Karnani Neel G, Reisfield Gary M, Wilson George R
Department of Community Health and Family Medicine, University of Florida Health Science Center, Jacksonville, Florida 32209, USA.
Am Fam Physician. 2005 Apr 15;71(8):1529-37.
Chronic dyspnea is defined as dyspnea lasting more than one month. In approximately two thirds of patients presenting with dyspnea, the underlying cause is cardiopulmonary disease. Establishing an accurate diagnosis is essential because treatment differs depending on the underlying condition. Asthma, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, cardiac ischemia, interstitial lung disease, and psychogenic causes account for 85 percent of patients with this principal symptom. The history and physical examination should guide selection of initial diagnostic tests such as electrocardiogram, chest radiograph, pulse oximetry, spirometry, complete blood count, and metabolic panel. If these are inconclusive, additional testing is indicated. Formal pulmonary function testing may be needed to establish a diagnosis of asthma, chronic obstructive pulmonary disease, or interstitial lung disease. High-resolution computed tomography is particularly useful for diagnosing interstitial lung disease, idiopathic pulmonary fibrosis, bronchiectasis, or pulmonary embolism. Echocardiography and brain natriuretic peptide levels help establish a diagnosis of congestive heart failure. If the diagnosis remains unclear, additional tests may be required. These include ventilation perfusion scans, Holter monitoring, cardiac catheterization, esophageal pH monitoring, lung biopsy, and cardiopulmonary exercise testing.
慢性呼吸困难定义为持续超过一个月的呼吸困难。在出现呼吸困难的患者中，约三分之二的潜在病因是心肺疾病。准确诊断至关重要，因为治疗方法因潜在病症而异。哮喘、充血性心力衰竭、慢性阻塞性肺疾病、肺炎、心脏缺血、间质性肺疾病和精神性病因占出现这一主要症状患者的85%。病史和体格检查应指导选择初始诊断测试，如心电图、胸部X光片、脉搏血氧饱和度测定、肺量计检查、全血细胞计数和代谢指标检测。如果这些检查结果不明确，则需进行进一步检测。可能需要进行正式的肺功能测试以诊断哮喘、慢性阻塞性肺疾病或间质性肺疾病。高分辨率计算机断层扫描对于诊断间质性肺疾病、特发性肺纤维化、支气管扩张或肺栓塞特别有用。超声心动图和脑钠肽水平有助于诊断充血性心力衰竭。如果诊断仍不明确，可能需要进行其他检查。这些检查包括通气灌注扫描、动态心电图监测、心导管检查、食管pH监测、肺活检和心肺运动试验。
