Mahler D A, Horowitz M B
Department of Medicine, Dartmouth Medical School, Lebanon, New Hampshire.
Clin Chest Med. 1994 Jun;15(2):259-69.
The medical history is the first step in the clinical evaluation of exertional dyspnea. It should include pertinent questions about the characteristics of dyspnea, especially descriptive qualities, onset, frequency, severity, and activities that provoke the symptom. Based on this information, along with the physical examination, the health care provider should be able to categorize the cause of exertional dyspnea as suspected cardiac disease, suspected respiratory disease, or as unexplained. Laboratory testing is ordered using a logical approach to diagnose the most probable cause of dyspnea. Cardiopulmonary exercise testing is indicated to differentiate cardiac and respiratory limitation, to document deconditioning, and to identify psychogenic dyspnea. The measurement of dyspnea and leg discomfort during exercise testing can be performed using the Borg 0 to 10 category-ratio scale or the visual analog scale. These perceptual responses can provide useful information about symptom limitation, which is complementary to physiologic data.
病史是劳力性呼吸困难临床评估的第一步。它应包括有关呼吸困难特征的相关问题，特别是描述性特征、起病情况、发作频率、严重程度以及引发该症状的活动。基于这些信息，结合体格检查，医疗保健人员应能够将劳力性呼吸困难的病因归类为疑似心脏病、疑似呼吸系统疾病或原因不明。采用逻辑方法进行实验室检查以诊断呼吸困难最可能病因。心肺运动试验用于区分心脏和呼吸功能受限、记录身体机能减退情况以及识别心因性呼吸困难。运动试验期间呼吸困难和腿部不适的测量可使用Borg 0至10级比率量表或视觉模拟量表。这些感知反应可提供有关症状受限的有用信息，这与生理数据相辅相成。
