COPD,???????

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????????? COPD,???????
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(760-47)0.21149.7
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??!
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0.75sec.
0.50sec.
0.0sec.
0.25sec.
PAO2
15Torr??
A-aDO2
PaO2
PaO2
80100Torr
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PaO2 ?60 Torr
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COPD
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?????? CO2???????????
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??? ??????????
??? ?Na????????
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??????????
????? ???? ?????COPD???????
????? ?????? ???????ARDS???????
????? ?????? ????????
????? ????? ??????
????? ????? ????
????? ???????????????ALS
????? ???????????
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COPD???
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???????COPD??????
2004?
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GOLD
2003?
GOLD updated2003
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GOLD?COPD???
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GOLD
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COPD???
????(??, ????, ??????)
COPD



???? ???? ???

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GOLD
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GOLD
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COPD???????????
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??????????????? 1998
?(?)
??

• Heart Disease 724,269
• Cancer 538,947
• Cerebrovascular disease (stroke) 158,060
• Respiratory Diseases (COPD) 114,381
• Accidents 94,828
• Pneumonia and influenza 93,207
• Diabetes 64,574
• Suicide 29,264
• Nephritis 26,295
• Chronic liver disease 24,936
• All other causes of death 469,314

GOLD
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??????????????????????
2001??????10? (10.4)
???????
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COPD???

• COPD????????????
• ?????????4720?? (???28????23) ???????
• WHO?????11??????????2025???16????????????????????
  ???????????????????

GOLD
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COPD?HRCT
????????????? ?????? ???????
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COPD???????
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COPD???
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GOLD
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???????????

• ???(VC)
• ??????(FVC)
• 1??(FEV1.0)

FEV1.0

• 1??

FVC
(FEV1.0)
??????????????
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100
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70
???????
1??
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100
80
0
???
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1??(FEV1.0)
FEV1.0lt70COPD?
COPD???
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1??(FEV1)
FEV1.0(???)
1??
FEV1.0(???)
COPD?FEV1??????????
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COPD?F-V??
1??
FEV1
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COPD??????
???? ?? 0 ????? ??????????? ???? (???)  I
?? FEV1/FVC lt 70 FEV1 ³ 80 ??(???)?????????
II ??? FEV1/FVC lt 70 50 FEV1 lt
80 ??(???)????????? III ?? FEV1/FVC lt 70
30 FEV1 lt 50 ??(????????)?????????
???? FEV1/FVC lt 70 FEV1 lt 30 ??? FEV1lt
50 ??????????????
GOLD
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COPD??????????
????? ?? ??? ?? ???
Stage0 Stage? Stage? Stage? Stage?

FEV1
30
50
80
??????????????????????????
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COPD????

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• ???????

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IPF ???????
NSIP ?????????
COP ????????
AIP ???????
DIP ????????
RBILD ??????????????
LIP ??????????
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IPF(???????)

• ????????????????
• ??????????
• HRCT??????????(???honeycomb)
• ??????????????????5??HOT?

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???????????????????

• ???????
• ??(?????????????)
• AIP(???????)
• ALI/ARDS
• ?????
• ????????

ALI Acute Lung Injury ARDS Acute Respiratory
Distress SyndromeAIP Acute Interstitial
Pneumonia
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AIP(???????)

1. ??X??CT???????????????,????????.
2. ??,???????????????,?????????????.
3. ???????????,CRP??,KL-6??????.
4. ????????????ARDS?????????.
5. ???Hamman-Rich???,???????????????????????????.

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ALI/ARDS

• ARDS????????????(ALIacute lung
  injury)???,ALI?????ARDS.
• ALI?ARDS?????????????????????????????????PF?(PaO2
  /FIO2)??????.P/F300???ALI,200???ARDS

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ARDS(?????????)
??????? ???????? PaO2/FiO2lt200
??????(???) ???????? ??????18mmHg??or?????????
(Bernard GR?,1994???)
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ARDS???
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ARDS???
???? ??????????PEEP 515cmH2O ???high
PEEP Permissive hypercapnia
???? ??? FOY?
???? ????? 10cmH2O?? ??????
?????? ????????? ??????????
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