In the treatment of emphysema patients, the patient’s primary diseases such as chronic bronchitis and bronchial asthma need to be treated first. Only by well controlling these primary diseases can the development of emphysema be ensured. Effective control.
1. General treatment
1. Supplementary oxygen: For patients with severe hypoxemia, long-term home oxygen therapy can be given. Nasal cannula is generally used to inhale oxygen to achieve the patient's arterial blood oxygen saturation rising to 90% and/or arterial blood oxygen partial pressure ≥60mmHg in the resting state.
2. Get rid of environmental pollution and quit smoking: Patients with no obvious symptoms in the early stage need to avoid pathogenic factors as much as possible, including measures to get rid of environmental pollution such as improving kitchen ventilation and quit smoking. Patients diagnosed with COPD due to incompletely reversible airway obstruction should be treated as COPD.
2. Emergency treatment
When a patient has poor treatment conditions, serious accompanying diseases, disturbance of consciousness, etc., he or she needs to be hospitalized. Perform acute phase oxygen therapy to ensure an oxygen saturation of 88% to 92%. Arterial gas and blood analysis should be performed after 30 to 60 minutes of oxygen therapy to ensure there is no carbon dioxide retention or acidosis. Properly replenish body fluids and electrolytes, and consider using low-molecular-weight heparin for patients who are bedridden, have polycythemia, or are dehydrated. Implement mechanical ventilation if necessary.
3. Drug treatment
1. Bronchodilator drugs: They can relax bronchial smooth muscles, dilate bronchi, and relieve airflow restriction. They are the main treatment measures to control symptoms. Short-term on-demand application can relieve symptoms, and long-term regular application can prevent and reduce symptoms and increase exercise tolerance, but it cannot improve the forced expiratory volume in the first second in all patients. Compared with oral drugs, inhalants have fewer side effects, so inhalants are often the first choice for treatment. The main bronchodilators include β2-receptor agonists, such as albuterol and terbutaline, anticholinergics such as tiotropium bromide, and theophyllines such as aminophylline, which are selected according to the effect of the drug and the patient's treatment response. Short-acting bronchodilators are cheaper but not as effective as long-acting preparations. The combination of drugs with different mechanisms of action and duration of action can enhance bronchodilation and reduce adverse reactions.
2. Glucocorticoid drugs: Long-term regular inhaled glucocorticoids combined with β2 receptor agonists are more effective than each alone. Currently, the commonly used ones are budesonide, formoterol, fluticasone or Two combination preparations of salmeterol.
3. Expectorants: They are beneficial to smooth airway drainage and improve ventilation. However, except for a few patients with sticky phlegm, the overall effect is not very accurate. Commonly used drugs include ambroxol hydrochloride, acetate, etc. Cysteine.
4. Antibiotics: For those without risk factors for Pseudomonas aeruginosa, antibacterial drugs can be selected. The main drugs include penicillin, amoxicillin, macrolides, etc. For patients with risk factors for Pseudomonas aeruginosa, oral or intravenous medication needs to be selected according to the patient's condition. The main drugs include ciprofloxacin and so on.
4. Surgical treatment
1. Giant bullae resection: suitable for a small number of emphysema lesions, such as severe bullae, which are only needed if the lung function is particularly poor. Surgical resection treatment.
2. Lung volume reduction surgery: The purpose of lung volume reduction surgery is to remove diseased areas with abnormal function and reduce residual gas, which can improve breathing.
3. Lung transplantation: When the lung damage is severe and other treatments are ineffective, lung transplantation can be selected. Many patients may develop bronchiolitis obliterans in the transplanted lung, causing severe dyspnea. Repeat lung transplantation is often required.
V. Other treatments
1. Respiratory muscle function exercise:
(1) Abdominal breathing method: semi-recumbent, standing or sitting position, two Half-bend the knees, relax the abdominal muscles, place two hands on the front chest and upper abdomen respectively, inhale slowly through the nose, let the diaphragm drop as much as possible, relax the abdominal muscles, lift the hands on the abdomen upward, and place the hands on the chest on the original position. Position; abdominal muscles contract during exhalation, increasing expiratory tidal volume.
(2) Lip-puckering breathing method: When exhaling, the abdomen should be inverted, while the chest should be tilted forward, and the lips should be narrowed to exhale the gas as much as possible, and the exhalation time should be prolonged to improve the patient's alveolar ventilation. , 2 times a day, 10 to 20 minutes each time.
2. Oxygen therapy: Low-flow oxygen inhalation can effectively improve hypoxia and prolong the survival time of patients.