曲受压— 肺A高压
（3）肺血管病变
原发性肺A高压 反复肺小A栓塞等
3 病理变化
肺 : 原病变 + 肺小血管病变
（中膜肥厚，动脉炎，纤维增生）
心脏: 右室肥厚（>5mm） 右心腔扩张
镜下：心肌萎缩变性，间质水肿，纤维增生
4 临床
右心衰
肺性脑病
第三节 肺尘埃沉着症
尘肺
长期吸入有害粉尘 — 沉积于肺 — 肺广泛纤维化
职业病
粉尘 无机：硅 石棉 煤
有机：真菌代谢物
细菌产物
动物性蛋白