Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina 27710, USA.
J Palliat Med. 2011 Oct;14(10):1167-72. doi: 10.1089/jpm.2011.0109. Epub 2011 Sep 6.
Dyspnea is a common symptom experienced by many patients with chronic, life-threatening, and/or life-limiting illnesses. Although it can be defined and measured in several ways, dyspnea is best described directly by patients through regular assessment, as its burdens exert a strong influence on the patient's experience throughout the trajectory of serious illness. Its significance is amplified due to its impact on family and caregivers.
Anatomic and physiologic changes associated with dyspnea, and cognitive perceptions related to patients and the underlying disease, provide insights into how to shape interventions targeting this oppressive symptom. Additionally, as described in the concept of "total dyspnea," the complex etiology and manifestation of this symptom require multidisciplinary treatment plans that focus on psychological, social, and spiritual distress as well as physical components. Several validated assessment tools are available for clinical and research use, and choice of method should be tailored to the individual patient, disease, and care setting in the context of patient-centered care.
This article, the first in a two-part series, reviews the identification and assessment of dyspnea, the burden it entails, and the underlying respiratory and nonrespiratory etiologies that may cause or exacerbate it.
呼吸困难是许多患有慢性、危及生命和/或生命有限疾病的患者常见的症状。虽然可以通过多种方式定义和测量呼吸困难，但通过定期评估，由患者直接描述呼吸困难最为准确，因为其负担会对患者在严重疾病整个过程中的体验产生强烈影响。由于其对患者家属和护理人员的影响，其重要性更加凸显。
与呼吸困难相关的解剖和生理变化，以及与患者和潜在疾病相关的认知感知，为如何针对这种压迫性症状制定干预措施提供了思路。此外，正如“总呼吸困难”这一概念所描述的，这种症状的复杂病因和表现需要多学科的治疗计划，既要关注心理、社会和精神方面的困扰，也要关注身体方面的问题。目前有几种经过验证的评估工具可用于临床和研究，在以患者为中心的护理背景下，应根据患者、疾病和护理环境的具体情况，选择适合个体的方法。
本文是两部分系列文章的第一部分，回顾了呼吸困难的识别和评估、其带来的负担，以及可能导致或加重呼吸困难的潜在呼吸和非呼吸病因。
