4zhvml8 发表于 2024-6-1 13:30:00

心力衰尽的呼气困难，是什么样的呼气困难？

<img src="https://mmbiz.qpic.cn/mmbiz_jpg/qqQM9yu7sNKibOe7CSNZ4R5NY2Zep9eHoEKtxW8PRiaoWba3Fb88zJiax8Iyfxkveq8iaic9S9DzXNfj8dyU3cX0hZA/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">点击上方<strong style="color: blue;"><span style="color: black;">蓝字</span></strong>，关注<strong style="color: blue;"><span style="color: black;">心内科王肖龙<span style="color: black;">专家</span></span></strong></span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/aq5KM8M5Jnw8BGCn7H9PLy1ibFdY66WibmSwA4n1eSHdSCyIHc1LjMYpWQz74zOQwXjZxeWk6LDatyRI82VXs0lw/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;">心衰的<span style="color: black;">呼气</span><span style="color: black;">衰尽</span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">识别心力<span style="color: black;">衰尽</span>，在于尽早识别心力<span style="color: black;">衰尽</span>的症状，<span style="color: black;">即时</span>就诊，其中<span style="color: black;">呼气</span>困难是心力<span style="color: black;">衰尽</span>、尤其是左心<span style="color: black;">衰尽</span><span style="color: black;">病人</span>的典型症状，但其它<span style="color: black;">疾患</span>如<span style="color: black;">呼气</span>系统<span style="color: black;">疾患</span><span style="color: black;">亦</span>会<span style="color: black;">引起</span><span style="color: black;">呼气</span>困难，<span style="color: black;">因此呢</span><span style="color: black;">呼气</span>困难≠心力<span style="color: black;">衰尽</span>。今天，<span style="color: black;">咱们</span>就来聊一聊：<span style="color: black;">什么样的</span><span style="color: black;"><span style="color: black;">呼气</span>困难，<span style="color: black;">大都是</span>心力<span style="color: black;">衰尽</span><span style="color: black;">引起</span>的<span style="color: black;">呼气</span>困难。</span></span></p><span style="color: black;">定义</span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">呼气</span>困难是主观感觉和客观征象的综合表现。主观上感觉吸气不足、<span style="color: black;">呼气</span>费力，而客观上表现为<span style="color: black;">呼气</span>频率、节律和深度的改变，严重者可<span style="color: black;">显现</span>张口<span style="color: black;">呼气</span>、鼻翼扇动、端坐<span style="color: black;">呼气</span>，<span style="color: black;">乃至</span>发绀。不同<span style="color: black;">原由</span><span style="color: black;">引起</span>的<span style="color: black;">呼气</span>困难各有其不同特点。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/eI5OBzD0iarsJVVjCdxkpmTrzWuicNDeMOFNvcOOkfiaN1nia5jbHEHwE7SuxBw0brwMVLQ7ibya4bVgyLo2fwBF7PQ/640?tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;">性质和时间</span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">左心<span style="color: black;">衰尽</span><span style="color: black;">引起</span>的<span style="color: black;">呼气</span>困难<span style="color: black;">重点</span>为肺淤血<span style="color: black;">导致</span>，从轻到重分别为：劳力性<span style="color: black;">呼气</span>困难，夜间阵发性<span style="color: black;">呼气</span>困难，端坐<span style="color: black;">呼气</span>，急性肺水肿。</span><span style="color: black;"><span style="color: black;">咱们</span>一个一个<span style="color: black;">来讲</span>：</span></p>0<span style="color: black;">1</span>劳力性<span style="color: black;">呼气</span>困难<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">顾名思义多在体力劳动、运动、<span style="color: black;">疲劳</span>的当下<span style="color: black;">显现</span>，<span style="color: black;">休憩</span>后多<span style="color: black;">能够</span>缓解。<span style="color: black;">倘若</span><span style="color: black;">休憩</span>时自觉透<span style="color: black;">不外</span>气，活动活动反而好了，多不是这种<span style="color: black;">呼气</span>困难。</span></p>0<span style="color: black;">2</span>夜间阵发性<span style="color: black;">呼气</span>困难<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">夜晚</span>睡觉时会<span style="color: black;">忽然</span>透<span style="color: black;">不外</span>气、憋醒，并<span style="color: black;">快速</span>坐起来，<span style="color: black;">必须</span>20-30分钟或更<span style="color: black;">长期</span><span style="color: black;">才可</span>缓解。有些时候<span style="color: black;">病人</span>并不表现为喘憋，而是夜间平卧后有较<span style="color: black;">显著</span>的干咳，有时会咳醒，坐起后方能缓解，这种咳嗽<span style="color: black;">亦</span>是夜间阵发性<span style="color: black;">呼气</span>困难的一种表现。</span></p>0<span style="color: black;">3</span>端坐<span style="color: black;">呼气</span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">是夜间阵发性<span style="color: black;">呼气</span>困难更严重时的表现，即<span style="color: black;">病人</span>平卧几分钟就会感到<span style="color: black;">呼气</span>困难，只能坐起来<span style="color: black;">呼气</span>，大多表现为<span style="color: black;">夜晚</span>睡觉<span style="color: black;">必须</span>垫高几个枕头，<span style="color: black;">没</span>法平躺。</span></p>0<span style="color: black;">4</span>急性肺水肿<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">是左心<span style="color: black;">衰尽</span>急性加重时的典型表现，<span style="color: black;">详细</span>可表现为突发的严重<span style="color: black;">呼气</span>困难、端坐<span style="color: black;">呼气</span>，伴咳嗽，常咳出粉红色<span style="color: black;">泡泡</span>痰，<span style="color: black;">病人</span>还会<span style="color: black;">显现</span>大汗淋漓、烦躁不安、口唇发绀等。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/eI5OBzD0iarsJVVjCdxkpmTrzWuicNDeMOnw6klYLqicdbHWezUCTIlFChpbAqB6feiaIvbB2AxezFbIfN22MzSWGQ/640?tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></span></p><span style="color: black;">诱发和缓解<span style="color: black;">原因</span></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心力<span style="color: black;">衰尽</span>发病时可有相应的诱发<span style="color: black;">原因</span>，<span style="color: black;">倘若</span>在这些诱发<span style="color: black;">原因</span>下<span style="color: black;">显现</span>了突发的<span style="color: black;">呼气</span>困难，并有典型表现，要<span style="color: black;">可疑</span>是心衰<span style="color: black;">爆发</span><span style="color: black;">导致</span>，其中<span style="color: black;">包含</span>：</span></p>01感染<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">最<span style="color: black;">平常</span>为<span style="color: black;">呼气</span>道感染，感染会加重肺循环淤血，<span style="color: black;">引起</span><span style="color: black;">呼气</span>困难加重。</span></p>0<span style="color: black;">2</span><span style="color: black;">心率</span>失常<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">房颤<span style="color: black;">平常</span>，尤其是心室率快时会诱发心衰加重，其它各类快速型或严重缓慢型<span style="color: black;">心率</span>失常<span style="color: black;">亦</span>可能加重症状。</span></p>0<span style="color: black;">3</span>全身血容量<span style="color: black;">增多</span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">见于输液<span style="color: black;">太多</span>、速度过快时，<span style="color: black;">亦</span>可见于饮水量<span style="color: black;">太多</span>，高盐<span style="color: black;">膳食</span>等。</span></p>0<span style="color: black;">4</span><span style="color: black;">心情</span>激动或过度体力消耗<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">如暴怒、过度<span style="color: black;">疲劳</span>等。</span></p>0<span style="color: black;">5</span>治疗<span style="color: black;">欠妥</span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">欠妥</span>停用利尿剂、降压药或其他抗心衰<span style="color: black;">药品</span>等。</span></p>0<span style="color: black;">6</span>原有心脏病变加重或<span style="color: black;">显现</span>其他并发症<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">如冠心病<span style="color: black;">病人</span><span style="color: black;">出现</span>急性心梗等。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/eI5OBzD0iarsJVVjCdxkpmTrzWuicNDeMOoxN9LibT7OUeZYVNZEcpym7geovmmyBEeuVflQUVHC1ufDeQITY4W8g/640?tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;"><span style="color: black;">伴同</span>症状</span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心力<span style="color: black;">衰尽</span><span style="color: black;">引起</span>的<span style="color: black;">呼气</span>困难多伴有其它心衰症状，其中左心<span style="color: black;">衰尽</span>者多伴有：</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/aq5KM8M5Jnw8BGCn7H9PLy1ibFdY66WibmSeoVl1w2Y8KZGGTcPLI3KpVwSaicFSia71xfdKEXZ5zvTR32GKGAibOiaA/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">①咳嗽、咳白色或粉红色<span style="color: black;">泡泡</span>状痰，是肺淤血时肺泡、支气管黏膜受刺激<span style="color: black;">导致</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">②乏力、<span style="color: black;">头昏</span>、心慌、运动量降低：为器官、组织血供不足，心率加快<span style="color: black;">导致</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">③少尿、水肿及肾损害症状：心脏泵血功能下降、组织灌注不足而<span style="color: black;">引起</span>肾血流量减少，<span style="color: black;">病人</span>多<span style="color: black;">显现</span>少尿，水肿，<span style="color: black;">长时间</span>严重时可<span style="color: black;">显现</span>肾功能损害。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/aq5KM8M5Jnw8BGCn7H9PLy1ibFdY66WibmSMa3Yqt3Pu5H3I40Yb1PEkgD8NSfD8hAzWhv4wtN7mhm2icRhdhhnAQ/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">右心<span style="color: black;">衰尽</span>和全心<span style="color: black;">衰尽</span>者可伴有：</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/aq5KM8M5Jnw8BGCn7H9PLy1ibFdY66WibmSeoVl1w2Y8KZGGTcPLI3KpVwSaicFSia71xfdKEXZ5zvTR32GKGAibOiaA/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">①水肿：<span style="color: black;">首要</span><span style="color: black;">显现</span>双足、双腿水肿，水肿自下而上蔓延至全身，严重者可因体循环淤血<span style="color: black;">引起</span>胸腔积液、腹腔积液等表现。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">②颈静脉血管充盈、怒张：回流入心脏的血液难被泵出，<span style="color: black;">引起</span>血液淤积于外周血管，其中颈部静脉血管充盈最易被看出，<span style="color: black;">大都是</span>右心衰最早的征象。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">③消化道症状：胃肠道淤血会<span style="color: black;">引起</span>腹胀、厌食、呕吐等。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/aq5KM8M5Jnw8BGCn7H9PLy1ibFdY66WibmSMa3Yqt3Pu5H3I40Yb1PEkgD8NSfD8hAzWhv4wtN7mhm2icRhdhhnAQ/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_gif/aq5KM8M5Jnw8BGCn7H9PLy1ibFdY66WibmSvQQSXFM6oGa81B02OGTujaDlXibAZV9uJlBPdKfHKZowh3ibAvUia1pw/640?wx_fmt=gif&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1" style="width: 50%; margin-bottom: 20px;">值得<span style="color: black;">重视</span>的是：<span style="color: black;">病人</span>由左心<span style="color: black;">衰尽</span>发展为全心<span style="color: black;">衰尽</span>时，其<span style="color: black;">呼气</span>困难的症状反而可能有所减轻，这并不<span style="color: black;">寓意</span>着病情好转，而是加重的表现，<span style="color: black;">病人</span>及家属应该有所<span style="color: black;">重视</span>、高度<span style="color: black;">注意</span>。<img src="https://mmbiz.qpic.cn/mmbiz_gif/aq5KM8M5Jnw8BGCn7H9PLy1ibFdY66WibmSvQQSXFM6oGa81B02OGTujaDlXibAZV9uJlBPdKfHKZowh3ibAvUia1pw/640?wx_fmt=gif&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/eI5OBzD0iarsJVVjCdxkpmTrzWuicNDeMOPWKlkG9YhwQQLKGlKuXpDe3EvZMGy9e59l6icxNcK82cTKx7WJjibctA/640?tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>危险<span style="color: black;">原因</span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心力<span style="color: black;">衰尽</span>是<span style="color: black;">各样</span>器质性心脏病的终末<span style="color: black;">周期</span>，<span style="color: black;">各样</span>心脏<span style="color: black;">疾患</span>和心脏外<span style="color: black;">疾患</span>所<span style="color: black;">引起</span>的<span style="color: black;">包含</span>心肌病变、瓣膜<span style="color: black;">疾患</span>、心脏负荷过重、心脏前负荷不足等，都是发展为心力<span style="color: black;">衰尽</span>的危险<span style="color: black;">原因</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">其中多见的有冠心病、心肌梗死、扩张型心肌病、瓣膜性心脏病、高血压、先天性心脏病、心肌炎等等，<span style="color: black;">倘若</span>有这些<span style="color: black;">疾患</span>的<span style="color: black;">病人</span><span style="color: black;">显现</span><span style="color: black;">以上</span><span style="color: black;">呼气</span>困难的表现，多要<span style="color: black;">思虑</span>可能<span style="color: black;">显现</span>了心力<span style="color: black;">衰尽</span>。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_gif/aq5KM8M5Jnw8BGCn7H9PLy1ibFdY66WibmSvQQSXFM6oGa81B02OGTujaDlXibAZV9uJlBPdKfHKZowh3ibAvUia1pw/640?wx_fmt=gif&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;"><span style="color: black;">显现</span><span style="color: black;">呼气</span>困难要<span style="color: black;">即时</span>就诊，<span style="color: black;">大夫</span><span style="color: black;">才可</span><span style="color: black;">按照</span>相应<span style="color: black;">检测</span>结果<span style="color: black;">知道</span>诊断、采取相应治疗<span style="color: black;">办法</span>。</span><span style="color: black;">若<span style="color: black;">显现</span>突发、严重的<span style="color: black;">呼气</span>困难，强迫坐位、咳粉红色<span style="color: black;">泡泡</span>痰等，高度<span style="color: black;">可疑</span>急性心衰<span style="color: black;">爆发</span>，应去急诊科进行<span style="color: black;">救治</span>处理。</span><span style="color: black;"><span style="color: black;">已然</span>确诊心衰的<span style="color: black;">病人</span>，<span style="color: black;">亦</span>要在<span style="color: black;">平常</span>生活中<span style="color: black;">重视</span><span style="color: black;">呼气</span>困难和其它心衰症状，有变化时<span style="color: black;">即时</span><span style="color: black;">看病</span>。</span><img src="https://mmbiz.qpic.cn/mmbiz_gif/aq5KM8M5Jnw8BGCn7H9PLy1ibFdY66WibmSvQQSXFM6oGa81B02OGTujaDlXibAZV9uJlBPdKfHKZowh3ibAvUia1pw/640?wx_fmt=gif&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1" style="width: 50%; margin-bottom: 20px;">往期<span style="color: black;">举荐</span>
    <h2 style="color: black; text-align: left; margin-bottom: 10px;"><span style="color: black;"><img src="https://mmbiz.qpic.cn/mmbiz_png/eI5OBzD0iarsgHY77DBOlq7sVJXPDu1EGRkInIXIXAVtJARzG43CJq5r7AjKYLDQj3zAhJftntXHS76rnbvBocg/640?tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><a style="color: black;">心衰<span style="color: black;">病人</span>应该做到的5点<span style="color: black;">平常</span><span style="color: black;">重视</span>事项</a></span></h2>
    <h2 style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/eI5OBzD0iarsgHY77DBOlq7sVJXPDu1EGRkInIXIXAVtJARzG43CJq5r7AjKYLDQj3zAhJftntXHS76rnbvBocg/640?tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><a style="color: black;"><span style="color: black;">与心衰</span></a><span style="color: black;">关联</span>的<span style="color: black;">检测</span>都有<span style="color: black;">那些</span>？</h2>
    <h2 style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/eI5OBzD0iarsgHY77DBOlq7sVJXPDu1EGRkInIXIXAVtJARzG43CJq5r7AjKYLDQj3zAhJftntXHS76rnbvBocg/640?tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><a style="color: black;"><span style="color: black;">跳出误区！心衰<span style="color: black;">病人</span><span style="color: black;">不可</span>只躺床上！</span></a></h2>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/eI5OBzD0iarv2eJicha5pzbOnxeEjOpUVGrVia5WEosaZCldofNg61lY4l890cicCrUcggicN52UdTJMO2xH8jia8jicw/640?tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>在看点<span style="color: black;">这儿</span><img src="https://mmbiz.qpic.cn/mmbiz_gif/qqQM9yu7sNLLQlDAOXO1m9qRQdIuShKIz1YmHrnNQr6GGB09JLQPxooiaLWAFUohT3SeX1cSEATpPTzGeMHmFfQ/640?wx_fmt=gif&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1" style="width: 50%; margin-bottom: 20px;">




4lqedz 发表于 2024-10-23 22:09:16

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