Pathologically, emphysema is characterized by abnormal and persistent expansion of the distal terminal bronchioles of the lung, accompanied by the destruction of alveolar walls and bronchioles without obvious fibrosis, but its pathogenesis is not completely clear. Constructing animal model of emphysema is helpful to study the pathogenesis of emphysema. What happened to emphysema? , welcome to read.

What disease is emphysema? Emphysema refers to the pathological state that the airway elasticity at the distal end of terminal bronchioles decreases, inflates, the lung volume increases or the airway wall is destroyed at the same time. According to its pathogenesis, emphysema has the following types: senile emphysema, compensatory emphysema, interstitial emphysema, focal emphysema, paraseptal emphysema and obstructive emphysema.

Etiology of emphysema The pathogenesis of obstructive emphysema is not completely clear. It is generally believed that it is related to bronchial obstruction and protease-antiprotease imbalance. Smoking, infection and air pollution cause bronchiolitis, and the lumen is narrow or blocked. When inhaling, the bronchiole cavity expands and air enters the alveoli; When exhaling, the lumen contracts, the air stays, and the pressure in the alveoli increases, leading to excessive expansion and even rupture of the alveoli. The radial traction loss around the bronchioles constricts the bronchioles, thus narrowing the lumen. Pulmonary intima thickening, alveolar wall blood supply reduction, alveolar elasticity weakening and so on. , promote the expansion of alveoli rupture. In the case of infection, the protease activity in the body increases. ? 1 patients with antitrypsin deficiency have weakened ability to inhibit protease, so emphysema is more likely to occur.

clinical picture

Clinical symptoms depend on the degree of emphysema. In the early days, you may feel asymptomatic or short of breath, only during labor and exercise. With the progress of emphysema, the degree of dyspnea is aggravated, so that after a little activity or even a complete rest, you still feel short of breath. Patients feel fatigue, weight loss, loss of appetite and bloating. Accompanied by cough, expectoration and other symptoms, typical emphysema patients have an enlarged chest diameter, a barrel chest, weakened respiratory movement, weakened voice tremor, voiced sound after percussion, lowered voiced boundary of the heart, lowered voiced boundary of the liver, weakened breathing sound, and sometimes dry and wet rales can be heard, and the heart sound is low.

Emphysema examination 1. X ray examination

Thoracic dilatation, intercostal space widening, ribs parallel, diaphragm lowering and flattening, and transparency of both lung fields increasing.

2. Electrocardiogram examination

Generally, there is no abnormality, and sometimes the limbs cause low voltage.

3. Respiratory function examination

It is of great significance to the diagnosis of obstructive emphysema, and the ratio of residual volume to total lung volume is >: 40%.

4. Blood gas analysis

If there is obvious anoxic carbon dioxide retention, the arterial oxygen partial pressure (PaO2 _ 2) decreases and the carbon dioxide partial pressure (PaCO2 _ 2) increases, decompensated respiratory acidosis may occur and the pH value will decrease.

5. Blood and sputum examination

Generally, there is nothing unusual.

The diagnosis of emphysema can be based on medical history, physical examination, X-ray examination and pulmonary function measurement. X-ray examination showed that the anterior and posterior diameter of thoracic cavity increased, the sternal protrusion and posterior space widened, the diaphragm was low and flat, the lung texture decreased, the transparency of lung field increased, the hanging heart, pulmonary artery and main branches widened, and the peripheral blood vessels were small. Pulmonary function examination showed that residual gas and total lung volume increased, the proportion of residual gas in total lung volume increased, FEV 1/FVC decreased obviously, and diffusion function decreased.

differential diagnosis

Attention should be paid to the differential diagnosis with tuberculosis, lung tumor and occupational lung disease. In addition, both chronic bronchitis and bronchial asthma belong to chronic obstructive pulmonary disease, and both chronic bronchitis and bronchial asthma can be complicated with obstructive emphysema. But there are both connections and differences between them. The pathological changes before chronic bronchitis complicated with emphysema are mainly confined to bronchi, and there may be obstructive ventilation disorder, but the degree is mild and the diffusion function is generally normal. At the onset of bronchial asthma, the symptoms are obstructive ventilation disorder and excessive lung expansion, and the gas distribution can be seriously uneven. However, the above changes are reversible and respond well to inhalation of bronchodilators. Diffuse sexual dysfunction did not change significantly.

complication

1. Spontaneous pneumothorax

Spontaneous pneumothorax complicated with obstructive emphysema is not uncommon, which is mostly caused by the rupture of subpleural pulmonary bullae and air leakage into pleural cavity. If the patient's basic lung function is poor and the pneumothorax is tension, even if the gas volume is small, the clinical manifestations are very serious, so it must be actively rescued.

2. Respiratory failure

Obstructive emphysema often seriously impairs respiratory function. Under the influence of some inducements, such as respiratory tract infection, secretion obstruction, improper oxygen therapy, surgery, etc., the ventilation dysfunction can be further aggravated and respiratory failure can be induced.

3. Chronic pulmonary heart disease

Obstructive emphysema with hypoxemia and carbon dioxide retention, alveolar capillary bed destruction, etc. , can cause pulmonary hypertension. There was no right heart failure in the compensatory period of cardiac function. When the pathological changes of respiratory system are further aggravated and arterial blood gas deteriorates, pulmonary artery pressure is obviously increased, cardiac load is aggravated, myocardial hypoxia, metabolic disorder and other factors can induce right heart failure.

4. Gastric ulcer

Patients with obstructive emphysema may be complicated with gastric ulcer. Its pathogenesis is not completely clear.

5. Sleep disordered breathing

Normal people's ventilation can be slightly reduced during sleep, while obstructive emphysema patients' ventilation function has been reduced when they are awake. Further reduction during sleep is more dangerous, which may lead to arrhythmia and pulmonary hypertension.

Treatment of emphysema 1. Proper use of bronchodilators.

Like aminophylline? 2 receptor stimulants. Glucocorticoids can be used appropriately when the condition requires.

2. Apply effective antibiotics according to pathogenic bacteria or experience.

Such as penicillins, aminoglycosides, quinolones and cephalosporins.

3. Respiratory function exercise

Abdominal breathing, lip contraction and deep and slow exhalation strengthen the activity of respiratory muscles. Increase diaphragm activity.

4. Home oxygen therapy

Giving oxygen 12 ~ 15 hours a day can prolong life. If oxygen therapy can be done 24 hours a day, the effect will be better.

5. Physical therapy

Make plans according to the illness, such as Tai Ji Chuan, breathing exercises, quantitative walking or climbing stairs.

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