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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=1740119973-JtWCoKiGzMhpc4xIaoCyFkeiSv2bvZf0-0-8fb15eeadf5aa96e0bca4348832f5512)
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=1740119973-aNvEvibqDKsNVYg8fsPeUKUnbIuxEiLw-0-4d14ba8a2ee8d044e3583d1b8ec9ec17)
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=1740119973-I8eu4qflZSO7VbUhhUDY6KPA3hG7FbXb-0-82ee73457dbb22e4a630bbaef8f263e6)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.3_1_59939.jpg?sign=1740119973-VpHdzly3LDd3r1fx0XBTOh4MJioz6aBk-0-08818a40a073de062d248142c91417dd)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.3_2_59940.jpg?sign=1740119973-BlGSWwZS8RjhHsuSlfC9USWyMtoPFy3X-0-1d3f24f45e1502fab77d74b7f36f9f91)
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=1740119973-IzrYMjJArRxuXAE8u8YIw3xiiWhu6eu2-0-f653acd14b5950358f5f0cb0de109814)
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=1740119973-jg7dpSmjRY5Dte7xEPEgwfQgxdPSPB3G-0-1991985c93e75e7e36d117c0557aef47)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.5_1_4016.jpg?sign=1740119973-Lpw2ueapg9DRnhsKqKKlWrkazAzwY9E1-0-db84ed1d975cbb1bc9c3e138f02c0733)