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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=1739290622-Qb9sJwn31aRICrzEj8kyX1Ud5ngxOXyu-0-239c52a8b4892ed7395370b58c459412)
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=1739290622-Qn8LHVU8C6C5crxEoZZtTNyyshQIliGA-0-618eb87dbc6d1821817108125dabab57)
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=1739290622-mUmOFJ1wY1uQFk6rkcLPkcCvzjCX6TxS-0-b99a249e6c519aad2d2befe55636fb5f)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.3_1_59939.jpg?sign=1739290622-ybHERFgsm3kOwRZIVeJ3hG5TzQwIceHL-0-a38fab1f996a678ed32df15e6147488b)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.3_2_59940.jpg?sign=1739290622-ENay0HUHUpZEnWbEnX8UN66uSv9yQ8oW-0-49f7f1d9a64e2f8ddc03a1aa80a7f4c7)
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=1739290622-U6vsNuZmq1XhO54cC2kW1AIYNojqDTk1-0-4ec3df30120c85b8f511b1d2d6206b3c)
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=1739290622-Mjz4AJ7kYzGzTjoAaFnhEYbluJZIz2WQ-0-b659e864265cbda6cf8edda02738a28d)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.5_1_4016.jpg?sign=1739290622-acqrkD0yneZC86SQVZsdf2TIyStkWSDB-0-8efc060672b68d8e60fc9f4777d177fa)