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1、EvaluationofChronicDyspneaNEELG.KARNANI,M.D.,GARYM.REISFIELD,M.D.,andGEORGER.WILSON,M.D.UniversityofFloridaHealthScienceCenter,Jacksonville,FloridaChronicdyspneaisdefinedasdyspnealastingmorethanonemonth.Inapproximatelytwothirdsofpatientspresentingwithdysp
2、nea,theunderlyingcauseiscardiopulmonarydisease.Establishinganaccu-ratediagnosisisessentialbecausetreatmentdiffersdependingontheunderlyingcondition.Asthma,congestiveheartfailure,chronicobstructivepulmonarydisease,pneumonia,cardiacischemia,inter-stitiallung
3、disease,andpsychogeniccausesaccountfor85percentofpatientswiththisprincipalsymptom.Thehistoryandphysicalexaminationshouldguideselectionofinitialdiagnostictestssuchaselectrocardiogram,chestradiograph,pulseoximetry,spirometry,completebloodcount,andmetabolicp
4、anel.Iftheseareinconclusive,FLOYDE.HOSMERadditionaltestingisindicated.Formalpulmonaryfunctiontestingmaybeneededtoestablishadiagnosisofasthma,chronicobstruc-tivepulmonarydisease,orinterstitiallungdisease.High-resolutionILLUSTRATIONBYcomputedtomographyispar
5、ticularlyusefulfordiagnosinginter-stitiallungdisease,idiopathicpulmonaryfibrosis,bronchiectasis,orpulmonaryembolism.Echocardiographyandbrainnatriureticpeptidelevelshelpestablishadiagnosisofcongestiveheartfailure.Ifthediagnosisremainsunclear,additionaltest
6、smayberequired.Theseincludeventilationperfusionscans,Holtermonitoring,cardiaccatheterization,esophagealpHmonitoring,lungbiopsy,andcardiopulmonaryexercisetesting.(AmFamPhysician2005;71:1529-37,1538.Copyright©2005AmericanAcademyofFamilyPhysicians.)▲Patienti
7、nformation:yspneaisacommonsymptomthatconsistsofqualitativelydistinctsensa-Ahandoutonshortnessinpatientspresentingtothepri-tionsthatvaryinintensity.”Chronicdyspneaofbreath,writtenbythemarycareoffice.Theproportionisdefinedasdyspnealastinglongerthanoneauthor
8、softhisarticle,isDprovidedonpage1538.ofofficevisitsforthissymp-month.tomriseswithage,withapeakincidenceDyspneaisasubjectivephenomenonSeepage1465for1inpatientswhoare55to69yearsofage.basedonthevariationinseverityforag