Scoala Sanitara G. Gh. Voda- Iasi Curs Pneumologie , Anul II, Dr. Roana Radu !

Poleac"
SINDROMUL DE OBSTRUCTIE PULMONARA BPOC
Definitie:
Sindrom caracterizat prin imitarea f!"!!i de aer pro#re$i%& a$ociat c! ra$p!n$ anorma
infamator a paman!!i a partic!e noci%e'
In acea$ta entitate $!nt c!prin$e:
( Bron$ita cronica
( Emfizem! p!monar
( A$tm! )ron$ic
*' Emfizem! p!monar
Afecti!ne caracterizata prin diatarea )ron+ioeor $i a a%eoeor p!monare in$otita de
modificari de $tr!ct!ra a perete!i a%eoar ,di$tr!#erea $ept!rior a%eoare-'
Ca$ificare anatomica:
( Pan(o)!ar dif!z , intre# parenc+im! e$te afectat-
( Centro(o)!ar , ocaizat doar a ni%e! porti!nii centrae a o)!!i p!monar& a%eoee
din periferia o)!!!i ramanand nemodificate-
Ta)o! cinic:
De)!t $arac in manife$tari' Ace$tea apar cand proce$ee ezionae atereaza *./ din capacitatea
p!monara '
Semn! cinic caracteri$tic e$te di$pneea $!) forma de 0+eezin# 1.2 t!$e' Di$pneea $e in$taeaza
treptat& pro#re$i%& de%enind $!paratoare & in$otita de cianoza' T!$ea $i e"pectoratia apar in $tadii
a%an$ate' In timp $e in$taeaza in$!ficienta cardiaca dreapta caracterizata prin: 3!#!are
t!r#e$cente& edeme a mem)ree inferioare& +epatome#aie'
E" cinic o)iecti%:
( Torace #o)!o$& c! $patii interco$tae ar#ite&
( In $tadii a%an$ate cianoza e"tremitatior& cianoza perioronazaa
( 4iper$onoritate
( M!rm!r %ezic!ar a)oit
Ta)o! paracinic:
( E" R" +ipertran$parenta p!monara& orizontaizarea coa$teor& $patii interco$tae ar#ite
( E" $# modificarea #azeor $an#%ine $cade $at!ratia in o"5#en& cre$te CO6
in$!ficienta re$piratorie
( Pro)e %entiatorii $pirometria $indrom de +iperinfatie p!monara , 7R& CR8& CPT
cre$c!te -& $indrom de o)$tr!cti%e )ron$ica , 7EMS $caz!t-
Tratament:
Profiactic inat!rarea factorior etioo#ici , a fe c! cei ai )ron$itei cornice-
Medicamento$
meti"antine Miofiin
Antit!$i%e Codeina fo$fat
9imna$tica re$piratorie
In caz!ri #ra%e o"i#enoterapie intermitenta
6' BPOC
Simptomatoo#ia cinica im)ina )ron$ita cronica c! emfizem! p!monar'
8!nctie de predominenta ceor 6 $indroame& BPOC prezinta 6 tip!ri cinice:
Tip! A :pin; p!ffer< predominant emfizemato$ :p!faitor! roz<
( Di$pnee pro#re$i%a& c! t!$e red!$a $i $p!ta m!coa$a minima
( Ta+ipnee& e"pir pre!n#it c! )!ze protr!zionate
( Prefera pozitia c! tr!nc+i! apecat anterior& c! $pri3inirea )rateor
( E"acer)arie m!cop!r!ente $!nt rare dar at!nci cand apar $!nt #ra%e& c! in$!ficienta
re$piratorie
( Se compica c! cord p!monar cronic in$!ficienta cardiac dreapta in $tadiie terminae
( Datorita !tiizarii m!$c+ior re$piratori acce$ori& pacient! e$te $a)& c! facie$ $!ferind& c!
pierdere ponderaa e%ident
( =!#!are t!r#e$cente
( 4iper$onoritate dif!za& matitate cardiaca a)$enta $a! red!$a& m!rm!r %e$ic!ar dimin!at&
$oc ape"ian a)$ent $a! $a) percepti)i $emne de +iperinfatie p!monara
( Radioo#ic +ipertran$parenta p!monara& de$en )ron+o%a$c!ar $ter$& diap+ra#m
apatizat $i co)orat& $i!eta cardiaca a!n#ita& cord :in picat!ra<& Diametre cre$c!te ae
c!tiei toracice& Ampit!dinea mi$carior re$piratorii $caz!ta
( E"c!r$ii co$tae de ampit!dine $caz!ta
( Ampit!dinea mi$carior re$piratorii $caz!ta
( E"c!r$ii co$tae de ampit!dine $caz!ta
(
( Capacitatea de efort e$te $e%er afectata
Tip! B :)!e )oater< predominant )ron$itic :a)a$tr! )!+ait<& :$cr!m)ia a)a$tra<
( Mare f!mator& mare t!$itor c! $p!ta m!coa$a
( T!$ea e$te a incep!t prezenta in anotimp! rece& apoi de%ine permanenta
( E"acer)arie m!cop!r!ente $!nt de$e $i din ce in ce mai !n#i& c! epi$oade de
in$!ficienta re$piratorie #ra%a
( Di$pneea e$te mai p!tin $e%era
( Pacient! e$te $!prapondera& cianotic& edemato$ , edem cardiac din in$!ficienta cardiaca
dreapta-
( 4iper$onoritate p!monara& ra!ri )ron$ice& 0ee$in#
( Semne de in$!ficienta cardiaca dreapta 3!#!are t!r#e$cente& edeme& +epatome#aie&
ref!" +epato(3!#!ar
( 4ipo"ie periferica de#ete +ipocratice& cianoza periferica $i centraa
( Radioo#ic in#ro$area peretior )ron$ici c! de$en p!monar accent!at& +i!ri ar#ite&
ca%itatie cardiace drepte marite& Diametre cre$c!te ae c!tiei toracice
( Ampit!dinea mi$carior re$piratorii $caz!ta
( E"c!r$ii co$tae de ampit!dine $caz!ta
( 9azometrie +ipercapnie ,PaCO6>?@mm4#-& +ipo"ie ma3ora PaO6A BB ( ?@mm4#-
( E" $an#e!i ca !rmare a de$at!rarii +emo#o)inei e$te $tim!ate eritropoieza c!
cre$terea +ematocrit!!i ,BBC( ?@C-( poi#o)!ie
E%o!tie ( $pre in$!ficienta re$piratorie
Tratament: O)iecti%e:
( Pre%enirea pro#re$iei )oii
( Scaderea $imptomatoo#iei
( Pre%enirea compicatiior
( Pre%enirea $i tratament! e"acer)arior
( Oprirea f!mat!!i
Medicamento$:
*' Bron+odiatatoare meti"antine& )eta6 $impaticomimetice& anticoiner#ice
6' 9!cocorticoizi in+aator
/' Anti)iotic in e"acer)arie infectioa$e
D' M!coitice t!$e c! e"pectoratie
B' Antit!$i%e t!$e $eaca
?' O"i#eno terapie in caz!ri #ra%e