呼吸困难病理课件

DyspneaDyspnea1DefinitionDyspneaisdefinedasanawarenessofdifficultyinbreathing.Mostpatientssufferfromactualdifficulty,somepatientsjusttasteanawarenessofhyperventilation(换气过度).DefinitionDyspneaisdefineda2HowtodescribethesesensationsCannotgetenoughairAirdoesnotgoallthewaydownSmotheringfeelinginthechestTightnessinthechestFatigueinthechestHowtodescribethesesensatio3DefinitionDilatationofnares(鼻翼扇动),cyanosis(紫绀),useofaccessorymusclesofrespirationAbnormalitiesofrespiratoryrate,depthorrhythmDefinitionDilatationofnares(4EtiologyRespiratorydiseaseCardicdiseaseToxicNero-PsychogenicHaematologicaldiseaseIncreaseofabdominalpressure(massiveascites(腹水),pregnancy(怀孕)etc)EtiologyRespiratorydisease5NormalpersonmayexperiencethephysiologicdyspneaduringheavyexerciseEnvironmentshortofoxygenNormalpersonmayexperiencet6呼吸困难病理课件7呼吸困难病理课件8RespiratorydyspneaRespiratorydyspneaiscausedbyabnormalventilationandgasexchange.Reductioninventilatorycapacity,hypercapnia(二氧化碳潴留)andhypoxemia(低氧血症)resultingfromrespiratorydisease.Threeclinicaltypes:inspiratorydyspnea,expiratorydyspnea,mixeddyspnea.RespiratorydyspneaRespiratory9InspiratorydyspneaClinicalcharacteristics:visibleindrawingoverthesternalnotch,thesupraclavicularspaces,theintercostalspacesandtheepigastriumintheinspiration(三凹症).Accompaniedbyacoarse,lowpitchedinspiratorywheezinganddrycough.Stenosisandobstructionoflarynx,trachea,andbronchiInspiratorydyspneaClinicalch10ExpiratorydyspneaClinicalcharacteristics:expirationisprolongedandlabouredwithwheezing.Cause:thedecreaseoflungelasticityandspasmnarrowingofthebronchiolesandsmallerbronchi.Familiardiseases:emphysema(肺气肿),bronchialasthma(支气管哮喘)andchronicasthmaticbronchitis(喘慢支).ExpiratorydyspneaClinicalcha11MixeddyspneaClinicalcharacteristics:breathingisdifficultduringbothinspirationandexpiration.Respiratoryfrequencyincreaseandrespirationsuperficial.Cause:decreaseofventilatorsandgasexchangecapacityFamiliardiseases:severepneumonia(肺炎),pulmonaryfibrosis(肺纤维化),massiveatelectasis(大片肺不张)etcMixeddyspneaClinicalcharacte12CardiacdyspneaCardiacdyspneaisusuallyattributabletopulmonaryvascularcongestionresultingfromtheleftand/orrightheartfailure.Dyspneaistheprimarysymptomofleftheartfailure.CardiacdyspneaCardiacdyspnea13呼吸困难病理课件14LeftheartfailureBasaldiseases:CoronaryheartdiseaseHypertensiveheartdiseaseRheumaticheartdiseaseCongenitalheartdiseaseLeftheartfailureBasaldiseas15LeftheartfailureMechanism:LungcongestiondecreasegasdispersionAlveoliarestiffandmoreworkisneededtoovercomeelasticrecoilThehighalveolarpressurestimulatestretchreceptorHighpulmonarycirculationpressurestimulaterespiratorynervecenterLeftheartfailureMechanism:16LeftheartfailureClinicalrepresentation:Exhausteddyspnea(劳力性呼吸困难)Orthopnea(端坐呼吸)Paroxysmalnocturnaldyspnea(夜间阵发性呼吸困难)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尿毒症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(急性喉水肿),spontaneouspneumothorax(自发性气胸),massivepulmonaryembolism.AccompanyingsymptomsParoxy31AccompanyingsymptomsDyspneawithchestpain.Itisfrequentlyobservedinlobarpneumonia(大叶性肺炎),pulmonaryinfarction(肺梗塞),spontaneouspneumothorax,acuteexudativepleurisy(急性渗出性胸膜炎),acutemyocardialinfarction(急性心肌梗死),andbronchialcarcinoma(支气管肺癌).AccompanyingsymptomsDyspne32AccompanyingsymptomsDyspneawithfever.Itiscommonlynotedinpneumonia,lungabscess(肺脓肿),pulmonarytuberculosis(肺结核),pleurisy,acutepericarditis(急性心包炎),andnervoussystemdiseases.AccompanyingsymptomsDyspne33AccompanyingsymptomsDyspneawithcoughandpurulentsputum.Itisoftenpresentinchronicbronchitis,obstructivepulmonaryemphysemawithinfection,purulentpneumonia,andlungabscess;Dyspneawithlargeamountoffoamysputumisoftenseeninacuteleftventricularheartfailureandorganophosphoruspoisoning(有机磷中毒).AccompanyingsymptomsDyspne34AccompanyingsymptomsDyspneawithcoma.Itsuggestscerebralhemorrhage(脑出血),pneumoniawi