慢支炎呼肿 病理学课件.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
失活
* α1-抗胰蛋白酶（ α1-antitrypsin, α1-AT)
产生 分泌：肝细胞
存在：血清 组织液 炎细胞等
作用：抑制多种蛋白水解酶
（弹力蛋白酶 基质金属蛋白酶等）
A 炎症：
N M — 弹力蛋白酶↑
— 自由基 — 抑制α1-AT活性 — 破坏
B α1-抗胰蛋白酶缺乏症 原发性肺气肿 欧洲
3. 病理变化
部位 肺腺泡（1级呼吸细支气管范围）
LM: 大 薄 断 少
肉眼：体积大 边缘钝 质地软 灰白
弹性差(压痕) 捻发音
呼吸性细支气管 肺泡管 肺泡囊 肺泡
中央型 扩张 ---
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