Dyspnea课件.ppt

Dyspnea Jin Yu-hua Dept. of Geriatrics Definition Dyspnea is defined as an awareness of difficulty in breathing. Most patients suffer from actual difficulty, some patients just taste an awareness of hyperventilation(换气过度). How to describe these sensations Cannot get enough air Air does not go all the way down Smothering feeling in the chest Tightness in the chest Fatigue in the chest Definition Dilatation of nares(鼻翼扇动), cyanosis(紫绀), use of accessory muscles of respiration Abnormalities of respiratory rate,depth or rhythm Etiology Respiratory disease Cardic disease Toxic Nero-Psychogenic Haematological disease Increase of abdominal pressure (massive ascites(腹水), pregnancy(怀孕) etc) Normal person may experience the physiologic dyspnea during heavy exercise Environment short of oxygen Respiratory dyspnea Respiratory dyspnea is caused by abnormal ventilation and gas exchange. Reduction in ventilatory capacity, hypercapnia(二氧化碳潴留) and hypoxemia(低氧血症) resulting from respiratory disease. Three clinical types: inspiratory dyspnea, expiratory dyspnea, mixed dyspnea. Inspiratory dyspnea Clinical characteristics: visible indrawing over the sternal notch, the supraclavicular spaces, the intercostal spaces and the epigastrium in the inspiration(三凹症). Accompanied by a coarse, low pitched inspiratory wheezing and dry cough. Stenosis and obstruction of larynx, trachea, and bronchi Expiratory dyspnea Clinical 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(肺气肿), bronchial asthma(支气管哮喘) and chronic asthmatic bronchitis(喘慢支). Mixed dyspnea Clinical characteristics: breathing is difficult during both inspiration and expiration. Respiratory frequency increase and respiration superficial. Cause: decrease of ventilators and gas exchange capacity Familiar diseases: severe pneumonia(肺炎), pulmonary fibrosis(肺纤维化), massive atelectasis(大片肺不张) e