![急诊临床路径](https://wfqqreader-1252317822.image.myqcloud.com/cover/11/36535011/b_36535011.jpg)
上QQ阅读APP看书,第一时间看更新
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=1739240238-s1B24jX5guKHMhkzI4oHlAmuS6g2jO7c-0-df3762a0104946124ca8825fa5bb149a)
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=1739240238-GhBbjfWeiIPYhCnTpONcSjzjwEWCdX9a-0-f03834df7f5d047493c7d7a1351bbcca)
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=1739240238-TgXU9c0OyxgZngDRpfQAOzqSyONSGwUl-0-2e2a87f068026ecd183611c9ec584f10)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.3_1_59939.jpg?sign=1739240238-gOMVx2E2l6gOfPvMXoQ66eMzGdBPFXhZ-0-fc848b654b7e25d5a379aaf6ff4f9345)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.3_2_59940.jpg?sign=1739240238-RqKg3S93R2J6Tb0oBRFYQ6CcAAxpouNb-0-d76f298e71eddea84903b00d284d3b0b)
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=1739240238-OpDZUHBEybdQGOppYUmlk96HHRbodxXu-0-002c01a8b3906400be77934a6b66bcff)
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=1739240238-ruOgJNbCP0zcc2RjuKHUTz4cpESoWMwj-0-a0274a77d0706a45859ed4d2b57bb275)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T3.5_1_4016.jpg?sign=1739240238-1OBSFVD3spX2Teg3Empw5UcDI0Z5JTKJ-0-0223c34260445e404fb05f30ba25a08b)