Dumitrescu Daniel, Sitbon Olivier, Weatherald Jason, Howard Luke S
Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany.
Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
Eur Respir Rev. 2017 Sep 6;26(145). doi: 10.1183/16000617.0039-2017. Print 2017 Sep 30.
Dyspnoea is a principal presenting symptom in pulmonary arterial hypertension (PAH), and often the most distressing. The pathophysiology of PAH is relatively well understood, with the primary abnormality of pulmonary vascular disease resulting in a combination of impaired cardiac output on exercise and abnormal gas exchange, both contributing to increased ventilatory drive. However, increased ventilatory drive is not the sole explanation for the complex neurophysiological and neuropsychological symptom of dyspnoea, with other significant contributions from skeletal muscle reflexes, respiratory muscle function, and psychological and emotional status. In this review, we explore the physiological aspects of dyspnoea in PAH, both in terms of the central cardiopulmonary abnormalities of PAH and the wider, systemic impact of PAH, and how these interact with common comorbidities. Finally, we discuss its relationship with disease severity.
呼吸困难是肺动脉高压（PAH）的主要症状，通常也是最令人痛苦的症状。PAH的病理生理学相对较为清楚，肺血管疾病的主要异常导致运动时心输出量受损和气体交换异常，两者均导致通气驱动增加。然而，通气驱动增加并非呼吸困难这一复杂神经生理和神经心理症状的唯一解释，骨骼肌反射、呼吸肌功能以及心理和情绪状态也有其他重要影响。在本综述中，我们探讨PAH中呼吸困难的生理方面，包括PAH的中心心肺异常以及PAH更广泛的全身影响，以及这些因素如何与常见合并症相互作用。最后，我们讨论其与疾病严重程度的关系。
