慢性阻塞性肺病


慢性支氣管炎: 支氣管道不斷發炎,不單令支氣管壁增厚,也會分泌大量黏液,製造更多痰涎,阻塞氣道;
肺氣腫:小支氣管未端的肺泡受損,失去彈性之餘,肺泡壁亦受破壞,未能令吸入的氧氣順利進入血管,達到換氣的功能,因而令患者出現缺氧的狀況。 受上述問題的影響,患者會感到呼吸困難,不單引致身體不適甚至死亡,亦正因呼吸是人類所有活動的必須,所以患者的日常生活亦會大受影響。


診斷及自我檢查
人每天需要呼吸20,000次11,可以想像慢性阻塞性肺病患者的呼吸若有困難,日常生活由步行、烹食、處理家務,都會大受影響。要減少對生活的影響,及早確診及接受治療,能有效控制病情,改善生活質素12。
治療方案

支氣管擴張劑
(Bronchodilator)17
作用是放鬆氣管旁的肌肉,協助打開氣管,讓病人容易呼吸。劑型常見分為短效與長效兩類,有時醫生會處方兩種混合使用

吸入式類固醇
(Inhaled Corticosteroids)18
吸入式類固醇的作用是減少氣管發炎,能改善徵狀、肺功能及患者生活質素。根據關注慢性阻塞性肺病的全球性醫學倡議組織Global Initiative For Chronic Obstructive Lung Disease於2019年發表的建議,吸入式類固醇適合嚴重患者,但不建議長期單一使用吸入式類固醇。

混合式治療18
將吸入式類固醇及長效β2-受體激動劑混合同用,關注慢性阻塞性肺病的全球性醫學倡議組織Global Initiative For Chronic Obstructive Lung Disease認為,這種混合式療法對於中度至嚴重的慢性阻塞性肺病患者而言,不論在改善患者的肺功能、健康狀況,以及減少病發,效果會比單一使用此兩種藥物為佳。

磷酸二酯酶-4抑制劑
(PDE4 inhibitor)18
能夠減少嚴重患者的復發,Global Initiative For Chronic Obstructive Lung Disease指出,與口服類固醇或長效支氣管擴張劑同用,均可達到此療效。此類藥物,患者需要每天服用以作預防慢阻肺病發18。

氧氣治療19
病情較為嚴重的病人,經醫生及職業治療師的評估後,或需長期使用家居氧氣治療,以控制病情,常見包括製氧機及手提氧氣瓶。製氧機適合在室內長期使用;手提氧氣瓶則適合外出時使用。由於每天不同活動的耗氧量會有分別,如洗澡、如廁需要較大體能,或需較多氧氣。醫生與職業治療師會因應病人需要而處方適當的氧氣度數,患者必須依循,不要擅自減用,否則有機會令病情惡化。而氧氣治療的好處包括:改善生活自理能力、保護心臟及相關器官、改善睡眠及延長壽命20。

復康治療10
胸肺科復康治療對慢性阻塞性肺病患者來說十分重要,內容包括教導病人控制氣喘、呼吸鍛鍊、清除痰涎、呼吸與身體動作的協調、體力鍛鍊、節省體力的方法等等,不單有助減少病人入院,亦有助改善患者的生活質素。

- 呼吸困難或咳嗽比平時多
- 上氣不接下氣影響日常活動
- 咳嗽起來比平日多黏性物質
- 黏性物質是黄色,绿色或鐵銹色
- 發燒超过華氏101度
- 覺得頭暈或頭昏眼花



參考:
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HK-11795 20/05/2025