问题 问答题

呼吸困难的因及临床表现

答案

参考答案:

(1)肺源性呼吸困难:由于呼吸器官功能障碍,包括呼吸道、肺、胸膜及呼吸肌的病变,引起肺通气、换气功能降低,使血中二氧化碳浓度增高及缺氧所致。

①吸气性呼吸困难:由于高位呼吸道炎症、异物、水肿及肿瘤等引起气管、支气管的狭窄或梗阻所致,临床表现为吸气费力。高度阻塞时呼吸肌极度紧张、胸腔内负压增高,并出现三凹征(胸骨上窝、锁骨上窝、肋间隙在吸气时明显凹陷),可伴有高调吸气性哮鸣音。

②呼气性呼吸困难:由于肺泡弹性减弱(肺气肿)及小支气管狭窄与痉挛(支气管哮喘)时,病人呼气费力,缓慢而延长,常伴有哮鸣音。

③混合性呼吸困难:见于肺呼吸面积减少(如肺炎、肺水肿、气胸、胸腔积液、成人呼吸窘迫综合征等)与胸廓运动受限时,病人表现呼气与吸气均费力,呼吸频率亦增快。

(2)心源性呼吸困难:由循环系统疾病所引起,主要见于左心或右心功能不全。心源性呼吸困难的特点为劳动时加重,休息时减轻;平卧时加重,坐位时减轻。因坐位时下半身静脉血与水肿液回流减少,从而减轻肺淤血的程度,并有利于膈肌的活动和增加肺活量,故常迫使病人采取端坐呼吸。

(3)中毒性呼吸困难:见于酸中毒(尿毒症、糖尿病酮中毒),高热,吗啡、巴比妥类药物中毒等。常见:①酸中毒-Kussmaul呼吸。

②尿毒症-呼出气有尿(氨)味。

③DM酮症酸中毒-呼出气有烂苹果味。

④高铁血红蛋白血症,氰化物中毒-呼吸深快。

⑤脑水肿,呼吸中枢抑制,镇静催眠药、麻醉药中毒-Cheyne-Stokes呼吸、Biots呼吸。

(4)血源性呼吸困难:重度贫血、高铁血红蛋白血症、硫化血红蛋白血症或一氧化碳中毒等,使红细胞携氧量减少,血氧含量减低。呼吸常加快加深。

(5)精神神经性呼吸困难

①颅脑疾患-呼吸变慢、变浅,常伴鼾声和严重呼吸节律异常。

②癔症-呼吸浅表、频数。

阅读理解
 
阅读理解。
     We once had a poster competition in our fifth grade art class.
     "You could win prizes," our teacher told us as she wrote the poster information on the blackboard.
She passed out sheets of construction paper while continuing, "The first prize is ten dollars. You just
have to make sure that the words on the blackboard appear somewhere on your poster."
      We studied the board critically. Some of us looked with one eye and held up certain colors against
the blackboard, rocking the sheets to the right or left while we conjured up our designs. Others twisted
their hair around their fingers or chewed their erasers while deep in thought. We had plans for that
ten-dollar grand prize, each and every one of us. I'm going to spend mine on candies, one hopeful would
announce, while another practiced looking serious, wise and rich.
     Everyone in the class made a poster. Some of us used parts of those fancy paper napkins, while
others used nothing but colored construction paper. Some of us used big designs, and some of us
preferred to gather our art tidily down in one corner of our poster and let the space draw the viewer's
attention to it. Some of us would wander past the good students' desks and then return to our own
projects with a growing sense of hopelessness. It was yet another grown-up trick of the sort they
seemed especially fond of, making all of us believe we had a fair chance, and then
always-always-rewarding the same old winners.
     I believe I drew a sailboat, but I can't say that with any certainty. I made it. I admired it. I determined
it to be the very best of all of the posters I had seen,and then I turned it in.
Minutes passed.
     No one came along to give me the grand prize, and then someone distracted me, and I probably
never would have thought about that poster again.
     I was still sitting at my desk, thinking, What poster? when the teacher gave me an envelope with
a ten-dollar bill in it and everyone in the class applauded for me.
1. What was the teacher's requirement for the poster?
A. It must appear in time.
B. It must be done in class.
C. It must be done on a construction sheet.
D. It must include the words on the blackboard.
2. The underlined phrase in Paragraph 3 most probably means ________.
A. formed an idea for
B. made an outline for
C. made some space for
D. chose some colors for
3. After the teacher's words, all the students in the class________.
A. looked very serious
B. thought they would be rich
C. began to think about their designs
D. began to play games
4. After seeing the good students' designs, some students________.
A. loved their own designs more
B. thought they had a fair chance
C. put their own designs in a corner
D. thought they would not win the prize
5. We can infer from the passage that the author________.
A. enjoyed grown up tricks very much
B. loved poster competitions very much
C. felt surprised to win the competition
D. became wise and rich after the competition
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