上海交通大学医学院仁济临床医学院(1).doc

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1、上海交通大学医学院仁济临床医学院理论课教案第1次课教学方式Lecture学时3专业diagnostics班级04级英文班2007年4月20日题日木课H的要求ddnnaaSaaleesppnnylodd・ltomofthendysptnyiofadpade.ceteene山de•dd•m出nncmn本课的重点、难点本课使用教材及参考书s文侯版9r-r皿诊66本次课应用教具及电化器材体媒多教学程序.时间分配及主要内容备注Totaltimeforcourse:2hoursDYSPNEADefinitionDyspneaisdefin

2、edasanawarenessofdifficultyinbreathing.Itisthereforeasymptom,usuallydescribedbythepatientas"shortnessofbreath/9whetherthesensationisduetoactualdifficultyinbreathingorisessentiallyanawarenessofhyperventilation.EtiologyThemostfrequentcausesofdyspneaarecardiorespirator

3、ydisease.Theotheristoxic,neuropsychogenic,hematologic,theincreaseofabdominalpressure(massiveascites,pregnancyetc).Mechanismandclinicalfeature1.Respiratorydyspnea:Respiratorydyspneaiscausedbyabnormalventilationandgasexchange,reductioninventilatorycapacity,hypercapnia

4、andhypoxemiaresultingfromrespiratorydisease.(1)Inspiratorydyspnea(2)Expiratorydyspnea(3)Mixeddyspnea2.CardiacdyspneaCardiacdyspneaisusuallyattributabletopulmonaryvascularcongestionresultingfromtheleftand/orrightheartfailure.Left-sidedheartfailureleadstoimpairedgasex

5、change・Right-sidedheartfailurecausesstasissystemiccirculation.Symptomsofcongestiveheartfailurecancauseorthopneaandparoxysmalnocturnaldyspneawhenelevated-fillingpressureispresent.Paroxysmanocturnaldyspneaisaspecificsymptom.3.Toxicdyspnea.Inthemetabolicacidosis(uremia

6、anddiabeticketosis),theacidmetabolitesstimulatetherespiratorycenter,causingdeepandregularrespirationwithsnoring.4.Neuro-Psychogenicdyspnea.Dyspneamayoccurinthepatientssufferingfromcerebrovasculardiseases(intracranialhemorrhage,elevatedintracerebralpressure).Therespi

7、ratorycenterlosesthebloodsupplyoriscompressed.Therespirationbecomesdeep,slowandirregula匚5.HematologicdyspneaInsevereanemia,sulfhemoglobinemia,methaemoglobinemiaorcarbonmonoxidepoisoningthedecreaseofoxygen-canyingcapacityandoxygencontentdevelopabnormalrespirationandi

8、ncreasedheartrate.AccompanyingsymptomsParoxysmaldyspneawithwheezing.1.Dyspneawithchestpain.2.Dyspneawithfever.3.Dyspneawithcoughandpurulen