![急诊临床路径](https://wfqqreader-1252317822.image.myqcloud.com/cover/11/36535011/b_36535011.jpg)
上QQ阅读APP看书,第一时间看更新
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=1738927518-9wJU4j41u530g3xccWWJmI4psr9wzVEc-0-5d39f4acef4295ec5f1171a40f85e354)
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=1738927518-Djl0g0d2b9GS3A7cisGy1Q9PEWiivYl8-0-873ffe8a8b926f2f5808f46a427d338a)
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=1738927518-shZC0qwcgWePPXFjMofyEfno6MGQ0ean-0-7f675416577489f52943d0d39affe0b6)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.3_1_59939.jpg?sign=1738927518-peWFqwjz4muwSWpGxfk8KhSegzwArWCw-0-00718e3526b1296b171d9f7c49cafbaf)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.3_2_59940.jpg?sign=1738927518-9QhIQLHr4W3kAssSNf9R5spKZrWmornq-0-3b3badf0cc3e723b9e51055b7ba4c86c)
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=1738927518-bgC1GoMu1gQjrz33yScbCjjwdseRnswv-0-1908d122622b2ef7290075c083853a7b)
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=1738927518-tsdyVN37VfXCCScgkNGOCKFxmgzvwR92-0-47ea0094044dbdd72f371be9a3695559)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.5_1_4016.jpg?sign=1738927518-V1a3IpVU7bENGu3VjYW7sWulDs8IhsZd-0-8180b2e770718937cfd1e0ed923a9ec8)