2011美国胸科协会 呼吸困难指南解读课件.ppt

AFFERENT SOURCES Stimulus PHYSIOLOGICAL MECHANISM Evaluation(common situations) Major conclusion② Three-dimensional brainimaging technology demonstrate that dyspnea activates cortico-limbic structures . Major conclusion③ Sensory–perceptual experience Affective distress Symptom impact or burden ② ① ③ DOMAINS OF DYSPNEA MEASUREMENT Major conclusion④ Evaluation Evaluation Specific biomarker Specific tests . History Physical examination BNP ABG Spirometry Major conclusion⑤ The first priority for treatment Identifying and relieving the pathologic process Intervention * 举例：PO2↓，PCO2↑，PH↓ ?外周化学感受器+中枢化学感受器?呼吸中枢（延髓、脑干、大脑皮层、边缘系统）?呼吸肌?改变肺通气 Er:Evaluation Tr:Treatment 4.Multiple factors:physiological, psychological, social, and environmental factors * Content Layouts Respiratory “work” and “effort” is commonly reported by patients with conditions such as asthma, chronic obstructive pulmonary disease (COPD),Cardiac disease and diseases that impair respiratory muscle performance As airway narrowing worsens, patients also report work/effort and air hunger/unsatisfied inspiration. Bronchoconstriction gives rise to both a sense of tightness and added physical work of breathing。 There is also evidence in patients with asthma that perception of increased work/effort does not respond as rapidly as tightness to treatment with nebulized albuterol , suggesting that work/effort may be more related to increased respiratory motor output needed to overcome airflow obstruction * In addition, patients with asthma, COPD, interstitial lung disease, and idiopathic hyperventilation are significantly more likely than healthy control subjects to report perceptions of air hunger when recalling perceptions of breathing at the end of exercise Others Intensity of air hunger/unsatisfied inspiration is magnified by imbalances among inspiratory drive, efferent activation (outgoing motor command from the brain), and feedback from afferent receptors throughout the respiratory system Inte