呼吸困難病理課件

DyspneaDyspnea1DefinitionDyspneaisdefinedasanawarenessofdifficultyinbreathing.Mostpatientssufferfromactualdifficulty,somepatientsjusttasteanawarenessofhyperventilation(換氣過度).DefinitionDyspneaisdefineda2HowtodescribethesesensationsCannotgetenoughairAirdoesnotgoallthewaydownSmotheringfeelinginthechestTightnessinthechestFatigueinthechestHowtodescribethesesensatio3DefinitionDilatationofnares(鼻翼扇動(dòng)),cyanosis(紫紺),useofaccessorymusclesofrespirationAbnormalitiesofrespiratoryrate,depthorrhythmDefinitionDilatationofnares(4EtiologyRespiratorydiseaseCardicdiseaseToxicNero-PsychogenicHaematologicaldiseaseIncreaseofabdominalpressure(massiveascites(腹水),pregnancy(懷孕)etc)EtiologyRespiratorydisease5NormalpersonmayexperiencethephysiologicdyspneaduringheavyexerciseEnvironmentshortofoxygenNormalpersonmayexperiencet6呼吸困難病理課件7呼吸困難病理課件8RespiratorydyspneaRespiratorydyspneaiscausedbyabnormalventilationandgasexchange.Reductioninventilatorycapacity,hypercapnia(二氧化碳潴留)andhypoxemia(低氧血癥)resultingfromrespiratorydisease.Threeclinicaltypes:inspiratorydyspnea,expiratorydyspnea,mixeddyspnea.RespiratorydyspneaRespiratory9InspiratorydyspneaClinicalcharacteristics:visibleindrawingoverthesternalnotch,thesupraclavicularspaces,theintercostalspacesandtheepigastriumintheinspiration(三凹癥).Accompaniedbyacoarse,lowpitchedinspiratorywheezinganddrycough.Stenosisandobstructionoflarynx,trachea,andbronchiInspiratorydyspneaClinicalch10ExpiratorydyspneaClinicalcharacteristics:expirationisprolongedandlabouredwithwheezing.Cause:thedecreaseoflungelasticityandspasmnarrowingofthebronchiolesandsmallerbronchi.Familiardiseases:emphysema(肺氣腫),bronchialasthma(支氣管哮喘)andchronicasthmaticbronchitis(喘慢支).ExpiratorydyspneaClinicalcha11MixeddyspneaClinicalcharacteristics:breathingisdifficultduringbothinspirationandexpiration.Respiratoryfrequencyincreaseandrespirationsuperficial.Cause:decreaseofventilatorsandgasexchangecapacityFamiliardiseases:severepneumonia(肺炎),pulmonaryfibrosis(肺纖維化),massiveatelectasis(大片肺不張)etcMixeddyspneaClinicalcharacte12CardiacdyspneaCardiacdyspneaisusuallyattributabletopulmonaryvascularcongestionresultingfromtheleftand/orrightheartfailure.Dyspneaistheprimarysymptomofleftheartfailure.CardiacdyspneaCardiacdyspnea13呼吸困難病理課件14LeftheartfailureBasaldiseases:CoronaryheartdiseaseHypertensiveheartdiseaseRheumaticheartdiseaseCongenitalheartdiseaseLeftheartfailureBasaldiseas15LeftheartfailureMechanism:LungcongestiondecreasegasdispersionAlveoliarestiffandmoreworkisneededtoovercomeelasticrecoilThehighalveolarpressurestimulatestretchreceptorHighpulmonarycirculationpressurestimulaterespiratorynervecenterLeftheartfailureMechanism:16LeftheartfailureClinicalrepresentation:Exhausteddyspnea(勞力性呼吸困難)Orthopnea(端坐呼吸)Paroxysmalnocturnaldyspnea(夜間陣發(fā)性呼吸困難)LeftheartfailureClinicalrep17ExhausteddyspneaDifficultyinbreathingwhenthepatientisinactivityrelivedwhenherelax.Doingexerciseimpelmorebloodintopulmonarycirculation.Moreoxygenisneededforbodydemand,especiallytheheart.ExhausteddyspneaDifficultyin18FunctionalclassificationClassⅠ–nolimitation:OrdinaryphysicalactivitydoesClassⅡ–slightlimitationofphysicalactivityClassⅢ–MarkedlimitationofphysicalactivityClassⅣ–inabilitytocarryoranyphysicalactivitywithoutdiscomfortFunctionalclassificationClass19OrthopneaDifficultyinbreathinginthesupinepositionrelivedbysittingupReducethedegreeofpulmonarycongestionbypoolingbloodinthelowerextremitiesImprovethediaphragmaticmovementIncreasevitalcapacityOrthopneaDifficultyinbreathi20Paroxysmalnocturnaldyspnea

Thepatientawakesshortofbreathatnight,butoftenobtainreliefbysittingupforaperiodoftime.Physicalexamination:moistralesatthebothlungbases,tachycardia,wheezingandbronchospasm(cardiacasthma心源性哮喘).Paroxysmalnocturnaldyspnea

T21ParoxysmalnocturnaldyspneaReason:Supinepostureforsleepimpelmorebloodintopulmonarycirculation,anddecreasevitalcapacity.Vagusexcitementcausecoronaryarteryconstrictionandbronchiolesspasm.ParoxysmalnocturnaldyspneaRe22RightheartfailureBasaldiseases:Acutecorpulmonale(肺心病)whichcausedbypulmonaryembolism(肺栓塞)Chroniccorpulmonalewhichcausedbychronicobstructivepulmonarydisease(慢阻肺)RightheartfailureBasaldisea23RightheartfailureMechanism:Thepressureofrightatriaandsuperiorvenacavaisthenaturalstimulusofrespiratorycenter.Hypoxemiaandtheaccumulationoftheacidmetabolitesstimulaterespiratorycenter.Therestrictionoftherespiratorymovementcausedbyenlargementofliver,ascitesandpleuraleffusion.RightheartfailureMechanism:24BiventricularfailureLeftheartfailureplusrightheartfailuremaycauseseveredyspnea?BiventricularfailureLefth25ToxicdyspneaInthemetabolicacidosis(uremia尿毒癥anddiabeticacidosis糖尿病性酸中毒),theacidmetabolitesstimulatetherespiratorycenter,causingdeepandregularrespiration(Kussmanul)withsnoring.ToxicdyspneaInthemetabo26ToxicdyspneaTheoverdoseofmorphineandpentobarbitalcandepressrespiratorycentercausingslowrespirationorCheyne-Stokessrespiration.ToxicdyspneaTheoverdoseofm27Neuro-PsychogenicdyspneaTherespiratorycenterlosesthebloodsupplyoriscompressedwhilepatientsufferingfromcerebrovasculardisease.Therespirationbecomesdeep,slowandirregular.Neuro-PsychogenicdyspneaTher28Nero-PsychogenicdyspneaPatientsufferfromhysteriawillbeseenrepetitivedeep,signingrespirationwithnumbnessofextremitiesorlips,cheiropedalspasm.Nero-PsychogenicdyspneaPatien29HaematologicldyspneaThedecreaseofoxygen-carryingcapacityandoxygencontentdevelopabnormalrespirationandincreaseheartrate,suchassevereanemia,carbonmonoxide.Hypotensioncanstimulaterespirationwhenpatientsufferfromshock.HaematologicldyspneaThedecre30AccompanyingsymptomsParoxysmaldyspneawithwheezing,Itispresentinbronchialasthmaandcardiacasthma.Paroxysmalseveredyspneaisoftenseeninacutelarynxedema(急性喉水腫),spontaneouspneumothorax(自發(fā)性氣胸),massivepulmonaryembolism.AccompanyingsymptomsParoxy31AccompanyingsymptomsDyspneawithchestpain.Itisfrequentlyobservedinlobarpneumonia(大葉性肺炎),pulmonaryinfarction(肺梗塞),spontaneouspneumothorax,acuteexudativepleurisy(急性滲出性胸膜炎),acutemyocardialinfarction(急性心肌梗死),andbronchialcarcinoma(支氣管肺癌).AccompanyingsymptomsDyspne32AccompanyingsymptomsDyspneawithfever.Itiscommonlynotedinpneumonia,lungabscess(肺膿腫),pulmonarytuberculosis(肺結(jié)核),pleurisy,acutepericarditis(急性心包炎),andnervoussystemdiseases.AccompanyingsymptomsDyspne33AccompanyingsymptomsDyspneawithcoughandpurulentsputum.Itisoftenpresentinchronicbronchitis,obstructivepulmonaryemphysemawithinfection,purulentpneumonia,andlungabscess;Dyspneawithlargeamountoffoamysputumisoftenseeninacuteleftventricularheartfailureandorganophosphoruspoisoning(有機(jī)磷中毒).AccompanyingsymptomsDyspne34AccompanyingsymptomsDyspneawithcoma.Itsuggestscerebralhemorrhage(腦出血),pneumoniawithshock,uremia,diabeticketoacidosis(糖尿病酮癥酸中毒),andacutepoisoning.AccompanyingsymptomsDyspne35小結(jié)呼吸困難的病因肺原性心原性中毒性神經(jīng)精神性血液病小結(jié)呼吸困難的病因36肺原性呼吸困難吸氣性呼氣性混合性肺原性呼吸困難37左心衰引起呼吸困難的機(jī)制臨床表現(xiàn)(勞力性、端坐呼吸、夜間陣發(fā)性氣急)及意義左心衰38右心衰引起呼吸困難的機(jī)制右心衰39復(fù)習(xí)思考題嚴(yán)重吸氣性呼吸困難最主要的特點(diǎn)是:A.端坐呼吸B.鼻翼煽動(dòng)C.哮鳴音D.呼吸加快加深E.三凹征復(fù)習(xí)思考題嚴(yán)重吸氣性呼吸困難最主要的特點(diǎn)是:40混合性呼吸困難的特點(diǎn)是A.呼氣費(fèi)力B.吸氣費(fèi)力C.可伴有干咳及高調(diào)吸氣性喉鳴D.由于肺呼吸面積減少,換氣功能障礙所致E.以上都不是混合性呼吸困難的特點(diǎn)是41X型題吸氣性呼吸困難的特點(diǎn)是:A.吸氣顯著費(fèi)力B.呼吸時(shí)間明顯延長,常伴有吸氣期哮鳴音C.嚴(yán)重者可見“三凹征”D.常見于喉部、氣管、支氣管的狹窄與阻塞E.由于肺呼吸面積減少導(dǎo)致?lián)Q氣功能障礙所致X型題吸氣性呼吸困難的特點(diǎn)是:42X型題呼氣性呼吸困難的主要特點(diǎn)有A.呼氣費(fèi)力、呼吸緩慢、呼吸時(shí)間明顯延長B.嚴(yán)重者有“三凹征”C.常伴有呼氣期哮鳴音D.由于肺泡彈性減弱或（和）小支氣管痙攣和炎癥所致E.常見于重癥肺炎、彌漫性肺間質(zhì)病變等X型題呼氣性呼吸困難的主要特點(diǎn)有43X型題左心衰竭引起的呼吸困難主要是由于A.體循環(huán)淤血B.肺淤血C.呼吸中樞功能障礙D.肺泡彈性減低E.肺循環(huán)壓力減低X型題左心衰竭引起的呼吸困難主要是由于44呼吸變慢變淺伴有呼吸節(jié)律異常見于A.喉炎B.左心衰竭C.右心衰竭D.呼吸功能中樞障礙E.癔癥呼吸變慢變淺伴有呼吸節(jié)律異常見于45DyspneaDyspnea46DefinitionDyspneaisdefinedasanawarenessofdifficultyinbreathing.Mostpatientssufferfromactualdifficulty,somepatientsjusttasteanawarenessofhyperventilation(換氣過度).DefinitionDyspneaisdefineda47HowtodescribethesesensationsCannotgetenoughairAirdoesnotgoallthewaydownSmotheringfeelinginthechestTightnessinthechestFatigueinthechestHowtodescribethesesensatio48DefinitionDilatationofnares(鼻翼扇動(dòng)),cyanosis(紫紺),useofaccessorymusclesofrespirationAbnormalitiesofrespiratoryrate,depthorrhythmDefinitionDilatationofnares(49EtiologyRespiratorydiseaseCardicdiseaseToxicNero-PsychogenicHaematologicaldiseaseIncreaseofabdominalpressure(massiveascites(腹水),pregnancy(懷孕)etc)EtiologyRespiratorydisease50NormalpersonmayexperiencethephysiologicdyspneaduringheavyexerciseEnvironmentshortofoxygenNormalpersonmayexperiencet51呼吸困難病理課件52呼吸困難病理課件53RespiratorydyspneaRespiratorydyspneaiscausedbyabnormalventilationandgasexchange.Reductioninventilatorycapacity,hypercapnia(二氧化碳潴留)andhypoxemia(低氧血癥)resultingfromrespiratorydisease.Threeclinicaltypes:inspiratorydyspnea,expiratorydyspnea,mixeddyspnea.RespiratorydyspneaRespiratory54InspiratorydyspneaClinicalcharacteristics:visibleindrawingoverthesternalnotch,thesupraclavicularspaces,theintercostalspacesandtheepigastriumintheinspiration(三凹癥).Accompaniedbyacoarse,lowpitchedinspiratorywheezinganddrycough.Stenosisandobstructionoflarynx,trachea,andbronchiInspiratorydyspneaClinicalch55ExpiratorydyspneaClinicalcharacteristics:expirationisprolongedandlabouredwithwheezing.Cause:thedecreaseoflungelasticityandspasmnarrowingofthebronchiolesandsmallerbronchi.Familiardiseases:emphysema(肺氣腫),bronchialasthma(支氣管哮喘)andchronicasthmaticbronchitis(喘慢支).ExpiratorydyspneaClinicalcha56MixeddyspneaClinicalcharacteristics:breathingisdifficultduringbothinspirationandexpiration.Respiratoryfrequencyincreaseandrespirationsuperficial.Cause:decreaseofventilatorsandgasexchangecapacityFamiliardiseases:severepneumonia(肺炎),pulmonaryfibrosis(肺纖維化),massiveatelectasis(大片肺不張)etcMixeddyspneaClinicalcharacte57CardiacdyspneaCardiacdyspneaisusuallyattributabletopulmonaryvascularcongestionresultingfromtheleftand/orrightheartfailure.Dyspneaistheprimarysymptomofleftheartfailure.CardiacdyspneaCardiacdyspnea58呼吸困難病理課件59LeftheartfailureBasaldiseases:CoronaryheartdiseaseHypertensiveheartdiseaseRheumaticheartdiseaseCongenitalheartdiseaseLeftheartfailureBasaldiseas60LeftheartfailureMechanism:LungcongestiondecreasegasdispersionAlveoliarestiffandmoreworkisneededtoovercomeelasticrecoilThehighalveolarpressurestimulatestretchreceptorHighpulmonarycirculationpressurestimulaterespiratorynervecenterLeftheartfailureMechanism:61LeftheartfailureClinicalrepresentation:Exhausteddyspnea(勞力性呼吸困難)Orthopnea(端坐呼吸)Paroxysmalnocturnaldyspnea(夜間陣發(fā)性呼吸困難)LeftheartfailureClinicalrep62ExhausteddyspneaDifficultyinbreathingwhenthepatientisinactivityrelivedwhenherelax.Doingexerciseimpelmorebloodintopulmonarycirculation.Moreoxygenisneededforbodydemand,especiallytheheart.ExhausteddyspneaDifficultyin63FunctionalclassificationClassⅠ–nolimitation:OrdinaryphysicalactivitydoesClassⅡ–slightlimitationofphysicalactivityClassⅢ–MarkedlimitationofphysicalactivityClassⅣ–inabilitytocarryoranyphysicalactivitywithoutdiscomfortFunctionalclassificationClass64OrthopneaDifficultyinbreathinginthesupinepositionrelivedbysittingupReducethedegreeofpulmonarycongestionbypoolingbloodinthelowerextremitiesImprovethediaphragmaticmovementIncreasevitalcapacityOrthopneaDifficultyinbreathi65Paroxysmalnocturnaldyspnea

Thepatientawakesshortofbreathatnight,butoftenobtainreliefbysittingupforaperiodoftime.Physicalexamination:moistralesatthebothlungbases,tachycardia,wheezingandbronchospasm(cardiacasthma心源性哮喘).Paroxysmalnocturnaldyspnea

T66ParoxysmalnocturnaldyspneaReason:Supinepostureforsleepimpelmorebloodintopulmonarycirculation,anddecreasevitalcapacity.Vagusexcitementcausecoronaryarteryconstrictionandbronchiolesspasm.ParoxysmalnocturnaldyspneaRe67RightheartfailureBasaldiseases:Acutecorpulmonale(肺心病)whichcausedbypulmonaryembolism(肺栓塞)Chroniccorpulmonalewhichcausedbychronicobstructivepulmonarydisease(慢阻肺)RightheartfailureBasaldisea68RightheartfailureMechanism:Thepressureofrightatriaandsuperiorvenacavaisthenaturalstimulusofrespiratorycenter.Hypoxemiaandtheaccumulationoftheacidmetabolitesstimulaterespiratorycenter.Therestrictionoftherespiratorymovementcausedbyenlargementofliver,ascitesandpleuraleffusion.RightheartfailureMechanism:69BiventricularfailureLeftheartfailureplusrightheartfailuremaycauseseveredyspnea?BiventricularfailureLefth70ToxicdyspneaInthemetabolicacidosis(uremia尿毒癥anddiabeticacidosis糖尿病性酸中毒),theacidmetabolitesstimulatetherespiratorycenter,causingdeepandregularrespiration(Kussmanul)withsnoring.ToxicdyspneaInthemetabo71ToxicdyspneaTheoverdoseofmorphineandpentobarbitalcandepressrespiratorycentercausingslowrespirationorCheyne-Stokessrespiration.ToxicdyspneaTheoverdoseofm72Neuro-PsychogenicdyspneaTherespiratorycenterlosesthebloodsupplyoriscompressedwhilepatientsufferingfromcerebrovasculardisease.Therespirationbecomesdeep,slowandirregular.Neuro-PsychogenicdyspneaTher73Nero-PsychogenicdyspneaPatientsufferfromhysteriawillbeseenrepetitivedeep,signingrespirationwithnumbnessofextremitiesorlips,cheiropedalspasm.Nero-PsychogenicdyspneaPatien74HaematologicldyspneaThedecreaseofoxygen-carryingcapacityandoxygencontentdevelopabnormalrespirationandincreaseheartrate,suchassevereanemia,carbonmonoxide.Hypotensioncanstimulaterespirationwhenpatientsufferfromshock.HaematologicldyspneaThedecre75AccompanyingsymptomsParoxysmaldyspneawithwheezing,Itispresentinbronchialasthmaandcardiacasthma.Paroxysmalseveredyspneaisoftenseeninacutelarynxedema(急性喉水腫),spontaneouspneumothorax(自發(fā)性氣胸),massivepulmonaryembolism.AccompanyingsymptomsParoxy76AccompanyingsymptomsDyspneawithchestpain.Itisfrequentlyobservedinlobarpneumonia(大葉性肺炎),pulmonaryinfarction(肺梗塞),sponta