Difficulty breathing

Introduction Dyspnea is an important symptom of respiratory insufficiency. It is subjectively characterized by insufficient air or breathing, and objectively manifested as changes in respiratory rate, depth, and rhythm. The respiratory rate of a person with difficulty in breathing is 16-20 times/min in adults, and the ratio of the number of beats to the heart is 1:4. When the patient feels that the air is insufficient, the breathing is laborious, objectively, the patient has strong breathing, the respiratory muscles and the auxiliary respiratory muscles all participate in the respiratory movement, the ventilation increases, and the respiratory frequency, depth and rhythm change. Dyspnea is an important symptom of respiratory insufficiency. It is subjectively characterized by insufficient air or breathing, and objectively manifested as changes in respiratory rate, depth, and rhythm.

Cause

According to the main pathogenesis, dyspnea can be divided into the following five types:

1. Pneumatic dyspnea: caused by respiratory disease, mainly in the following three forms:

1) Inspiratory dyspnea: manifested as wheezing, inspiratory sternum, supraclavicular fossa and rib gap depression - three concave sign. Common in the throat, tracheal stenosis, such as inflammation, edema, foreign bodies and tumors.

2) Expiratory dyspnea: prolonged expiratory phase with wheezing, seen in bronchial asthma and obstructive pulmonary disease.

3) Mixed dyspnea: seen in pneumonia, pulmonary fibrosis, massive pleural effusion, pneumothorax, etc.

2. Cardiac dyspnea: Cardiac pulmonary edema caused by left ventricular dysfunction, its clinical features:

1) The patient has a serious history of heart disease.

2) Mixed dyspnea, obvious in the lying position and at night.

3) The middle and small wet voices may appear at the bottom of the lungs and vary with body position.

4) X-ray examination: abnormal changes in the heart shadow, congestion in the hilar and its vicinity or both pulmonary edema.

3. Toxic dyspnea: Acidosis caused by various causes can increase blood carbon dioxide, lower pH, stimulate peripheral chemoreceptors or directly stimulate the respiratory center, increase respiratory ventilation, and express deep and large breathing. Difficulties; respiratory inhibitors such as morphine, barbiturates and other poisoning, can also inhibit the respiratory center, making breathing shallow and slow.

4. Blood-borne dyspnea: severe anemia can be caused by red blood cells, blood oxygenation and shortness of breath, especially after the activity; major bleeding or shock due to ischemia and blood pressure, stimulate the respiratory center and cause breathing difficulties.

V. Neuropsychiatric and myopathy dyspnea: Severe brain diseases such as encephalitis, cerebrovascular accidents, brain tumors, etc. directly involve the respiratory center, abnormal respiratory rhythms, resulting in difficulty breathing; myasthenia gravis crisis causes respiratory muscles Paralysis, leading to severe breathing difficulties; In addition, snoring can also have dyspnea episodes, which are characterized by significant respiratory rate and superficiality, due to respiratory phlegm poisoning often accompanied by hand and foot sputum.

an examination

Related inspection

Serum complement bypass pathway active respiratory muscle tone determination pleural effusion clinical chemistry examination lung biopsy fiber bronchoscopy

1. Laboratory examination of difficulty breathing. Blood routine examination showed an increase in white blood cell count, an increase in neutrophils during infection, and an increase in eosinophil count in allergic diseases. Bronchial-lung disease should pay attention to the amount, nature, smell and bacterial culture, fungal culture, and tuberculosis in the sputum have certain diagnostic value.

2. Instrumental examination of difficult breathing. X-ray examination has obvious cardiopulmonary X-ray signs of dyspnea caused by heart and lung disease. Bronchial angiography diagnoses bronchiectasis, bronchial adenoma, and cancer. Patients with heart disease can do electrocardiogram, echocardiography and other tests. Pulmonary function tests for chronic lung diseases such as chronic obstructive pulmonary disease (COPD), bronchial asthma, etc., to diagnose the nature and extent of lung function damage. Fiberoptic bronchoscopy is used for the diagnosis and treatment of bronchial tumors, stenosis and foreign bodies. Pulmonary biopsy is of great significance for pulmonary fibrosis and tumors.

Differential diagnosis

It is necessary to distinguish from the following symptoms: slow breathing: slow breathing is a symptom of severe respiratory failure. Difficulty breathing, three concave signs are obvious or not obvious, breathing changes from shallow to slow, rhythm disorder, often jaw breathing and apnea, respiratory sounds are reduced, lips cyanosis is aggravated, limbs are cyanotic, cold, lethargic or coma, Even horrified. In severe cases, cerebral edema (conjunctival edema or optic nerve head edema), cerebral palsy (different sizes on both sides of the pupil) may occur.

Abdominal Abnormal Breathing: Abnormal breathing is a pathological respiratory movement, which is caused by multiple rib fractures in the chest after chest trauma, softening of the chest, normal body in the chest when inhaling, chest wall falling during exhalation; abnormal breathing movement On the contrary, the chest is lowered during inhalation and the chest wall is raised when exhaling.

Central apnea syndrome: Central sleep apnea syndrome (CSAS) refers to the absence of airflow in the upper airway for more than 10 s without chest and abdomen breathing. CSAS is less common and can coexist with obstructive sleep apnea syndrome (OSAS). It can occur in any sleep phase, but obvious abnormalities are only seen in slow phase sleep (NREM, also known as normal phase sleep and slow wave sleep). CSAS can exist alone or in conjunction with central nervous system diseases such as brain stem trauma, tumors, infarctions, and infections. There have also been reports of CSAS associated with neuromuscular disorders such as polio and myotonic dystrophy. Appropriate ventilation can be maintained when awake, but during sleep, there is an abnormal regulation of the respiratory center, and a central (or obstructive) apnea occurs.

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