Ray P, Birolleau S, Riou B
Service d'Accueil des Urgences, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47 boulevard de l'hôpital, 75013 Paris, France.
Rev Mal Respir. 2002 Sep;19(4):491-503.
There is a natural physiological decline in pulmonary function and the cardiovascular system with age. In emergency medicine, acute dyspnoea is a common problem among elderly patients. Some causes, such as pulmonary embolism and diastolic heart failure, are probably under-diagnosed. A good clinical history and examination are as important as arterial blood gas analysis, chest radiography and electrocardiography. Few studies have examined acute dyspnoea in elderly patients, except in the setting of pneumonia. Establishing the underlying diagnosis is often difficult because of atypical presentation and the interaction between cardiac and pulmonary underlying functions. This topic describes several respiratory and cardiac diseases presenting as acute dyspnoea, especially "cardiac asthma" and pulmonary embolism. The clinical usefulness of new investigations such as cardiac and lung echography, pulmonary function tests, serum Brain Natriuretic Peptide and thoracic CT scan are discussed. Further studies looking at acute dyspnoea in elderly patients are needed.
随着年龄增长，肺功能和心血管系统会出现自然的生理衰退。在急诊医学中，急性呼吸困难是老年患者的常见问题。一些病因，如肺栓塞和舒张性心力衰竭，可能未得到充分诊断。详细的临床病史和检查与动脉血气分析、胸部X线摄影及心电图检查同样重要。除了肺炎相关研究外，很少有研究关注老年患者的急性呼吸困难。由于临床表现不典型以及心脏和肺部基础功能之间的相互作用，往往难以确立潜在病因诊断。本主题描述了几种表现为急性呼吸困难的呼吸和心脏疾病，尤其是“心源性哮喘”和肺栓塞。还讨论了心脏和肺部超声检查、肺功能测试、血清脑钠肽及胸部CT扫描等新检查方法的临床应用价值。还需要针对老年患者急性呼吸困难开展进一步研究。
