Elsasser S, Perruchoud A P
Abteilung für Pneumologie, Departement Innere Medizin, Universitätsklinik Basel.
Schweiz Rundsch Med Prax. 1992 Jan 7;81(1-2):11-4.
Dyspnea can be defined as an unusual perception of respiration and/or urge to breath more than usual. Up to 70% of all tumour patients suffer at one time from this complaint, and often only an incomplete palliation is achieved. Dyspnea in the tumour patient is often associated with anxiety, which leads itself to a further exacerbation of dyspnea (through increased respiratory work and dead-space ventilation). A thorough evaluation should exclude treatable causes of dyspnea such as atelectasis, pleural effusions, pneumonias, congestive heart failure, pulmonary emboli, reversible exacerbations of coexisting obstructive lung disease, central tumour obstruction and pericardial effusion. Therapeutic measures include bronchoscopic suction of retained secretions and physical measures to reduce secretions. Supplemental oxygen is indicated in hypoxemic patients and in those who derive benefit of it. The nonspecific drug therapy with benzodiazepines and/or opiates remains clinically useful, although its efficacy is questioned by some controlled studies.
呼吸困难可定义为对呼吸的异常感知和/或比平常更强烈的呼吸冲动。高达70%的肿瘤患者曾遭受过这种不适，而且往往只能实现不完全的缓解。肿瘤患者的呼吸困难常与焦虑相关，这又会导致呼吸困难进一步加重（通过增加呼吸功和无效腔通气）。全面评估应排除可治疗的呼吸困难原因，如肺不张、胸腔积液、肺炎、充血性心力衰竭、肺栓塞、并存的阻塞性肺疾病的可逆性加重、中央型肿瘤阻塞和心包积液。治疗措施包括支气管镜吸引潴留的分泌物以及采取物理措施减少分泌物。低氧血症患者及能从中获益的患者需给予补充氧气。使用苯二氮䓬类药物和/或阿片类药物的非特异性药物治疗在临床上仍然有用，尽管一些对照研究对其疗效提出了质疑。
