3. 急性呼吸困难
概 述
呼吸困难指患者主观上感觉呼吸费力或不适。平卧位呼吸困难而被迫采取坐位,称为端坐呼吸。呼吸困难同时伴有响声者,称为哮喘或喘息。因呼吸困难在夜间睡着时憋醒,醒后又可入睡,称为夜间阵发性呼吸困难。以下是急性呼吸困难诊疗的临床路径。
表3.1 急性呼吸困难的重点评估
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.1_3749.jpg?sign=1738999505-n9uDaHezjVrRgpwqSQsp8C2khrKUNXAj-0-c3e22ed98e50682e94254c360e42db2e)
表3.2 急性呼吸困难的紧急检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.2_3756.jpg?sign=1738999505-vpRXgnlDDM8oO7NSq8ad1JE6jmnY6Rlw-0-49e1c6cabc0714b65344e694ab40d74d)
注:EDTA,乙二胺四乙酸
表3.3 急性呼吸困难的病因
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.3_59938.jpg?sign=1738999505-jeN4cgDNkQjgkXtncdTjmdFtypDzKOnN-0-a174a65d0e14cabba82fb30ca17313d6)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.3_1_59939.jpg?sign=1738999505-mpvRWtHG5aN6y1zIsxcXrF3lfwS47jLo-0-326b15ba992b0800521e6bb7b18e78c0)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.3_2_59940.jpg?sign=1738999505-3OhZeKUh8B64ETp9PK9doP1vYfdDhNan-0-6b177b88fae62e8af5cd3c6bccdb9f8d)
表3.4 胸部X线无特殊肺部表现的呼吸困难患者的动脉血气和pH
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.4_59941.jpg?sign=1738999505-RxBBQ7U1YNNnPrM8dduXABl6lJRz59lV-0-80e96089d0c151940c6ead8b426c3e82)
注:*,呼吸性碱中毒可与代谢性酸中毒相互抵消。注意识别混合型酸碱平衡紊乱
+,多是由于病毒或卡氏肺囊虫引起
++,诊断原发性过度换气之前,需要排除引起呼吸急促的器质性原因,包括糖尿病酮症酸中毒和急性哮喘,要检查动脉血气和pH,如果这两项显示异常,患者应做进一步检查
表3.5 胸部X线显示急性呼吸困难的病因
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.5_59612.jpg?sign=1738999505-ZvJDg4sA4mJ959Dv8Jyh8D8dFYRNtNYl-0-1ad9806a95c51a6084ab8a7631b702a2)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.5_1_4016.jpg?sign=1738999505-jCDtx3x7FH6AzR1WqpUxym7qVFCEhXBk-0-f6314dacf12ad4f5ebbced17ad7b3f38)