pbl呼吸困难培训课件.ppt

Cardiac dyspnea The dyspnea caused by right-sided heart failure is less severe than that one caused by left-sided. Mechanism: (1) The pressure of right atrial and superior vena cava is the natural stimulus of respiratory center. (2) The decrease of oxygen content and the accumulation of the acid metabolites, such as lactic, stimulate respiratory center. (3) The restriction of the respiratory movement caused by enlargement of liver resulting from congestion, ascites and pleural effusion. 体循环淤血 右心房舆上腔V压↑ 刺激压力感受器 反射性兴奋呼吸中枢 血氧含量↓,酸性产物堆积 刺激呼吸中枢 淤血性肝大、胸水、腹水 呼吸运动受限 常见于：慢性肺心病、风湿性心脏病.另外，也可见于各种原因所致的急性或慢性心包积液。其发生呼吸困难的主要机制是大量心包渗液致心包压塞或心包纤维性增厚、钙化、缩窄，使心脏舒张受限，引起体循环静脉瘀血所致。 右心衰竭发生呼吸困难的机制 一男性67岁患者，因反复胸闷气急伴咳嗽咳痰10余天，加重2天入急诊，既往无明确慢支病史，但有吸烟：2～3包×30年，无结核史，胸片示两肺纹理增多伴感染，呼吸科两班医生会诊考虑支气管炎予收治，因床位紧张在急诊留观，第二天，当班二唤（第3个呼吸科会诊医生）说查个心超看看，排除一下心脏问题，结果示大量心包积液，立即请心内科会诊收治，马上行心包穿刺引流，化验脱落细胞阳性，家属一直对急诊当时差点漏诊耿耿于怀。体检没有发现心包积液的体症么，哎。 Cardiac dyspnea Symptoms of congestive heart failure can cause orthopnea and paroxysmal nocturnal dyspnea when elevated-filling pressure is present. 2．心源性呼吸困难 半坐位或端坐体位呼吸(orthopnea) 夜间阵发性呼吸困难 (书上没有内容) 2．心源性呼吸困难 夜间阵发性呼吸困难发生机制 夜间阵发性呼吸困难发作症状 “心源性哮喘”(cardiac asthma) orthopnea Orthopnea is difficulty in breathing in the supine position, this may be relived by sitting up, which reduces the degree of pulmonary congestion by pooling blood in the lower extremities and lowering left ventricular filling pressures, improving the diaphragmatic movement, increasing vital capacity. paroxysmal nocturnal dyspnea Symptoms: The patient awakes short of breath at night, but often obtain relief by sitting up for a period of time. In the most advanced cases, the patients become acutely dyspneic, cyanotic and very frequently produce foamy sputum tinged with blood. Signs: Moist rales at the both lung bases, tachycardia, wheezing and bronchospasm, the markedly accentuated second heart sound in the pulmonic area. Mechanism: Supine posture for sleep