首页 国际呼吸杂志 2023年43卷02期 慢性阻塞性肺疾病急性加重诊治中国专家共识(2023年修订版)
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慢性阻塞性肺疾病急性加重诊治中国专家共识(2023年修订版)
慢性阻塞性肺疾病急性加重诊治专家组 
作者及单位信息
·
DOI： 10.3760/cma.j.cn131368-20221123-01066
Expert consensus on the acute exacerbation of chronic obstructive pulmonary disease in China (revision in 2023)
Expert group on management of acute exacerbation of chronic obstructive pulmonary disease
Cai Baiqiang
Yan Xixin
Authors Info & Affiliations
Expert group on management of acute exacerbation of chronic obstructive pulmonary disease
Cai Baiqiang
Yan Xixin
·
DOI： 10.3760/cma.j.cn131368-20221123-01066
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摘要
慢性阻塞性肺疾病急性加重(AECOPD)是慢性阻塞性肺疾病患者死亡与疾病进展的主要诱因。AECOPD诊治专家组依托近4年来相关文献，第4次更新了共识核心内容，提出AECOPD新的定义、严重程度分级与分级诊疗方案，细化了抗菌药物经验性选择建议，对支气管舒张剂及糖皮质激素的使用、呼吸支持与氧疗策略等方面也进行了更新调整。
肺疾病，慢性阻塞性;急性加重;专家共识
ABSTRACT
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the main cause of death and disease progression in patients with chronic obstructive pulmonary disease (COPD).Through literature review within the past 4 years, the Expert Group on the Management of Acute Exacerbation of Chronic Obstructive Pulmonary Disease has revised and updated the core contents of the consensus for the fourth time, which has proposed the new definition of AECOPD, and the classification of the severity and corresponding graded diagnosis and treatment regimens.In particular, the empirical selection of antimicrobial agents, and the use of bronchodilators and glucocorticoids have been more specific, and respiratory support and oxygen therapy strategies have been modified as well.
Pulmonary disease, chronic obstructive;Acute exacerbation;Expert consensus
Cai Baiqiang, Email: mocdef.labiamtoh9002qbiac;
Yan Xixin, Email: mocdef.3ab61nay_nix_ix
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引用本文
慢性阻塞性肺疾病急性加重诊治专家组. 慢性阻塞性肺疾病急性加重诊治中国专家共识(2023年修订版)[J]. 国际呼吸杂志,2023,43(02)：132-149.
DOI:10.3760/cma.j.cn131368-20221123-01066PERMISSIONS
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更正
本文中表5左侧“2022GOLD报告”改为“2023GOLD报告”，“AECOPD中国专家共识（2022版）”改为“AECOPD中国专家共识（2017年更新版）”。更正的同时表示歉意！
慢性阻塞性肺疾病(简称慢阻肺)是一种异质性肺部病变，其特征是慢性呼吸系统症状(呼吸困难、咳嗽、咳痰)，原因与气道异常(支气管炎、细支气管炎)和(或)肺泡异常(肺气肿)相关，通常表现为持续性、进行性加重的气流阻塞[
1
]。慢阻肺是我国最常见的慢性呼吸系统疾病，患病率高，疾病负担重。2018年王辰院士牵头的"中国肺部健康研究"显示我国40岁以上人群中慢阻肺发病率达13.7%[
2
]，较钟南山院士2007年报道的8.2%[
3
]高出5.5%。全国慢阻肺总患病人数约1亿人。慢阻肺患者每年发生0.5~3.5次急性加重，是慢阻肺患者的首位死亡因素。2013年我国慢阻肺总死亡人数为91万，单病种排名第三，占全球慢阻肺死亡总人数的31.1%[
4
]。其影响因素众多，也与早期防控和规范化治疗不到位密切相关[
5
]。
慢性阻塞性肺疾病全球倡议(global initiative for chronic obstructive lung disease，GOLD)指出，由于慢阻肺危险因素的持续存在和人口老龄化，其经济负担将逐年增加[
6
]，慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease，AECOPD)是该病医疗费用的主要支出部分。例如，2006年美国AECOPD住院死亡率为4.3%，人均次住院费用为9 545美元[
7
]。王辰等报道的AECOPD住院死亡率仅为0.1%，主要原因与中国患者住院及时、治疗积极、病情相对较轻有关[
8
]。北京市315 116例次AECOPD患者2009年人均次住院费用为19 760元人民币，2017年上升至20 119元人民币[
9
]。因AECOPD死亡的患者末次住院费用显著增加，与生命支持和高端抗菌药物使用有关[
10
]。因此，AECOPD早期预防、早期诊断和规范治疗是临床上一项重大而艰巨的任务。
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