Dyspnea呼吸困難課件

1、DefinitionDyspnea is defined as an awareness of difficulty in breathing.Most patients suffer from actual difficulty, some patients just taste an awareness of hyperventilation(換氣過度).1DefinitionDyspnea is defined aHow to describe these sensationsCannot get enough airAir does not go all the way downSmo

2、thering feeling in the chestTightness in the chestFatigue in the chest2How to describe these sensatioDefinitionDilatation of nares(鼻翼扇動(dòng)), cyanosis(紫紺), use of accessory muscles of respirationAbnormalities of respiratory rate,depth or rhythm3DefinitionDilatation of nares(EtiologyRespiratory diseaseCa

3、rdic diseaseToxicNero-PsychogenicHaematological diseaseIncrease of abdominal pressure (massive ascites(腹水), pregnancy(懷孕) etc)4EtiologyRespiratory disease4Normal person may experience the physiologic dyspnea during heavy exerciseEnvironment short of oxygen5Normal person may experience t6677Respirato

4、ry dyspneaRespiratory dyspnea is caused by abnormal ventilation and gas exchange.Reduction in ventilatory capacity, hypercapnia(二氧化碳潴留) and hypoxemia(低氧血癥) resulting from respiratory disease.Three clinical types: inspiratory dyspnea, expiratory dyspnea, mixed dyspnea.8Respiratory dyspneaRespiratoryI

5、nspiratory dyspneaClinical characteristics: visible indrawing over the sternal notch, the supraclavicular spaces, the intercostal spaces and the epigastrium in the inspiration(三凹癥).Accompanied by a coarse, low pitched inspiratory wheezing and dry cough.Stenosis and obstruction of larynx, trachea, an

6、d bronchi9Inspiratory dyspneaClinical chExpiratory dyspneaClinical characteristics: expiration is prolonged and laboured with wheezing.Cause: the decrease of lung elasticity and spasm narrowing of the bronchioles and smaller bronchi.Familiar diseases: emphysema(肺氣腫), bronchial asthma(支氣管哮喘) and chro

7、nic asthmatic bronchitis(喘慢支). 10Expiratory dyspneaClinical chaMixed dyspneaClinical characteristics: breathing is difficult during both inspiration and expiration. Respiratory frequency increase and respiration superficial.Cause: decrease of ventilators and gas exchange capacityFamiliar diseases: s

8、evere pneumonia(肺炎), pulmonary fibrosis(肺纖維化), massive atelectasis(大片肺不張) etc11Mixed dyspneaClinical characteCardiac dyspneaCardiac dyspnea is usually attributable to pulmonary vascular congestion resulting from the left and/or right heart failure.Dyspnea is the primary symptom of left heart failure

9、.12Cardiac dyspneaCardiac dyspnea1313Left heart failureBasal diseases:Coronary heart diseaseHypertensive heart diseaseRheumatic heart diseaseCongenital heart disease14Left heart failureBasal diseasLeft heart failureMechanism:Lung congestion decrease gas dispersionAlveoli are stiff and more work is n

10、eeded to overcome elastic recoilThe high alveolar pressure stimulate stretch receptorHigh pulmonary circulation pressure stimulate respiratory nerve center15Left heart failureMechanism:15Left heart failureClinical representation:Exhausted dyspnea(勞力性呼吸困難)Orthopnea(端坐呼吸)Paroxysmal nocturnal dyspnea(夜

11、間陣發(fā)性呼吸困難)16Left heart failureClinical repExhausted dyspneaDifficulty in breathing when the patient is in activity relived when he relax.Doing exercise impel more blood into pulmonary circulation.More oxygen is needed for body demand, especially the heart. 17Exhausted dyspneaDifficulty inFunctional c

12、lassificationClass no limitation: Ordinary physical activity doesClass slight limitation of physical activityClass Marked limitation of physical activityClass inability to carry or any physical activity without discomfort18Functional classificationClassOrthopneaDifficulty in breathing in the supine

13、positionrelived by sitting upReduce the degree of pulmonary congestion by pooling blood in the lower extremitiesImprove the diaphragmatic movementIncrease vital capacity19OrthopneaDifficulty in breathiParoxysmal nocturnal dyspneaThe patient awakes short of breath at night, but often obtain relief by

14、 sitting up for a period of time.Physical examination: moist rales at the both lung bases, tachycardia, wheezing and bronchospasm (cardiac asthma心源性哮喘).20Paroxysmal nocturnal dyspneaTParoxysmal nocturnal dyspneaReason:Supine posture for sleep impel more blood into pulmonary circulation, and decrease

15、 vital capacity.Vagus excitement cause coronary artery constriction and bronchioles spasm.21Paroxysmal nocturnal dyspneaReRight heart failureBasal diseases:Acute cor pulmonale(肺心病) which caused by pulmonary embolism(肺栓塞)Chronic cor pulmonale which caused by chronic obstructive pulmonary disease(慢阻肺)

16、22Right heart failureBasal diseaRight heart failureMechanism:The pressure of right atria and superior vena cava is the natural stimulus of respiratory center.Hypoxemia and the accumulation of the acid metabolites stimulate respiratory center.The restriction of the respiratory movement caused by enla

17、rgement of liver,ascites and pleural effusion.23Right heart failureMechanism:2Biventricular failure Left heart failure plus right heart failure may cause severe dyspnea?24Biventricular failure Left hToxic dyspnea In the metabolic acidosis (uremia尿毒癥 and diabetic acidosis糖尿病性酸中毒), the acid metabolite

18、s stimulate the respiratory center, causing deep and regular respiration (Kussmanul) with snoring.25Toxic dyspnea In the metaboToxic dyspneaThe overdose of morphine and pentobarbital can depress respiratory center causing slow respiration or Cheyne-Stokess respiration.26Toxic dyspneaThe overdose of

19、mNeuro-Psychogenic dyspneaThe respiratory center loses the blood supply or is compressed while patient suffering from cerebro vascular disease. The respiration becomes deep, slow and irregular. 27Neuro-Psychogenic dyspneaThe rNero-Psychogenic dyspneaPatient suffer from hysteria will be seen repetiti

20、ve deep, signing respiration with numbness of extremities or lips, cheiropedal spasm.28Nero-Psychogenic dyspneaPatienHaematologicl dyspneaThe decrease of oxygen-carrying capacity and oxygen content develop abnormal respiration and increase heart rate, such as severe anemia, carbon monoxide.Hypotensi

21、on can stimulate respiration when patient suffer from shock.29Haematologicl dyspneaThe decreAccompanying symptoms Paroxysmal dyspnea with wheezing, It is present in bronchial asthma and cardiac asthma. Paroxysmal severe dyspnea is often seen in acute larynx edema(急性喉水腫), spontaneous pneumothorax(自發(fā)性

22、氣胸), massive pulmonary embolism. 30Accompanying symptoms ParoxyAccompanying symptoms Dyspnea with chest pain. It is frequently observed in lobar pneumonia(大葉性肺炎), pulmonary infarction(肺梗塞), spontaneous pneumothorax, acute exudative pleurisy(急性滲出性胸膜炎), acute myocardial infarction(急性心肌梗死), and bronchi

23、al carcinoma(支氣管肺癌).31Accompanying symptoms DyspneAccompanying symptoms Dyspnea with fever. It is commonly noted in pneumonia, lung abscess(肺膿腫), pulmonary tuberculosis(肺結(jié)核), pleurisy, acute pericarditis(急性心包炎), and nervous system diseases.32Accompanying symptoms DyspneAccompanying symptoms Dyspnea with cough and purulent sputum. It is often present in chronic bronchitis, obstructive pulmonary emphysema with infection, purulent pneumo