呼吸困難背後的多重原因:挑戰與診斷策略

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呼吸困難是門診常見症狀,影響高達25%的患者。它可能源於多種不同的基礎狀況,有時是生命威脅性疾病的表現。急性與慢性呼吸困難需區分開來;後者定義為持續超過四周。病史、體格檢查和觀察呼吸模式通常能導向正確診斷,但約30-50%的病例需進一步診斷測試,包括生物標誌物測量等。當存在多個疾病時,診斷可能更加困難。呼吸困難的原因包括心臟和肺部疾病(如充血性心衰、急性冠狀動脈綜合症、肺炎、慢性阻塞性肺病)以及其他情況(如貧血、心理障礙)。

呼吸困難的鑑別診斷

The Differential Diagnosis of Dyspnea

Berliner D, Schneider N, Welte T, Bauersachs J. The Differential Diagnosis of Dyspnea. Dtsch Arztebl Int. 2016 Dec 9;113(49):834-845. doi: 10.3238/arztebl.2016.0834. PMID: 28098068; PMCID: PMC5247680.

https://pubmed.ncbi.nlm.nih.gov/28098068/

Abstract

Background

Dyspnea is a common symptom affecting as many as 25% of patients seen in the ambulatory setting. It can arise from many different underlying conditions and is sometimes a manifestation of a life-threatening disease.

Methods

This review is based on pertinent articles retrieved by a selective search in PubMed, and on pertinent guidelines.

Results

 The term dyspnea refers to a wide variety of subjective perceptions, some of which can be influenced by the patient’s emotional state. A distinction is drawn between dyspnea of acute onset and chronic dyspnea: the latter, by definition, has been present for more than four weeks. The history, physical examination, and observation of the patient’s breathing pattern often lead to the correct diagnosis, yet, in 30-50% of cases, more diagnostic studies are needed, including biomarker measurements and other ancillary tests. The diagnosis can be more difficult to establish when more than one underlying disease is present simultaneously. The causes of dyspnea include cardiac and pulmonary disease (congestive heart failure, acute coronary syndrome; pneumonia, chronic obstructive pulmonary disease) and many other conditions (anemia, mental disorders).

Conclusion

The many causes of dyspnea make it a diagnostic challenge. Its rapid evaluation and diagnosis are crucial for reducing mortality and the burden of disease.

摘要

背景

呼吸困難是常見症狀,門診患者中高達25%的人受此影響。它可能源自許多不同的潛在狀況,有時是危及生命疾病的表現。

方法

本綜述基於在PubMed中進行的有選擇性搜索所獲得的相關文章,以及相關指南。

結果

呼吸困難一詞指的是各種主觀感受,其中一些可能受患者情緒狀態的影響。急性起始的呼吸困難與慢性呼吸困難之間有所區別:後者按定義已經持續了超過四周。病史、體格檢查和觀察患者的呼吸模式往往能導致正確診斷,然而,在30-50%的病例中,需要更多診斷研究,包括生物標誌物測量和其他輔助檢測。當同時存在多種潛在疾病時,診斷可能更難確立。呼吸困難的原因包括心臟和肺部疾病(充血性心力衰竭、急性冠狀動脈綜合症;肺炎、慢性阻塞性肺病)以及許多其他狀況(貧血、心理障礙)。

結論

呼吸困難的眾多原因使其成為診斷挑戰。對其進行快速評估和診斷對於降低死亡率和疾病負擔至關重要。

圖1 慢性呼吸困難的診斷評估,修改自(3, 9, 22, 24)

BNP:腦利尿肽
CT:電腦斷層掃描
ECG:心電圖
FEV1:一秒鐘強迫呼氣量
Hb:血紅蛋白
IVC:吸氣肺活量
MRI:磁共振成像
NT-proBNP:N端前驅腦利尿肽
TSH:甲狀腺刺激激素

圖2

具有降低或保留左心室射血分數的充血性心力衰竭的心臟超聲診斷標準(分別為HFrEF和HFpEF),以及所謂中間射血分數範圍(HFmrEF)的新分類;修改自(17, 38)。
LV:左心室
LVEF:左心室射血分數
LAVI:左心房容積指數
LVMI:左心室質量指數

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