abnormal breathing
Introduction
Introduction The human respiratory rate is 16 to 20 times per minute for adults, and the ratio to the number of heart beats is 1:4. The average amount of Honduras breathing in quiet time is 500ml (300~700ml), and the ventilation per minute is about 8~10l. Abnormal breathing refers to the frequency of breathing and the change in rhythm concept. 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, the respiratory rate, the depth and the rhythm change, which is called dyspnea.
Cause
Cause
(1) Pneumatic dyspnea caused by respiratory diseases, including:
1, upper respiratory tract disease, posterior pharyngeal abscess, tonsil enlargement, laryngeal foreign body, laryngeal edema, laryngeal cancer.
2, bronchial disease bronchitis, bronchial asthma, bronchiectasis, bronchial foreign body and tumor caused by stenosis and obstruction.
3, lung disease chronic obstructive pulmonary disease (COPD) various types of pneumonia, tuberculosis, pulmonary congestion, atelectasis, pulmonary edema, pulmonary cysts, pulmonary infarction, lung cancer, sarcoidosis, diffuse sound fibrosis, acute respiration Distress syndrome (ARDS), etc.
4, pleural disease spontaneous pneumothorax, a large number of pleural effusion, severe pleural adhesion thickening, pleural stromal tumor and so on.
5, pleural disease thoracic deformity, chest wall inflammation, tuberculosis, trauma, rib fracture, rheumatoid spondylitis, chest wall respiratory muscle paralysis, scleroderma, myasthenia gravis, obesity and so on.
6, mediastinal disease mediastinal inflammation, emphysema, fistula, aortic aneurysm, lymphoma, teratoma, intrathoracic thyroid tumor, thymoma.
(B) cardiogenic dyspnea: rheumatic valvular heart disease (mitral stenosis and regurgitation, aortic stenosis and regurgitation, etc.), hypertensive heart disease, coronary heart disease, myocarditis, pericarditis, constriction Difficulty in breathing occurs when pericarditis and other severe left and right heart dysfunctions occur.
(3) toxic dyspnea: infectious toxemia, uremia, diabetic ketoacidosis, drug poisoning such as morphine, barbital, organophosphorus pesticides, herbicide poisoning; chemical poisons or toxic gases such as nitrite, aniline , oxides, nitrogen oxides, chlorine, phosgene, ammonia, ozone, sulfur dioxide, etc.
(D) blood-borne dyspnea: severe anemia, blood transfusion reaction, methemoglobinemia, carbon monoxide poisoning, leukemia and so on.
(5) Neuropsychiatric dyspnea: central nervous system diseases such as encephalitis, cerebral hemorrhage, brain abscess, cerebral edema, brain tumor, craniocerebral injury polio, sleep apnea syndrome, Guillain-Barré syndrome, Severe cerebral arteriosclerosis and hypoxia during cerebral infarction, respiratory central dysfunction caused by carbon dioxide retention, and rickets.
Examine
an examination
First, clinical manifestations
1. Respiratory frequency Breathing exceeds 24 times per minute. The respiratory rate is accelerated. It is found in respiratory diseases, cardiovascular diseases, anemia, and fever. Less than 10 times per minute is called a slowing of the respiratory rate. It is the manifestation of respiratory central inhibition, seen in anesthesia, sleeping pills poisoning, increased intracranial pressure, uremia, hepatic coma.
2. Deep breathing Respiratory deepening is seen in diabetes and uremia acidosis. Deep and slow breathing is called kussi hair breathing, and breathing is seen in emphysema, respiratory muscle paralysis and sedative overdose.
3. Respiratory rhythm tidal breathing or Chen-spiring, manifested as a period of apnea, followed by a series of tidal volume increased ventilation, the rate is accelerated, there is shortness of breath, then the depth and rate of breathing rapidly decrease, and then enter An apnea, so regularly repeated circulation, which is a manifestation of decreased excitability in the respiratory center, indicating serious condition; seen in central nervous system diseases and brain blood circulation disorders such as cerebral arteriosclerosis, heart failure, increased intracranial pressure, uremia Symptoms, diabetes coma and mountain sickness. Biot's apnea, changeable period, is an irregular rhythm of breathing, seen in encephalitis, meningitis, the Department of the Department, brain damage and so on.
4. Age, gender, dyspnea, attention to respiratory foreign bodies, congenital diseases, acute infections, etc.; more common pleural lesions, tuberculosis, rheumatic valvular disease in young adults; elderly patients with coronary heart disease, tumor, emphysema, etc. Difficulty breathing is more common in young women.
5. Respiratory time limit, inspiratory dyspnea is more common in the upper respiratory tract obstruction such as foreign body. Diphtheria, edema of the throat, laryngeal cancer or lung compliance reduce diseases such as pulmonary interstitial fibrosis, extensive inflammation, pulmonary edema, etc. Expiratory dyspnea is more common in inferior respiratory tract obstruction such as chronic bronchitis, bronchial asthma, emphysema and so on. Breathing and inhaling are difficult, such as a large number of pleural effusions, a large number of pneumothorax, respiratory muscle paralysis, and thoracic restrictive diseases.
6. The onset of urgency is seen in the heart, lung chronic diseases such as tuberculosis, pneumoconiosis, emphysema, pulmonary fibrosis, coronary heart disease, congenital heart disease, etc., acute onset such as lung no swelling, atelectasis, acute bronchus Lung infection, a large number of pleural effusions that grow rapidly. Sudden occurrence of severe respiratory difficulties include respiratory foreign bodies, high-pressure spontaneous spontaneous pneumothorax, massive pulmonary infarction, and acute respiratory distress syndrome.
7. The patient's position, the patient with congestive heart failure is easy to breathe after sitting up, said to sit and breathe, one side of a large number of pleural effusions on the side of the affected side, one side of a large number of pneumothorax is prone to the side of the supine position, severe emphysema Often sit still and slowly blow; pulmonary edema often panic and restlessness, large lung infarction often suddenly screams; extensive myocardial infarctions are chest pain.
8. Physical exertion after dyspnea is an early manifestation of heart failure in mitral stenosis, emphysema, pulmonary interstitial fibrosis, congenital heart disease with labor dyspnea as an early manifestation.
9. Occupational environment exposure to various dust occupations can diagnose all kinds of pneumoconiosis, and can be diagnosed if you have difficulty breathing with exposure to poisonous gas or poisons; exposure to mildew, pigeons, mushroom breeding, etc. is a foreign matter. Alveolitis is now the highest mountain pulmonary edema when the mountain is struggling.
10. Basic disease Cardiovascular patients with dyspnea are heart failure, pulmonary edema, radiation therapy for lung cancer, dyspnea is radiation pneumonitis; recent history of chest and abdomen surgery considered to be atelectasis, shortness of breath > 8 times / min when thinking Acute respiratory distress syndrome; elderly people with long-term bed rest have dyspnea and often pneumonia. Sudden dyspnea after extensive abdominal or pelvic surgery should be thought of as pulmonary infarction. Diabetes patients with acid leakage are acidosis, immunity or hypoxia Pulmonary infection should be considered as a conditional pathogen, fungus, Pneumocystis carinii infection.
11. Associated with cough, fever, bronchial, pulmonary infection, with nervous system symptoms, attention to the brain, meningeal disease or metastatic tumor, a large number of pink foam-like sputum considering pulmonary edema e Horner syndrome is seen in the lung cancer, Metastatic lymph node metastasis of lung cancer, mediastinal tumor with upper vena cava syndrome, mediastinal emphysema when the neck is subcutaneously exposed to emphysema.
Second, laboratory inspection
Blood routine examination has increased white blood cell count, increased neutrophils, increased eosinophil count in allergic diseases or parasitic diseases, positive urine glucose, positive urine ketone body, high blood sugar, and reduced carbon dioxide binding. Urinary protein positive, urinary protein and red, white blood cells, etc., blood urea ammonia and serum creatinine increased; bronchial-lung disease should pay attention to the amount, nature, smell and bacterial culture, fungal culture, sputum to find tuberculosis, Pathology to find cancer cells, etc. have a certain diagnostic value.
Third, the device inspection
X-ray examination has obvious cardiopulmonary X-ray signs of dyspnea caused by cardiopulmonary disease. Microscopic examination can be used to diagnose pneumoconiosis and reticular structure, and tomography can be used to identify the nature of the mass or to find mediastinal and hilar masses. X Line ray imaging to identify pericardial effusion and cardiac enlargement, large hemangioma and tumor; bronchial angiography for diagnosis of bronchiectasis, bronchial adenoma and carcinoma, pulmonary angiography for diagnosis of pulmonary infarction, mediastinal gastroscope and tomography for establishing tumor and mediastinal relationship Has diagnostic value. Patients with heart disease can do electrocardiogram, echocardiography, late potential, cardiac function, 24h dynamic electrocardiogram, 24h dynamic hypertension, etc., for chronic lung diseases such as chronic bronchitis, chronic obstructive pulmonary disease (COPD), bronchial asthma, etc. Pulmonary function tests (forced vital capacity FVO, one-second forced expiratory volume FEVI, maximum expiratory mid-flow velocity FEJ0.25~0.75, lung closed volume measurement, residual gas measurement, etc.) were used to diagnose the nature and extent of lung function loss. Pulmonary radionuclide scanning for the diagnosis of emphysema and pulmonary vascular disease. Fiberoptic bronchoscopy is used for the diagnosis and treatment of bronchial tumors, stenosis, and foreign bodies, while lung biopsy is a clear diagnosis. Pulmonary biopsy is significant for pulmonary fibrosis and tumors.
Diagnosis
Differential diagnosis
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.
Irregular breathing patterns are characteristic of increased intracranial pressure. Common tidal breathing, shallow and fast breathing, sobbing-like breathing. Respiratory slowing is more common in patients with posterior fossa hematoma. Irregular breathing and tidal breathing are common in brain stem injury.
Tidal breathing: Also known as Chen-Shi breathing, it is a periodic breathing abnormality with a period of about 0.5 to 2 seconds. Breathing is slowed down and slowed down, then the breathing gradually deepens and accelerates, alternating in cycles. More common in central nervous system diseases, such as encephalitis, meningitis, increased intracranial pressure, barbiturate poisoning. Shortness of breath (shortness of breath) is a common clinical respiratory symptom. It is often caused by respiratory diseases or early symptoms of respiratory insufficiency caused by organs or tissue lesions that affect breathing. The condition is further aggravated by respiratory distress or difficulty breathing. Respiratory failure and life-threatening. Because of the anatomical and physiological characteristics of the respiratory system, infants are more prone to shortness of breath and respiratory distress once the disease affects breathing. Breathing slows down and the rule is seen in overdose of sleeping pills. The sleeping pills are also known as stable. Breathing, circulatory system initial breathing rate slows down and rules, then the breathing slows down irregularly. Severe breathing difficulties, purpura, pulse acceleration, blood pressure, oliguria, circulatory failure.
