小儿呼吸困难误诊漏诊临床分析

目的探讨误诊漏诊的小儿呼吸困难及其原因。方法回顾性分析我院儿科62例误诊漏诊呼吸困难患儿的临床资料。结果62例误诊漏诊的呼吸困难患儿中,呼吸道误吸19例,呼吸系统解剖异常14例,先天性心脏病12例,纵隔占位性疾病6例,糖尿病酮症酸中毒3例,吉兰-巴雷综合征2例,其它6例。其中单一病因(非肺炎疾患)所致呼吸困难14例,复合病因(肺炎+基础疾病)48例。因疾病表现不典型或基础疾病被肺炎掩盖而误诊漏诊。结论小儿呼吸困难误诊漏诊的主要疾病是呼吸道误吸。对那些不能单独用呼吸系统疾病合理解释的呼吸困难,应尽早做相应检查以便确诊。     

一次性气管套管置入后呼吸困难的临床分析

目的 探讨在施用一次性塑料套管时出现呼吸困难原因分析及治疗。方法 近年来行气管切开置入一次性气管套管患者发生逐渐呼吸困难症状，给予鼻内窥镜检查，换管对症治疗。结果 7例均因气管填塞出现症状。结论 在应用无内管塑料气管套管时，应随时注意呼吸变化，对病程较长的患者及时换管，避免给患者造成二次伤害。     

Respiratory Muscles and Dyspnea in Obese Nonsmoking Subjects

To our knowledge no data have been reported on the contribution to acute increase in dyspnea by the respiratory muscles in obese nonsmoking subjects. To better focus on this topic, we studied seven obese subjects and an age-matched normal control group, assessing baseline pulmonary function, breathing pattern, esophageal pressure (Pes), and gastric (Pga) and transdiaphragmatic (Pdi) pressures. Pes was also recorded during a sniff maneuver (Pessn). During a hypercapnic rebreathing test we recorded inspiratory swing in Pes (Pessw), expiratory changes in Pga, and inspiratory swings in Pdi (Pdisw). Change in inspiratory capacity was considered the mirror image of end-expiratory lung volume (EELV). Dyspnea was assessed by a modified Borg scale. Under control conditions, patients exhibited a reduced expiratory reserve volume and intrinsic positive end-expiratory pressure (PEEPi). At the end of hypercapnic stimulation, compared with controls our obese subjects exhibited greater respiratory frequency (Rf), shorter expiratory time, greater Pessw, and lower Pdisw. Increases in EELV and PEEPi were found in the obese subjects but not in controls. Changes in Borg correlated with changes in PETCO₂, VE, Pessw (%Pessn), and Pdisw to a greater extent in patients than in controls. Stepwise regression analysis indicated the amount of variability in Borg that was predicted by both Pdisw (r² = 0.31, p < 0.0004), and Pessw (%Pessn) (r² = 0.09, p < 0.005) in controls, and by Pessw (%Pessn) (r² = 0.40, p <0.00001) in obese subjects. We conclude that the rib cage muscles contributed to dyspnea to a greater extent in this subset of obese subjects. This work was supported by grants of the Università degli Studi di Firenze.     

Measurement of dyspnea: word labeled visual analog scale vs. verbal ordinal scale

We previously used a verbal ordinal rating scale to measure dyspnea. That scale was easy for subjects to use and the words provided consistency in ratings. We have recently developed a word labeled visual analog scale (LVAS) with labels placed by the subjects, retaining the advantages of a verbal scale while offering a continuous scale that generates parametric data. In a retrospective meta-analysis of data from 43 subjects, individuals differed little in their placement of words on the 100 mm LVAS (mean+/-S.D. for slight=20+/-2.5 mm, moderate=50+/-5 mm and severe=80+/-6 mm) and ratings were distributed uniformly along the scale. A significant stimulus-response correlation was obtained for both the LVAS (r(2)=0.98) and for the verbal ordinal scale (Spearman r=0.94). The resolution of the two scales differed only slightly. With meaningful verbal anchors, well-defined end-points, and clear instructions about the specific sensation to be rated, both scales provide valid measures of dyspnea.     

便携式超声心动图仪在诊治急性发作性呼吸困难中的应用

目的探讨便携式超声心动图仪在诊治急性发作性呼吸困难中的应用价值。方法分析81例急性发作性呼吸困难患者的床边心脏超声检查资料，对同时完成便携式超声心动图仪和传统心脏超声仪检测的45例患者的资料进行分析。结果45例患者2种心脏超声仪检测的二维成像符合率达100％。81例患者中，经心脏超声证实临床诊断74例（91．4％），经心脏超声纠正诊断6例（7．4％），误诊1例（1．2％）。便携式超声心动图仪能即刻诊断心包积液，实时监护心包穿刺术的进行和监测积液量的变化。结论便携式超声心动图仪检查能为急性发作性呼吸困难的诊治提供快速、明确的诊断信息，能参与并指导临床干预，增加临床干预的准确性、科学性和有效性，并使现场超声成为可能。     

The impact of emotions on symptom perception in patients with asthma and healthy controls

Accurate perception of respiratory symptoms is highly important for course and treatment of asthma. Recent findings suggest that emotions can greatly impact respiratory symptom perception. This study compared the impact of emotions on respiratory symptom perception between patients with asthma and matched healthy controls. Pleasant and unpleasant emotional states were elicited by viewing emotional picture series while symptom reports and respiratory parameters were measured. Greater symptom report was observed for the unpleasant compared to the pleasant emotional state that was not related to respiratory parameters. Notably, this effect was comparable between patients with asthma and healthy controls. The present results suggest that the impact of emotions on respiratory symptom perception is a rather general phenomenon and not dependent upon previous experiences with asthma symptoms.     

X线第一前肋间肺静脉直径与肺毛细血管嵌压的关系及对心力衰竭诊断价值探讨

目的探讨X线第一前肋间肺静脉直径(PVDFAI)与肺毛细血管嵌压(PCWP)的关系及对心力衰竭(CHF)的诊断价值。方法入选住院呼吸困难患者195例,正常健康组67例,测定肺毛细血管嵌压(PCWP)并行后前位X线胸片检查,测量PVDFAI。以PCWP>12mmHg作为左心功能不全的诊断标准,将患者分为心衰组和肺源性呼吸困难组。计算PVDFAI诊断心衰的不同截值的敏感性、特异性、准确性。结果正常对照组PVDFAI(1.34±0.49)mm与肺源性呼吸困难组PVDFAI(1.43±0.37)mm差异无显著统计学意义(q=0.2700,P>0.05)。心源性呼吸困难组PVDFAI(2.49±0.93)mm与肺源性呼吸困难组和正常对照组比较均有明显增宽(q=17.0676,P<0.01;q=15.1143,P<0.01)。PVD-FAI与PCWP密切相关(r=0.388,P=0.000)。多元Logistic回归分析表明胸片PVDFAI是CHF的独立预测因子(P=0.000,比数比28.103)。PVDFAI判定肺源性呼吸困难或心衰,其曲线下面积95.24%(95%可信区间,91.73%~98.85%)。判断左心功能不全的PVDFAI最佳截值为2.5 mm,其诊断左心功能不全的敏感度97.17%,特异度93.26%,准确度95.38%。结论第一前肋间肺静脉直径可用以识别有、无肺静脉高压,对诊断心衰有价值。     

COPD患者6分钟步行检测参数意义的分析

目的：应用因子分析法初步探讨定时步行距离检测中诸生理参数之间的内在联系。方法：对象为３２例慢性阻塞性肺疾病患者；６分钟步行检测前后记录肺功能、动脉血气及呼吸困难程度积分，然后对ＭＲＣ积分、肺活量占预计值的百分比、第１秒肺活量占预计值的百分比、动脉血氧分压、实际步行距离占步行预计距离百分比（％ＷＤｐｒｅｄ）、Ｂｒｏｇ积分（ＢＳ）、步行检测前后的心率变化（ΔＨＲ）、动脉血碱剩余变化及血氧饱和度变化（ΔＳｐＯ２）等９项生理参数作因子分析。结果及结论：上述９项参数可合并为４个因子。其中４项基本参数，％ＷＤｐｒｅｄ、ＢＳ、ΔＨＲ及ΔＳｐＯ２被分别分类于４个因子中。通过具体分析各参数在４个因子中的位置，可对各项参数的意义及其联系作一初步解析。