某医学院诊断学呼吸障碍课件

同济医学院诊断学呼吸障碍同济医学院诊断学呼吸障碍同济医学院诊断学呼吸障碍同济医学院诊1Definition:Definition:Dyspnea is defined as an awareness of difficulty in breathing It is therefore a symptom,usually described by the patient as“short of breath,”whether the sensation is due to actual difficulty in breathing or is essentially an awareness of hyperventilation.If the symptom becomes striking,it always companies with dilatation of nares,cyanosis,use of accessory muscles of respiration and abnormalities of respiratory rate,depth or rhythm.Definition:2Respiratory diseases Circulatory diseases Poisoning Hematology Neuropsychogenic factorsEtiologyRespiratory diseasesEtiology3Respiratory dyspnea Caused Caused by by abnormal abnormal ventilation ventilation and and gas gas exchange,exchange,reduction reduction in in ventilatory ventilatory capacity,capacity,hypercapnia hypercapnia and and hypoxemia resulting from respiratory disease.hypoxemia resulting from respiratory disease.Three clininal types:Three clininal types:Inspiratory dyspneaInspiratory dyspnea Expiratory dyspnea Expiratory dyspnea Mixed dyspnea Mixed dyspneaRespiratory dyspneaCaused by a4Inspiratory dyspnean nTends to occur primarily when there is obstruction(such as inflammation,edema,tumor and foreign body)Tends to occur primarily when there is obstruction(such as inflammation,edema,tumor and foreign body)in larynx,trachea and major bronchi.in larynx,trachea and major bronchi.n nCharacterized by the depression sigh,in which visible indrawing over the sternal notch,the supraclavioular Characterized by the depression sigh,in which visible indrawing over the sternal notch,the supraclavioular spaces,the intercostal spaces and the epigastrium in the inspiration can be seen.spaces,the intercostal spaces and the epigastrium in the inspiration can be seen.n nOften accompanied by a coarse,low pitched inspiratory wheezing and dry cough.Often accompanied by a coarse,low pitched inspiratory wheezing and dry cough.Inspiratory dyspneaTends to oc5Expiratory dyspnean nExpiratory dyspnea is due to the decrease of lung elasticity and spasm narrowing of the bronchioles and Expiratory dyspnea is due to the decrease of lung elasticity and spasm narrowing of the bronchioles and smaller bronchi as in emphysema,bronchial asthma and asthmatic bronchitis.smaller bronchi as in emphysema,bronchial asthma and asthmatic bronchitis.n nExpiration is prolonged and laboured with wheezing.Expiration is prolonged and laboured with wheezing.Expiratory dyspneaExpiratory d6Mixed dyspnean nOccurs with the extensive lung disease,such as severe pneumonia,pulmonary fibrosis,massive atelectasis,Occurs with the extensive lung disease,such as severe pneumonia,pulmonary fibrosis,massive atelectasis,pleural effusion and pneumothorax.pleural effusion and pneumothorax.n nResults in the decrease of ventilators and gas exchange capacity.Results in the decrease of ventilators and gas exchange capacity.n nBreathing is difficult during both inspiration and expiration.Breathing is difficult during both inspiration and expiration.Mixed dyspneaOccurs with the e7Cardiac dyspnea Cardiac Cardiac dyspnea dyspnea is is usually usually attributable attributable to to pulmonary pulmonary vascular vascular congestion congestion resulting resulting from from the the left left and/or right heart failure.and/or right heart failure.Cardiac dyspnea Cardiac dysp8Cardiac dyspnean nIn In Left-sided heart failureLeft-sided heart failure,compliance is reduced,and therefore,ventilation is decreased to the,compliance is reduced,and therefore,ventilation is decreased to the edematous lung regions and vital capacity reduced.Alveoli are stiff and more work is needed to edematous lung regions and vital capacity reduced.Alveoli are stiff and more work is needed to overcome elastic recoil,the high alveolar pressure will stimulate stretch receptor and initiate the inflation overcome elastic recoil,the high alveolar pressure will stimulate stretch receptor and initiate the inflation reflex resulting in early turning off of inspiration and an increase in respiratory rate.reflex resulting in early turning off of inspiration and an increase in respiratory rate.Cardiac dyspneaIn Left-sided h9Cardiac dyspnean nThe dyspnea caused by The dyspnea caused by right-sided heart failureright-sided heart failure is less severe than that one caused by left-sided.is less severe than that one caused by left-sided.n nMechanism:Mechanism:(1)The pressure of right atrial and superior vena cava is the natural stimulus of respiratory center.(2)The (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 decrease of oxygen content and the accumulation of the acid metabolites,such as lactic,stimulate respiratory center.center.(3)The restriction of the respiratory movement caused by enlargement of liver resulting from congestion,(3)The restriction of the respiratory movement caused by enlargement of liver resulting from congestion,ascites and pleural effusion.ascites and pleural effusion.Cardiac dyspneaThe dyspnea cau10Cardiac dyspnea Symptoms of congestive heart failure can cause Symptoms of congestive heart failure can cause orthopneaorthopnea and and paroxysmal nocturnal dyspneaparoxysmal nocturnal dyspnea when when elevated-filling pressure is present.elevated-filling pressure is present.Cardiac dyspnea Symptoms of 11orthopnean nOrthopnea is difficulty in breathing in the supine position,this may be relived by sitting up,which reduces 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 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.filling pressures,improving the diaphragmatic movement,increasing vital capacity.orthopneaOrthopnea is difficul12paroxysmal nocturnal dyspnean nSymptoms:The patient awakes short of breath at night,but often obtain relief by sitting up for a period of 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 time.In the most advanced cases,the patients become acutely dyspneic,cyanotic and very frequently produce foamy sputum tinged with blood.produce foamy sputum tinged with blood.n nSigns:Moist rales at the both lung bases,tachycardia,wheezing and bronchospasm,the markedly Signs:Moist rales at the both lung bases,tachycardia,wheezing and bronchospasm,the markedly accentuated second heart sound in the pulmonic area.accentuated second heart sound in the pulmonic area.paroxysmal nocturnal dyspneaSy13n nMechanism:Supine posture for sleep results in resorbtion of extracellular fluid into the intravascular space,Mechanism:Supine posture for sleep results in resorbtion of extracellular fluid into the intravascular space,causing arise in filling pressure.causing arise in filling pressure.n n The paroxysmal dyspnea is termed as cardiac asthma.It can be seen in the hypertensive heart disease and The paroxysmal dyspnea is termed as cardiac asthma.It can be seen in the hypertensive heart disease and coronary heart disease.coronary heart disease.paroxysmal nocturnal dyspneaMechanism:Supine posture for 14Toxic dyspnean nIn In the the metabolic metabolic acidosis acidosis(uremia(uremia and and diabetic diabetic ketosis),ketosis),the the acid acid metabolites metabolites stimulate stimulate the the respiratory respiratory center,causing deep and regular respiration with snoring.center,causing deep and regular respiration with snoring.n nThe overdose of morphine and pentobarbital can depress respiratory center causing deep respiration or The overdose of morphine and pentobarbital can depress respiratory center causing deep respiration or Cheyne-Stokess respiration Cheyne-Stokess respiration Toxic dyspneaIn the metabolic 15 Neuro-Psychogenic dyspnean nIn patients suffering from cerebrovascular diseases(intracranial hemorrhage,elevated intracerebral In patients suffering from cerebrovascular diseases(intracranial hemorrhage,elevated intracerebral pressure),the respiratory center loses the blood supply or is compressed.The respiration becomes deep,pressure),the respiratory center loses the blood supply or is compressed.The respiration becomes deep,slow and irregular.slow and irregular.n nIn some cases the dyspnea may be psychogenic,which is characterized by repetitive deep,sighing In some cases the dyspnea may be psychogenic,which is characterized by repetitive deep,sighing respiration with numbness of extremities or lips,cheiropedal spasm.These are also manifestations of acute respiration with numbness of extremities or lips,cheiropedal spasm.These are also manifestations of acute hypocapnia and respiratory alkalosis.hypocapnia and respiratory alkalosis.Neuro-Psychogenic dyspneaIn p16Hematological dyspnea n nIn severe anemia,sulfhemoglobinemia,methaemoglobinemia or carbon monoxide poisoning the decrease of In severe anemia,sulfhemoglobinemia,methaemoglobinemia or carbon monoxide poisoning the decrease of oxygen-carrying capacity and oxygen content develop abnormal respiration and increased heart rate.oxygen-carrying capacity and oxygen content develop abnormal respiration and increased heart rate.n nThe respiration rate also increases in shock which stimulates respiration center because of hypotension.The respiration rate also increases in shock which stimulates respiration center because of hypotension.Hematological dyspnea In sever17 Accompanied SymptomParoxysmal dyspnea with wheezing.Dyspnea with chest pain.Dyspnea with fever.Dyspnea with cough and purulent sputum.Dyspnea with coma.Accompanied Symptom18n nParoxysmal dyspnea with wheezingParoxysmal dyspnea with wheezing It is present in bronchial asthma and cardiac asthma.Paroxysmal severe dyspnea is often seen in acute It is present in bronchial asthma and cardiac asthma.Paroxysmal severe dyspnea is often seen in acute larynx edema,foreign body in bronchi,massive pulmonary embolism,and spontaneous pneumothorax.larynx edema,foreign body in bronchi,massive pulmonary embolism,and spontaneous pneumothorax.Paroxysmal dyspnea with wheezi19n nDyspnea with chest pain.Dyspnea with chest pain.It is frequently observed in lobar pneumonia,pulmonary infarction,spontaneous pneumothorax,acute exudative It is frequently observed in lobar pneumonia,pulmonary infarction,spontaneous pneumothorax,acute exudative pleurisy,acute myocardial infarction,and bronchial carcinoma.pleurisy,acute myocardial infarction,and bronchial carcinoma.Dyspnea with chest pain.20n nDyspnea with fever.Dyspnea with fever.It is commonly noted in pneumonia,lung abscess,pulmonary tuberculosis,pleurisy,acute pericarditis,and It is commonly noted in pneumonia,lung abscess,pulmonary tuberculosis,pleurisy,acute pericarditis,and nervous system diseases.nervous system diseases.Dyspnea with fever.21n nDyspnea with cough and purulent sputumDyspnea with cough and purulent sputum.It is often present in chronic bronchitis,obstructive pulmonary emphysema with infection,purulent It is often present in chronic bronchitis,obstructive pulmonary emphysema with infection,purulent pneumonia,and lung abscess;Dyspnea with large amount of foamy sputum is often seen in acute left pneumonia,and lung abscess;Dyspnea with large amount of foamy sputum is often seen in acute left ventricular heart failure and organophosphorus poisoning.ventricular heart failure and organophosphorus poisoning.Dyspnea with cough and purulen22n nDyspnea with comaDyspnea with coma.It suggests cerebral hemorrhage,meningitis,pneumonia with shock,uremia,diabetic ketoacidosis,and It suggests cerebral hemorrhage,meningitis,pneumonia with shock,uremia,diabetic ketoacidosis,and acute poisoning.acute poisoning.Dyspnea with coma.23谢谢！谢谢！谢谢！24