肺の役割と呼吸不全 - dobin.jp94x%82%cc%93%ad%82%ab%82… · 肺の役割と呼吸不全...
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COPD,
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(760-47)0.21=149.7
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0.0sec. 0.25sec. 0.50sec. 0.75sec.
PAO2
PaO2
A-aDO2
80100Torr
15TorrPaO2
-
PaO2 60 Torr
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COPD
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CO2
Na
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COPD
ARDS
ALS
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COPD
-
COPD
2004
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GOLD
GOLD updated
2003
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GOLDCOPD
GOLD
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(, , )
COPD
GOLD
COPD
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GOLD
-
COPD
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1998
1. Heart Disease 724,269 2. Cancer 538,9473. Cerebrovascular disease (stroke) 158,0604. Respiratory Diseases (COPD) 114,3815. Accidents 94,8286. Pneumonia and influenza 93,2077. Diabetes 64,5748. Suicide 29,2649. Nephritis 26,29510. Chronic liver disease 24,936
All other causes of death 469,314
GOLD
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10
10.4
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COPD
()
WHO
COPD
()
WHO
GOLD
COPD
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COPDHRCT
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COPD
-
GOLD
COPD
-
VC) FVC) FEV1.0
FEV1.0
FVCFEV1.0%
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80%
70%
0%
100%
100%
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FEV1.0%)
FEV1.0%70%COPD
COPD
FEV1.0
FVCFEV1.0%=
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%%FEV1)
% FEV1.0
FEV1.0
COPD%FEV1
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COPDF-V
%FEV1
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0:
()
I: FEV1/FVC < 70%; %FEV1 80%
II: FEV1/FVC < 70%; 50% %FEV1 < 80%
III: FEV1/FVC < 70%; 30% %FEV1 < 50%
: FEV1/FVC < 70%; %FEV1 < 30% % FEV1< 50%
0:
()
I: FEV1/FVC < 70%; %FEV1 80%
II: FEV1/FVC < 70%; 50% %FEV1 < 80%
III: FEV1/FVC < 70%; 30% %FEV1 < 50%
: FEV1/FVC < 70%; %FEV1 < 30% % FEV1< 50%
GOLD
COPD
-
COPD
Stage0 Stage Stage Stage Stage
80% 50% 30%%1
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COPD
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IPF NSIP COP AIP DIP RBILD LIP
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IPF
HRCT
honeycomb
HOT
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AIPALI/ARDS
ALI: Acute Lung InjuryARDS: Acute Respiratory Distress SyndromeAIP: Acute Interstitial Pneumonia
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AIP1. XCT
2. .
3. CRPKL-.
4. ARDS
5. Hamman-Rich.
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ALI/ARDS
ARDSALIacute lung injuryALIARDS
ALIARDSPFPaO2/FIO2P/F300ALI200ARDS
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ARDS)
PaO2/FiO2200
()
18mmHgor
(Bernard GR1994)
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ARDS
-
ARDS
PEEP 515cmH2O
high PEEP
Permissive hypercapnia
10cmH2O
FOY
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COPDCOPDFEV1.0%)%%FEV1)COPDF-VCOPDCOPDIPFAIPALI/ARDS