哮喘持续状态的急救

刘***夫

什么是哮喘持续状态
  美国胸科协会将哮喘持续状态定义为：哮喘从发作初期即出现严重的气道阻塞或发作后哮喘病情加重，并且对常规治疗无效的急性发作性哮喘。因此，哮喘严重发作通常称为哮喘持续状态。这种哮喘持续状态只是指一次发作情况而言，并不代表该患者的基本病情，但往往发生于重症的哮喘患者，而且与预后有关，可威胁患者的生命。
  哮喘持续状态的临床表现为：哮喘发作进行性加重，胸部紧迫甚至有窒息感，患者被迫端坐，不能平卧，头向前俯，两肩耸起，两手撑于膝盖上、桌上或床边，用力喘气，呼吸、心跳均加快，说话断断续续，焦虑烦躁，大汗淋漓，甚至出现嗜睡，口唇指甲发绀，在患者身旁即可闻到喘息音。这些表现说明患者有明显气道阻塞，身体缺氧，需要紧急处理。
哮喘持续状态的急救
  1.立即吸氧。一般应用低流量1~2L/min，随着低氧血症的纠正，呼吸肌获得足够氧气，收缩有力，改善通气，同时也避免缺氧对身体重要器官的损害。
  2.迅速应用支气管扩张剂。β2受体激动剂可以迅速缓解支气管收缩，起效快，副作用少，它一般分为长效与短效两种，哮喘持续状态主要应用短效制剂，如沙丁胺醇（又名喘乐宁或舒喘灵）2.5mg溶于生理盐水中雾化，从气道吸入，每隔20min1次，共3次；也可加用胆碱能受体拮抗剂，如溴化异丙托品（又名爱喘乐）250~500μg加2ml生理盐水雾化吸入。若治疗效果不好或患者昏迷、烦躁无法使用吸入治疗，可皮下注射肾上腺素（1/1000）0.3ml，也可用氨茶碱0.25g加生理盐水或葡萄糖液50ml静脉缓慢推注。
  3.尽快应用糖皮质激素以减轻气道急性炎症，加速急性发作的缓解，一般应用琥珀酸氢化可的松100~200mg，或甲基**2mg/kg体重，加入生理盐水或葡萄溶液中，每4~6h静脉推注1次，病情好转后改用口服强地松，每天30~40mg。
  4.有明显呼吸道感染，症状仍不缓解，动脉血氧分压仍低于60mmHg，意识不清或是昏迷状态，应考虑机械通气。
  如果在家中发生哮喘持续状态，而又无法立即送医院时，首先将患者放在空气流通的地方，解开衣领，注意保暖，如家中备有制氧仪或附近诊所有氧气，应立即用鼻导管吸氧。并迅速应用装有支气管扩张药的定量手控气雾剂，如喘乐宁或可必特（喘乐宁加爱喘乐，一般哮喘患者均备有），立即气道吸入2~4喷，每隔20min可重复吸1次；如家中备有博利康尼药片，可口服1片（2.5mg）。同时口服强的松30mg，或到附近诊所静脉推注**5mg加生理盐水10ml，并及时应用装有糖皮质激素（如必可酮或普米克）的定量手控雾化剂吸入，每隔20min吸入2喷。此外，哮喘持续状态的患者如果曾有致命的哮喘发作史，或过去1年内曾因哮喘而住院、急诊就诊，或因哮喘曾有气管插管史，或目前出现气喘、紫绀进行性加重、肺部呼吸音及哮喘音逐渐减弱等情况，均为非常危险信号，应紧急送往医院。

華*

如果附上英文,那就可以给你加分了

凌*枫

{MOD}:handshake

午*茶

不错 且 实用

勿*蓝

很实用啊！:victory:

月*湾

还要积极去除导致哮喘持续的因素，控制感染、补足液体量防止痰栓堵塞气道 ，解除二氧化碳潴留，控制心衰等

h****4

谢谢分享！！！

乔*儿

谢谢啊！！好东东！！！

w****n

原帖由 刘延红大夫 于 2006-10-29 11:33 发表

                               
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什么是哮喘持续状态
  美国胸科协会将哮喘持续状态定义为：哮喘从发作初期即出现严重的气道阻塞或发作后哮喘病情加重，并且对常规治疗无效的急性发作性哮喘。因此，哮喘严重发作通常称为哮喘持续状态。这种哮喘 ...

我是外行翻译一下有喜欢的就凑合的看吧！
Any is the asthma continues the condition The American chest branch association continues the asthma thecondition definition is: The asthma after manifests suddenly theinitial period namely to appear the serious gas channel to block or tomanifest suddenly the asthma condition to aggravate, and toconventional treatment invalid acute manifesting suddenly asthma.Therefore, the asthma seriously manifests suddenly usually is calledthe asthma to continue the condition. This kind of asthma continuesthe condition only is refers time manifests suddenly the situation tosay, certainly does not represent this patient's basic condition, butoften has Yu Zhongzheng asthma patient, moreover after pre- related,may threaten patient's life. The asthma continues the condition the clinical manifestation is: Theasthma manifests suddenly carries on the nature to aggravate, thechest urgent even has suffocates the feeling, the patient is compelledto sit well, cannot horizontal, bends down to front, two shoulderspeaks get up, two support nearby the knee, the table or the bed, makesan effort to gasp for breath, the breath, the palpitation speed up,speaks off and on, anxious is agitated, sweats profusely, even appearsis addicted to rests, the lips nail cyanosis, then 闻到 the respitesound nearby the patient body. These performance explained the patienthas the obvious gas channel to block, the bodily oxygen deficit, needsurgently to process. The asthma continues the condition the first aid
1. Attracts the oxygen immediately. Generally applies lowcurrent capacity 1~2L/min, along with the low oxygen blood sicknesscorrection, breathes myo- obtains the enough oxygen, the contractionis powerful, the improvement ventilates, simultaneously also avoidsthe oxygen deficit to the bodily important organ harm.
2. Rapid application bronchiectasis medicinal preparation. Beta 2acceptors excited medicinal preparations may rapidly alleviate thebronchial tube contraction, gets up the effect quickly, side effectfew, it generally divides into the persistent effect and the shorteffect two kinds, the asthma continues the condition mainly to applythe short effect preparation, if the sand butylamine is mellow (othername to breathe heavily Le Ninghuo shu Chuanling) 2.5mg to dissolve tothe physiological saline 中雾, from gas channel inspiration, each20min1, altogether 3; Also the coca can the acceptor oppress the anti-medicinal preparation with the choline, if the bromination differentthird 托品 (other name likes happy breathing heavily) 250~500 mu gto add the 2ml physiological saline atomization inspiration. If thetreatment result is not good or the patient stupor, is agitated isunable to use the inspiration treatment, but hypodermic injectionadrenalin (1/1,000) 0.3ml, also may use aminophylline 0.25g to add thephysiological saline or the glucose fluid 50ml vein slowly pushes thenote.
3. Reduces the gas channel acute inflammation as soon as possibleusing the sugar cortical hormone, alleviating which the accelerationacute manifests suddenly, generally applies the succinic acidhydrogenation to be possible pine 100~200mg, or the methyl **2mg/kg body weight, joins in the physiological saline or the grapesolution, each 4~6h vein pushes note 1, after the condition changesfor the better changes to takes orally strongly the pine, every day30~40mg.
4. Has the obvious respiratory tract to infect, the symptom still didnot alleviate, the artery blood oxygen partial pressure still waslower than 60mmHg, realized is unclear perhaps the comatose condition,should consider the machinery ventilated. If has the asthma in the home to continue the condition, when also isunable delivers the hospital immediately, first the patient puts onthe air circulation place, unties the collar, the attention maintainswarmth, if in the family has the oxygen manufacture meter or nei**orthe clinic has the oxygen, should use the nose drive pipe to attractthe oxygen immediately. And the rapid application is loaded with thebronchiectasis medicine the quota manually controlled gas spraymedicinal preparation, if breathes heavily Le Ninghuo to be possibleto have especially (to breathe heavily Le Ningjia to like breathingheavily happy, common asthma patient has), gas channel inspiration 2~4spurts immediately, each 20min may duplicate attracts 1 time; If inthe family has 博利 the Connie pill, may take orally 1 piece(2.5mg). Simultaneously takes orally strong pine 30mg, or pushes note** 5mg to the nei**or clinic vein to add physiologicalsaline 10ml, and the prompt application is loaded with the sugarcortical hormone (for example to have to be possible alkone or PuMick) quota manually controlled atomization medicinal preparationinspiration, each the 20min inspiration 2 spurts. In addition, theasthma continues the condition patient's if once had the fatal asthmato manifest suddenly the history, either passed in for 1 year once tobe hospitalized because of the asthma, the emergency medical treatmentreceives a medical examination, either because the asthma once had thetrachea to insert a tube the history, either at present appears theasthma, purple dark purple carries on the nature to aggravate, thelungs 呼吸音 and the asthma sound gradually weakens and so on thesituation, for the unusual danger signal, should urgently escort tothe hospital.

j****l

学习了，谢谢分享！！！:P

w***m

谢谢各位无私奉献

a****4

很实用啊

d****0

学习

m****h

实用，学习了

r****9

谢谢各位老师

庄*

谢谢分享

b****i

学习

p****i

学习了

w****h

简明实用

z****3

学习