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呼吸困难的发生机制、评估及非药物治疗

The occurrence mechanism, assessment, and non-pharmacological treatment of dyspnea.

作者信息

Gao Beiyao, Wang Siyuan, Jiang Shan

机构信息

Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing, China.

出版信息

Med Rev (2021). 2024 Apr 22;4(5):395-412. doi: 10.1515/mr-2024-0006. eCollection 2024 Oct.

DOI:10.1515/mr-2024-0006
PMID:39444798
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11495473/
Abstract

Dyspnea is a subjective sensation often described as a feeling of respiratory effort, tightness, or air hunger. The underlying mechanisms of this symptom are multifaceted and involve factors such as respiratory centers, cardiovascular system, airways, neuromuscular components, and metabolic factors, although not fully elucidated. The classical theory of imbalance between inspiratory neural drive (IND) and the simultaneous dynamic responses of the respiratory system posits that the disruption of a normal and harmonious relationship fundamentally shapes the expression of respiratory discomfort. Assessment and comprehensive treatment of dyspnea are crucial for patient rehabilitation, including subjective self-reporting and objective clinical measurements. Non-pharmacological interventions, such as pulmonary rehabilitation, fan therapy, exercise, chest wall vibration, virtual reality technology, traditional Chinese medicine (acupuncture and acupressure), and yoga, have shown promise in alleviating dyspnea symptoms. Additionally, oxygen therapy, has demonstrated short-term benefits for patients with pre-hospital respiratory distress and hypoxemia. This review provides a comprehensive overview of dyspnea, emphasizing the importance of a multifaceted approach for its assessment and management, with a focus on non-pharmacological interventions that contribute to enhanced patient outcomes and quality of life.

摘要

呼吸困难是一种主观感觉,常被描述为呼吸费力、紧绷或气促的感觉。尽管尚未完全阐明,但这种症状的潜在机制是多方面的,涉及呼吸中枢、心血管系统、气道、神经肌肉成分和代谢因素等。吸气神经驱动(IND)与呼吸系统同时动态反应之间失衡的经典理论认为,正常和谐关系的破坏从根本上塑造了呼吸不适的表现。呼吸困难的评估和综合治疗对患者康复至关重要,包括主观自我报告和客观临床测量。非药物干预措施,如肺康复、风扇疗法、运动、胸壁振动、虚拟现实技术、传统中医(针灸和指压)以及瑜伽,已显示出缓解呼吸困难症状的前景。此外,氧疗已证明对院前呼吸窘迫和低氧血症患者有短期益处。本综述全面概述了呼吸困难,强调了多方面评估和管理方法的重要性,重点关注有助于改善患者预后和生活质量的非药物干预措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d61/11495473/ebaf7892d963/j_mr-2024-0006_fig_005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d61/11495473/ed776f8a7b4c/j_mr-2024-0006_fig_001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d61/11495473/b0474ba05348/j_mr-2024-0006_fig_002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d61/11495473/9ca1a45cfcc4/j_mr-2024-0006_fig_003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d61/11495473/a8500c40be6f/j_mr-2024-0006_fig_004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d61/11495473/ebaf7892d963/j_mr-2024-0006_fig_005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d61/11495473/ed776f8a7b4c/j_mr-2024-0006_fig_001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d61/11495473/b0474ba05348/j_mr-2024-0006_fig_002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d61/11495473/9ca1a45cfcc4/j_mr-2024-0006_fig_003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d61/11495473/a8500c40be6f/j_mr-2024-0006_fig_004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d61/11495473/ebaf7892d963/j_mr-2024-0006_fig_005.jpg

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[Pathogenesis and assessment of exertional dyspnea in chronic obstructive pulmonary disease].[慢性阻塞性肺疾病中运动性呼吸困难的发病机制与评估]
Zhonghua Jie He He Hu Xi Za Zhi. 2023 Nov 12;46(11):1136-1140. doi: 10.3760/cma.j.cn112147-20230823-00104.
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风扇疗法在缓解呼吸困难中的应用。
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Relationship Between Dyspnoea Scales and Quality of Life in Stroke Survivors: A Retrospective Analysis.中风幸存者呼吸困难量表与生活质量的关系:一项回顾性分析
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