急性呼吸困难的鉴别诊断临床研究

目的对导致临床常见的呼吸困难症状的原因进行分析探索鉴别诊断方法。方法本文入组因呼吸困难就诊患者289例，测定其最大呼气峰流速（peak expiratory flow rate，PEF）、动脉血气分析、血脑利钠肽（brain natriuretic peptide，BNP），并计算其气急鉴别指数DDI（dyspnea differentiation index，DDI）。在后期条件允许时检查肺功能、胸片、心脏彩超、心电图等，并经2位主治医师以上职称人员确认该患者呼吸困难原因，分为4组：A组：肺源性呼吸困难组，B组：心源性呼吸困难组，C组：肺源性合并心源性呼吸困难组，D组：其它原因呼吸困难组。统计前三组呼吸困难患者的PEF值、DDI值、BNP值。结果A、B、C三组患者PEF、DDI、BNP值分别为140．7±50．4，8．5±3．5，118．5±13．5；170．2±30．2．14．4±3．5，450．5±32．5；158．5±42．5，11．5±4．5，220．5±25．5。A、B两组间PEF统计学差异，DDI、BNP有较显著统计学差异，C组与A、B组间各指标无统计学差异。结论DDI侧重于肺源性呼吸困难的肯定诊断，BNP侧重于心源性呼吸困难的肯定，BNP以500ng／L为临界值结合DDI以13mm-Hg＊L／min为临界值可以用于鉴别肺源性呼吸困难和心源性呼吸困难。

Clinical Research on Differential Diagnosis of Acute Respiratory Difficulty

Objective To investigate a diffenciatial diagnostic method for pulmonary and cardiac dyspnea. Methods 289 dysp- nea cases were enrolled. PEF（ peak expiratory flow rate, PEF） ,did the arterial blood gas analysis ,determined the BNP（ brain natriuretic peptide, BNP） ,and calculated DDI（ dyspnea differentiation index, DDI） were measured The pulmonary function test, chest x-ray, echo- cardiography, were examined in later period when conditions permit. All the cases were divided into 4 groups： A： the pulmonary dyspnea group ; B ： the cardiac dyspnea group ; C ： the pulmonary dyspnea complications with cardiac dyspnea group ; D ： others. Results The PEF, DDI and BNP of group-A, group-B and group-C were 140. 7 ± 50. 4,8.5 ± 3.5,118.5 ± 13.5 ; 170.2 ±30.2,14.4 ± 3.5,450. 5 ±32. 5 and 158.5 ±42.5,11.5 ±4.5,220. 5 ±25.5. There is an significant difference of PEF between group-A and group-B. The critical value of BNP is 500 ng/L, and DDI is 13 mmHg ＊ L/min for group A and group B. Conclusion DDI emphasis on the confirmatory diagnosis of pulmonary dyspnea, and BNP emphasis on the confirmatory diagnosis of cardiac dyspnea. The combination of BNP and DDI can be used to identify pulmonary dyspnea and cardiac dyspnea.