Han Jiang-na, Zhu Yuan-jue, Li Shun-wei, Luo Dong-mei, Hu Zheng, Van Diest I, De Peuter S, Van de Woestijne K P, Van den Bergh O
Laboratory of Respiratory Psychophysiology, Department of Pneumology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
Chin Med J (Engl). 2004 Jan;117(1):6-13.
Medically unexplained dyspnea occurs commonly in medical settings and remains poorly understood. This study was conducted to investigate the psychophysiological characteristics of medically unexplained dyspnea and the efficacy of breathing retraining for these patients.
A group of patients with medically unexplained dyspnea were compared to patients with a variety of organic lung diseases and healthy subjects. In another group of patients, the influence of breathing therapy on complaints, anxiety, and breath-holding was evaluated for an average of 1.5 years.
Patients with medically unexplained dyspnea reported more intense dyspnea than patients with a variety of organic lung diseases. Additionally, they were anxious and presented a broad range of symptoms in daily life and under challenge, for instance voluntary hyperventilation. More than one third of them qualified for panic disorder. They had shorter breath-holding time at rest, less increase in breath-holding time and higher chances of showing a "paradoxical" decrease of breath-holding time after hyperventilation. A combination of PaO2, forced expiratory volume in one second (FEV1), and anxiety measures distinguished them from organic dyspnea. Breathing retraining profoundly improved their symptoms and decreased the level of state and trait anxiety. Moreover, they better tolerated the voluntary hyperventilation and the symptoms induced were also markedly decreased after therapy. Breath-holding time was prolonged and PetCO2 in a representative group of patients increased.
Patients with medically unexplained dyspnea appear to have the feature of a "psychosomatic" patient: an anxious patient with a wide variety of symptoms of different organ systems that do not have an organic basis. They can be distinguished from organic dyspnea using a small set of physiological and psychological measures. Breathing retraining turns out to be an effective therapy for those "difficult to treat patients".
医学上无法解释的呼吸困难在医疗环境中很常见，目前仍了解不足。本研究旨在调查医学上无法解释的呼吸困难的心理生理特征以及呼吸训练对这些患者的疗效。
将一组医学上无法解释的呼吸困难患者与患有各种器质性肺病的患者及健康受试者进行比较。在另一组患者中，平均随访1.5年评估呼吸治疗对症状、焦虑和屏气的影响。
医学上无法解释的呼吸困难患者报告的呼吸困难比患有各种器质性肺病的患者更强烈。此外，他们焦虑，在日常生活和面临挑战时表现出广泛的症状，例如自愿过度通气。超过三分之一的患者符合惊恐障碍的诊断标准。他们静息时的屏气时间较短，屏气时间增加较少，过度通气后出现屏气时间“反常”减少的可能性更高。动脉血氧分压（PaO2）、一秒用力呼气量（FEV1）和焦虑测量指标的组合可将他们与器质性呼吸困难区分开来。呼吸训练显著改善了他们的症状，降低了状态焦虑和特质焦虑水平。此外，他们对自愿过度通气的耐受性更好，治疗后诱发的症状也明显减轻。屏气时间延长，一组代表性患者的呼气末二氧化碳分压（PetCO2）升高。
医学上无法解释的呼吸困难患者似乎具有“心身疾病”患者的特征：即一名焦虑的患者，有各种不同器官系统的症状，但没有器质性基础。使用一小套生理和心理测量方法可将他们与器质性呼吸困难区分开来。呼吸训练被证明是治疗这些“难治性患者”的有效疗法。
