雾化吸入治疗专家共识.ppt

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level,*,*,主要内容,雾化吸入方式,临床中常用雾化吸入药物,常见疾病吸入药物及剂量推荐,雾化吸入治疗的不良反应及注意事项,药物配伍注意事项,雾化吸入疗法原理,雾化吸入疗法是利用气体射流原理，将水滴撞击的微小雾滴悬浮于气体中，形成气雾剂而输入呼吸道，进行呼吸道湿化或药物吸入的治疗方法，作为全身治疗的辅助和补充。,雾化微粒平均直径决定了药物沉积部位：,20ml),用药量大，浓度低,颗粒大小无选择性,不能雾化某些药物（如大分子化合物和类固醇类药物）,病人耐受性差,不能彻底洗涤和消毒,机器寿命短,喷射式雾化器,超声波雾化器,机械通气时提高雾化效果措施,药液尽量充满雾化器,临时中止湿化装置,吸气时喷雾,喷雾气流,6l/min,距人工气道,Y,末端,30-45cm,雾化吸入治疗优势,药物直达靶器官,起效迅速,局部药物浓度高,所用药物剂量小,全身副作用最小,吸入治疗的局限性,需要患者的配合,受气道的病理状态影响,气道痉挛、分泌物吸附,受雾粒的药物代谢影响,颗粒大小、生物运转、代谢降解,有治疗价值的雾粒：直径应在,0.5-10.0m,之间,精细颗粒：,5m,主要内容,雾化吸入方式,临床中常用雾化吸入药物,常见疾病吸入药物及剂量推荐,雾化吸入治疗的不良反应及注意事项,药物配伍注意事项,吸入性糖皮质激素（,ICS,）,吸入性糖皮质激素是当前,治疗支气管哮喘最有效,的抗炎药物,缓解哮喘症状,提高生活质量,降低急性发作及病死率,规律吸入糖皮质激素治疗,适用于重度伴频繁发作急性加重的,COPD,患者,常用吸入糖皮质激素,布地奈德混悬液,(Budesonide),：目前国内常用的雾化吸入剂型,丙酸氟替卡松（,Fluticasone propionate,）,:,雾化吸入剂型尚未在中国上市,地塞米松（,Dexamsthasone,）：较难通过吸入发挥局部抗炎作用，不作常规推荐,吸入速效支气管舒张剂,支气管舒张剂是哮喘和,COPD,患者预防和缓解症状所必须的药物,主要药物：,速效,2,受体激动剂：沙丁胺醇,&,特布他林,短效抗胆碱能药物：异丙托溴铵,肾上腺素、异丙肾上腺素,复方异丙托溴铵,其它常用药物,黏液溶解剂,盐酸氨溴索,:,该药产品说明书未推荐雾化吸入使用,但在我国已有较多的临床应用静脉制剂进行雾化治疗的经验报道。目前国外已有雾化吸入剂型。,-,糜蛋白酶,:,多肽酶,没有证据表明可以吸入中小气道产生治疗作用,此外也没有配伍相关的药理学研究数据,禁用超声方式进行雾化治疗，目前已很少应用,N-,乙酰半胱氨酸：国内已有专用吸入剂型,抗菌药物,庆大霉素,:,在我国临床应用较多,但其疗效及安全性尚缺乏充分的循证医学证据,两性霉素,B:,可用于雾化吸入,妥布霉素,(Novartis:TOBI),被,FDA,批准用于雾化吸入治疗囊性纤维化疾病,其余药物的安全性均未获得确认,茶碱,:,不推荐用于雾化吸入治疗,中成药注射液,:,不推荐使用,主要内容,雾化吸入方式,临床中常用雾化吸入药物,常见疾病吸入药物及剂量推荐,雾化吸入治疗的不良反应及注意事项,药物配伍注意事项,哮喘急性发作,对于轻中度哮喘急性发作，首先,SABA,单药治疗，疗效不佳时联合,SAMA,雾化吸入,联合雾化吸入,SABA,和糖皮质激素，具有更好的支气管扩张作用,哮喘急性发作雾化吸入治疗方案推荐,主要症状 雾化方案,呼吸困难,SABA,持续雾化吸入,1,小时,1,小时后症状不能缓解,糖皮质激素 添加,SAMA,常用雾化吸入药物推荐剂量,主要内容,雾化吸入方式,临床中常用雾化吸入药物,常见疾病吸入药物及剂量推荐,雾化吸入治疗的不良反应及注意事项,药物配伍注意事项,雾化吸入治疗的并发症及危险性,药物相关的不良反应,支气管痉挛,医院内感染,气道灼伤,无效的气道水化,雾化吸入治疗的不良反应,不良反应的应答率低，只有,53.8%,的问卷有应答,雾化吸入治疗的注意事项,装置相关,雾化吸入治疗的注意事项,药物相关,主要内容,雾化吸入方式,临床中常用雾化吸入药物,常见疾病吸入药物及剂量推荐,雾化吸入治疗的不良反应及注意事项,药物配伍注意事项,常用雾化吸入药物的配伍,注,:,有字母,C,的深绿色阴影部分表示临床研究中有证据证实这种配伍的稳定性和相容性,;,有字母,R,的蓝色阴影部分表示没有足够的证据评价相容性,但在我国有广泛的临床报道,;,有字母,X,的红色阴影部分表示有证据证实或提示这种配伍是不相容或不合适的,;,有字母,NI,的黄色阴影部分表示没有足够的证据评价相容性,因此,除非将来获得进一步的证据,否则应避免使用这种配伍,药物配伍注意事项,盐酸氨溴索,静脉注射的产品说明书,未推荐,雾化吸入使用，但目前有,较多的临床使用经验,。建议临床使用雾化剂型。,有研究显示,SABA,和盐酸氨溴索有协同排痰作用,吸入用复方异丙托溴铵溶液,说明书特别提醒使用者注意“,不要把本品与其他药品混合在同一雾化器中使用！,”,结论一,呼吸道疾病雾化方案,哮喘急性发作,对于轻中度哮喘急性发作，首先,SABA,单药治疗，疗效不佳时联合,SAMA,雾化吸入,联合雾化吸入,SABA,和糖皮质激素，具有更好的支气管扩张作用,SAMA,不是支气管哮喘急性发作的“必须”选择用药,COPD,急性加重,急性加重期推荐，单独吸入速效,2,受体激动剂或联合速效抗胆碱能药物,优先选择支气管舒张药物,SABA,联合氨溴索具有协同排痰作用,雾化吸入激素可替代全身激素治疗,结论二,雾化吸入方式和注意事项,喷射雾化更符合临床需要，但应注意消毒管理,常用配伍方案,尽量选着绿色药物配伍,注意各种雾化产品的说明书，如：吸入用复方异丙托溴按溶液不应和其他药物在同一雾化器重联用。,