Acute neck tendonitis with dyspnea:A case report

BACKGROUND Longus colli tendinitis(LCT)with dyspnea is a relatively less-reported condition in the literature,and physicians should be aware of its existence.Misdiagnosis of this condition may cause unnecessary treatment for dyspnea.CASE SUMMARY Herein,we report the case of a 40-year-old man with acute neck tendonitis.The patient presented to the pneumology department clinic with a complaint of acute neck tendonitis with dyspnea.An emergency cervical magnetic resonance examination was performed,and the preliminary diagnosis was“acute longus cervicalis tendinitis.”After aggressive medical treatment,the symptoms obviously improved.CONCLUSION LCT is a self-limiting disease that usually improves after three to seven days of conservative treatment following a definite diagnosis.However,owing to its insidious onset and complex clinical manifestations,most relevant personnel are not fully understood.The definite diagnosis of LCT is based on a comprehensive understanding of the triad,rare symptoms,and the clear identification of cervical 1 and 2 levels calcification and prevertebral edema by medical imaging examination,especially magnetic resonance imaging and computed tomography.

Etiologies and Prognostic Factors of Dyspnea in Infants at the University Hospital Center (CHU) of Bouaké (Ivory Coast)

Identify the epidemiological characteristics, etiologies and evolutionary aspects of dyspnea in infants. This was a retrospective study of infants hospitalized for dyspnea from January 1 to December 31, 2020. The parameters studied were sex, age, origin, vaccination status, existence of underlying pathology. Underlying, the diagnosis and the evolutionary modalities. Data analysis and processing were possible using Word, Excel and EPI info version 7 software. We retained 152 infants. The sex ratio was 1.34 and the median age was 4 months. Vaccines according to expanded immunization program (EPI) were up to date in 76.32%. The main antecedents with risk identified were malnutrition, hypotrophy at birth, interventricular communication. The pathologies observed were low acute respiratory diseases in 90.79%, ENT diseases in 04.60% and cardiac diseases in 03.95%. The median length of hospitalization was 4 days. Infants who died accounted for 15.13%. The median age of infants who died was 4 months. The median time to onset of death was 1.63 days. The risk factors for death were age < 6 months (p = 0.003;CI [1.27;9.33]), outdated vaccines (p = 0.012;CI [1.18;5.17]), history with risk (p = 0.031;CI [1.02;4.54]). Dyspnea in infants remains a concern in our service. Reducing mortality involves developing procedures for the management of lower respiratory ailments, continuous staff training and strengthening the technical platform.

Modulation of Respiratory Neural Drive by Physiological Loads in COVID-19 Patients with Dyspnea

COVID-19 patients often experience dyspnea due to several factors. The underlying unique pathophysiology of dyspnea in COVID-19 is not yet fully understood, but it is believed to be related to a combination of respiratory, cardiovascular, and neuromuscular factors. Hypoxemia is considered one of the key symptoms of COVID-19. This affects the respiratory drive, which determines the rate, depth, and pattern of breathing. The relationship between increased ventilatory neural drive and abnormal gas exchange, particularly in the context of ventilation/perfusion (V/Q) mismatches and chemosensitivity, has gained significant attention following the COVID-19 pandemic. The ACE2 receptors allow viral entry into the lungs, leading to the loss of surfactant, hypoxic vasoconstriction, and intrapulmonary shunting that may result in a V/Q mismatch. Additionally, acidosis, hypercapnia, elevated 2,3-diphosphogly-cerate levels and fever may shift the oxygen diffusion curve rightward, lowering arterial oxygen saturation levels and triggering ventilatory responses. This paper examines how physio pathological factors such as altered gas diffusion, chemosensory feedback, V/Q ratios, altered compliance, arterial blood gases, and respiratory muscle dysfunction in these patients affect ventilatory drive. A review of the published literature was also conducted to determine the mechanism of dyspnea. To ensure appropriate gas exchange, individuals need to augment their minute ventilation (VE) when physiological dead space is elevated. This serves as a compensatory mechanism to counteract the effects of compromised gas exchange and keep adequate oxygenation throughout the body. The respiratory centers may experience dysregulation due to the impact of the virus on the respiratory system, which could affect the rhythm-generating and pattern-generating signals that are vital for regulating the respiratory rate and depth of breathing effort. The cerebral cortex, in conjunction with the brain stem centers, plays a crucial role in regulating ventilation during prolonged hypoxemia. This interaction between these two components may help elucidate the conscious respiratory sensation (or dyspnea) experienced by patients. It is hypothesized that neuroventilatory decoupling acts as a mechanism to prevent sensory signals from translating into mechanical or ventilatory responses. This decoupling phenomenon is believed to have a notable impact on the intensity of breathlessness. By understanding the relationship between increased ventilatory neural drive and abnormal gas exchange, particularly in the context of ventilation/perfusion (V/Q) mismatches and altered chemosensitivity, healthcare professionals can develop strategies to optimize respiratory support for COVID-19 patients.

Blockage of the habenular nucleus can eliminate dyspnea induced by electrostimulation of the insular cortex

BACKGROUND： The insular cortex and habenular nucleus may be a regulatory center for obstructive sleep apnea syndrome, and dyspnea may be caused by insular cortex activity. The insular cortex is a cortical representation of obstructive sleep apnea syndrome. The habenular nucleus is a station for descending insular cortex activity. OBJECTIVE： Through actively stimulating the rat insular cortex, to observe rat respiratory movement, myoelectric activities of genioglossus, arterial partial pressure of oxygen, partial pressure of carbon dioxide and acidity-alkalinity, and to verify a hypothesis that the insular cortex is a superior-position regulation center, and the habenular nucleus is an inferior-position nervous nuclei of the insular cortex in patients with obstructive sleep apnea syndrome. DESIGN, TIME AND SETTING： The randomized, controlled animal study was performed at the Laboratory of Electrophysiology, Department of Physiology, Norman Bathune College of Medicine, Jilin University, China from September 2004 to June 2008. MATERIALS： We used L-glutamic acid （Dingguo Biological Product Research Center, Beijing, China）, lidocaine hydrochloride （Seventh Pharmacy Co., Ltd., Wuxi, China）, electric stimulator （Nihon Kohden, Japan）, and an AVL-OPTI blood gas analyzer （AVL Scientific Co., Roswell, GA, USA）. METHODS： The insular cortex of healthy adult Wistar rats underwent electrostimulation and L-glutamic acid stimulation to record changes in the myoelectric activity of genioglossus and respiratory movement. Some rats were injected with lidocaine to block the habenular nucleus before electrostimulation or L-glutamic acid stimulation. L-glutamic acid and lidocaine were injected by microelectrodes embedded in nuclear groups. MAIN OUTCOME MEASURES： Myoelectric activities of genioglossus, arterial partial pressure of oxygen, partial pressure of carbon dioxide and acidity-alkalinity were measured following apnea in rats undergoing electrostimulation in the insular cortex and following blockade of the habenular nucleus. RESULTS： Following electrostimulation and L-glutamic acid stimulation, rats developed apnea or respiratory rhythm disorders. Simultaneously, the amplitude of myoelectric activity of the genioglossus was reduced （P 〈 0.01 ）, and the electromyogram integral was decreased （P 〈 0.01）. Arterial blood gas analysis showed arterial blood acidosis, a decrease in pH （P 〈 0.05）, and an increase in the negative value of alkaline reserve （P 〈 0.01）. Lidocaine in the habenular nuclear blocked respiratory and other index changes after insular cortex stimulation. CONCLUSION： Dyspnea induced by stimulating the insular cortex may require the habenular nucleus. Paralysis of the habenular nucleus can completely eliminate insular cortex stimulation-induced dyspnea.

High serum lactate dehydrogenase and dyspnea:Positive predictors of adverse outcome in critical COVID-19 patients in Yichang

BACKGROUND Coronavirus disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)outbreak in China,constitutes a Public Health Emergency of International Concern.It is well known that COVID-19 patients may have increased serum lactate dehydrogenase(LDH)levels in the early stage.The clinical changes in LDH may have predictive value in disease evolution and prognosis in critically ill COVID-19 patients.AIM To examine serum LDH and clinical characteristics in patients with COVID-19 and their predictive value for prognosis.METHODS This retrospective study analyzed the clinical data of forty-seven critical COVID-19 patients in the intensive care unit of the Third People's Hospital of Yichang City from January 27 to March 25,2020 and divided them into survivors and nonsurvivors.The patients were diagnosed according to the World Health Organization interim guidance and critical cases met any one of the following criteria:Respiratory failure and required mechanical ventilation,the occurrence of shock,and the combined failure of other organs that required intensive care unit monitoring and treatments,according to the diagnostic criteria of critical COVID-19.Clinical data including symptoms,detection of SARS-CoV-2,chest computed tomography(CT)images,changes in serum LDH in different clinical phases,and prognosis were collected.Statistical analysis of the data was performed.Continuous variables were expressed as median(interquartile range)and compared with the Mann-Whitney U test.Categorical variables were compared with the Chi-square test.Survival data were analyzed using Kaplan-Meier survival curves and log-rank tests.RESULTS According to chest CT images,we observed the alveolitis and fibrosis stages in all critical patients in this study.Most non-survivors died in the fibrosis stage.Nonsurvivors had fewer days of hospitalization,shorter disease duration,shorter duration of alveolitis and fibrosis,and had dyspnea symptoms at disease onset(P=0.05).Both first and lowest LDH values in the alveolitis stage were more pronounced in non-survivors than in survivors(449.0 U/L vs 288.0 U/L,P=0.0243;445.0 U/L vs 288.0 U/L,P=0.0199,respectively),while the first,lowest and highest values of serum LDH in non-survivors were all significantly increased compared to survivors in the fibrosis phase(449.0 U/L vs 225.5 U/L,P=0.0028;432.0 U/L vs 191.0 U/L,P=0.0007;1303.0 U/L vs 263.5 U/L,P=0.0001,respectively).The cut-off points of first LDH values in the alveolitis and fibrosis phase for distinction of non-survivors from survivors were 397.0 U/L and 263.0 U/L,respectively.In the fibrosis stage,non-survivors had more days with high LDH than survivors(7.0 d vs 0.0 d,P=0.0002).Importantly,patients with high LDH had a significantly shorter median survival time than patients with low LDH in the alveolitis phase(22.0 d vs 36.5 d,P=0.0002),while patients with high LDH also had a significantly shorter median survival time than patients with low LDH in the fibrosis phase(27.5 d vs 40.0 d,P=0.0008).The proportion of non-survivors with detectable SARS-CoV-2 until death in the alveolitis stage was significantly increased compared with that in the fibrosis stage(100%vs 35.7%,P=0.0220).CONCLUSION High LDH and dyspnea symptoms were positive predictors of an adverse outcome in critical COVID-19.The rapid progressive fibrosis stage was more perilous than the alveolitis stage,even if SARS-CoV-2 is undetectable.

Evaluation of Life Quality and Dyspnea Intensity on Chronic Airway Diseases Patients in Pulmonary Rehabilitation Program

The chronic obstructive pulmonary disease (COPD) and asthma are chronic airway diseases that cause considerable physical, emotional and social restrictions. The life quality of patients who suffer from these diseases, is more affected by dyspnea then by other symptoms. That way is possible to correlate the impact of dyspnea on their life quality. The Pulmonary Rehabilitation Program (PRP) helps to improve the physical fitness and quality of life. This paper presents a study of the life quality and the dyspnea intensity in chronic lung disease patients. The research has participation of fourteen patients, distributed as seven suffering from COPD and the other seven suffering from asthma, for both gender and with an age average of 74.2 ± 8.9. The patients answer the following questionnaires: Baseline Dyspnea Index (BDI), Medical Research Council (MRC) Dyspnea Scale, Airways Questionnaire 20 (AQ20) and the Brazilian version of the Short-Form (SF-36) life quality questionnaire. From the present study, it was concluded that asthma patients have a less impaired life quality, since the dyspnea intensity is lesser, compared to the one with COPD.

Correlation of Self-Reported Breathlessness with Post Exercise Dyspnea in Obesity

Background: Dyspnea in obesity is common and dyspnea questionnaires are mostly validated for chronic respiratory diseases. The study aims to assess how modified Medical Research Council (mMRC) dyspnea scale correlates with post exercise dyspnea Borg scale in 6-minute walk test of the obese population. Methods: We performed a retrospective observational study on 342 obese patients with 6 MWT tests from February 2008 to November 2014 at a single tertiary hospital. Linear regression analysis was used to assess the relationship between mMRC and Borg dyspnea score. Fractional polynomial regression was used to analyze the relationship of mMRC and Borg scores with BMI. Results: MMRC dyspnea score was a strong predictor of post exercise dyspnea Borg score in the obese population in a univariate regression model (coefficient = 0.764, p ≤ 0.001). When adjusted to age, BMI, 6 MWT distance and PFT parameters in a multivariate regression model, the relationship remained statistically significant (coefficient = 0.587, p ≤ 0.001). The relationship was stronger in obese group with no airflow obstruction. Conclusion: In obese population, pre-exercise mMRC dyspnea score correlates significantly with post exercise dyspnea Borg score regardless of airflow obstruction. This is the first validity study regarding mMRC scale in assessing dyspnea in the obese population.

Relation of Indices of Lung Hyperinflation to Dyspnea in Patients with Chronic Obstructive Pulmonary Disease: A Physiologic Assessment and Discussion

Background: The severity of COPD is commonly assessed by the reduction in forced expiratory volume at one second (FEV1), although more recently prognostic factors influencing survival have also incorporated functional capacity, degree of breathlessness on exertion, and body mass index. Increasingly, the reliability of physiological parameters such as FEV1 to predict patient-centered outcomes has been brought into question. Objectives: To evaluate the relationship between dyspnea as assessed by the Modified Medical Council Dyspnea (MMRC) scale, the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2014) staging and indices of lung hyperinflation and spirometry. Methods: Data were retrospectively analyzed at a 600-bed tertiary care center including spirometry, plethysmographic lung volumes, single breath carbon monoxide diffusion capacity and dyspnea graded according to MMRC, and GOLD staging. Results: Data for 331 patients were analyzed. Differences amongst FEV1, IC, IC/TLC, FRC and RV/TLC were significant between GOLD I/II and GOLD III/IV groups. The closest relationship to GOLD staging was seen with FEV1, FVC and slow vital capacity (SVC). FEV1/FVC, IC, and IC/TLC were inversely associated with MMRC score, while RV/TLC exhibited a positive relation with MMRC score. Conclusions: Indices of lung hyperinflation are closely associated, with dyspnea as assessed by MMRC grading with TLC, RV/TLC and IC exhibiting the closest relations, more so than FEV1. GOLD staging also shows strong correlations with lung volume subdivisions (weakly with TLC), more so than with FEV1. That TLC changed little between GOLD stages can be explained by the presence of collateral interalveolar channels and population characteristics different from those of other studies. These findings further support the concept that more than a reduction in FEV1, lung hyperinflation contributes to the sensation of dyspnea in airflow limitation.

An unusual case of chest pain and dyspnea on exertion

Congenital coronary artery anomalies occur in less than 1% of the general population with clinical consequences ranging from benign incidental findings to sudden cardiac death. More often than not this diagnosis is made on a postmortem examination but up to one third of the patients have symptoms such as exertional chest pain and dyspnea. Due to the correctable nature of this entity and the fact that anomalous origins of coronary arteries can be readily diagnosed by noninvasive cardiac imaging modalities, timely clinical suspicion based on symptoms is critical. We present a case of a 37 years old with exertional chest pain and dyspnea of several years duration who was found to have an anomalous origin of the left main coronary artery. A surgical correction was undertaken which resulted in resolution of his symptoms. Our case highlights the importance of keeping congenital coronary anomalies on the differential diagnosis for exertional chest pain and dyspnea in young individuals and following inconclusive noninvasive testing with more definitive diagnostic modalities.

Value of Real-Time Bedside Ultrasonography in the Etiologic Diagnosis of Acute Dyspnea

Objective: To explore the value of real-time bedside ultrasonography in the etiologic diagnosis of acute dyspnea. Methods: Sixty-two patients with acute dyspnea who were treated in our hospital from January 2016 to December 2020 were randomly selected and their clinical data were retrospectively analyzed. All patients were randomly divided into a control group for routine examinations (n = 31) and an observation group for real-time beside ultrasonography (n = 31). The costs of medical examinations, examination duration, and diagnostic results of severe pneumonia, acute cardiogenic pulmonary edema, pulmonary embolism, chronic obstructive pulmonary disease, and pneumothorax (including sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy) of the two groups of patients were compared and analyzed. Results: Compared with the control group, the observation group had significantly shorter examinations (P < 0.05). Although the cost of medical examinations of the observation group tended to be higher, the difference between groups was not significant (P > 0.05). Moreover, there were no significant differences in left ventricular ejection fraction, left ventricular end-diastolic diameter, or brain natriuretic peptide between the two groups (P > 0.05). Comparison of the etiologic diagnosis results between the two groups showed that the observation group had significantly higher diagnostic sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for various causes compared with the control group (P < 0.05). Conclusion: Real-time bedside ultrasonography for the etiologic diagnosis of patients with acute dyspnea was quicker and had higher diagnostic accuracy;thus providing accurate guidance for the disease treatment, and having a higher promotional value in clinical practice compared with routine examinations.

Expiratory Flow Limitation and Its Relation to Dyspnea and Lung Hyperinflation in Patients with Chronic Obstructive Pulmonary Disease: Analysis Using the Forced Expiratory Flow-Volume Curve and Critique

Background: Tidal expiratory flow limitation (tEFL) is defined as absence of increase in air flow during forced expiration compared to tidal breathing and is related to dyspnea at rest and minimal exertion in patients with chronic airflow limitation (CAL). Tidal EFL has not been expressed as a continuous variable (0% - 100%) in previous analyses. Objective: To relate the magnitude of tEFL to spirometric values and Modified Medical Research Council (MMRC) score and Asthma Control Test (ACT). Methods: Tidal EFL was computed as percent of the tidal volume (0% - 100%) spanned (intersected) by the forced expiratory-volume curve. Results: Of 353 patients screened, 192 (114 M, 78 F) patients (136 with COPD, 56 with asthma) had CAL. Overall characteristics: (mean ± SD) age 59 ± 11 years, BMI 28 ± 7, FVC (% pred) 85 ± 20, FEV1 (% pred) 66 ± 21, FEV1/FVC 55% ± 10%, RV (% pred) 147 ± 42. Tidal EFL in patients with tEFL was 53% ± 39%. Using univariate analysis, strongest correlations were between tEFL and FVC and between tEFL and RV in patients with BMI < 30 kg/m2. In patients with nonreversible CAL, tEFL was positively associated with increasing MMRC, negatively with spirometric measurements, and positively with RV/TLC. In asthmatics, ACT scores were higher in patients with mean BMI ≥ 28 kg/m2 (p < 0.00014) and RV/TLC values > 40% (p < 0.03). Conclusions: Dyspnea is strongly associated with tEFL and lung function, particularly in patients with nonreversible CAL. Air trapping and BMI contribute to tEFL.

Is acute dyspnea related to oxaliplatin administration?

The standard adjuvant treatment of colon cancer is fluorouracil plus leucovorin. Oxaliplatin improves the ef-ficacy of this combination in patients with stage Ⅲ colon cancer and moreover its toxicity is well tolerable. We de-scribe a rare clinical case of acute dyspnoea probably re-lated to oxaliplatin at one month from the end of the ad-juvant treatment. A 74-year-old man developed a locally advanced sigmoid carcinoma (pT3N1M0). A port a cath attached to an open-ended catheter was implanted in order to administer primary chemotherapy safely according to the FOLFOX4 schedule. One month following the end of the 6th cycle, the patient referred a persistent cough and moderate dyspnoea. Chest radiography displayed a change in the lung interstitium, chest CT scan con-firmed this aspect of adult respiratory distress syndrome, spirometry reported a decreased carbon monoxide diffu-sion capacity. Antibiotic and corticosteroids were admin-istered for 10 d, then a repeated chest X ray evidenced a progressive pulmonary infiltration. A transbronchial biopsy and cytology did not show an infective process, a CT scan reported radiological abnormalities including linear and nodular densities which were becoming con-fluents. Antimicotic and antiviral drugs did not evidence any benefit. The antiviral therapy was stopped and high dose metilprednisolone was started. The patient died of pulmonary distress after 10 d.

Hospital without dyspnea： rationale and design of a multidisciplinary intervention

呼吸困难是普通、停用的症状呼吸并且心疾病，它在发生正在成长。在医院承认期间，呼吸急促下面诊断、下面对待，尽管有为控制症状可得到的治疗。我们开发了指导到医药职员在处理呼吸困难支持这些药理学和非药理学工具的应用程序的定制的实现策略。主要目的是不收到呼吸困难的足够的消除的病人的率到减少。这是四阶段的伪试验性的研究。干预在将在心病学和呼吸的药部门被教的二次教学谈话在于。内容将被辩解的照顾专家准备，基于为呼吸困难和病人需要的管理的可得到的工具。在就医的病人的呼吸困难的代表性的研究将在干预前后被执行在诊所由于变化在呼吸困难紧张查明改进。最后阶段为根据我们的经验基于的呼吸困难管理在一致协议的创造在于。这研究的结果被期望价值大并且在不久的将来可以改变临床的实践并且支持一变化为呼吸困难照顾更好。

Treatment of Cough and Dyspnea due to Acute Bronchitis by Plaster for Cough and Dyspnea——A Report of 735 Cases

In the light of the theory of treating the internal disease externally, an externally used plaster for treating cough and dyspnea due to acute bronchitis (Ke Chuan Yi Tie Kang 咳喘一贴康) was successfully applied to 735 cases of acute bronchitis (the treatment group), with the other 423 cases treated with routine western drugs as controls. The results showed that the cure rate in the treatment group was significantly higher than that in the control group (P<0.01); and that in the treatment group, the cure rate for the wind-cold type of acute bronchitis was significantly higher than that for the wind-heat type of acute bronchitis (P<0.01).

对比床旁急诊肺超声与联合心肺及附加超声诊断急性呼吸困难病因的准确性

目的对比床旁急诊肺超声(BLUE)与联合心肺及附加超声(CLAUS)方案诊断急性呼吸困难病因的准确性。方法回顾性分析1016例急性呼吸困难患者,根据病因分为心源性肺水肿组(n=268)、肺炎组(n=574)、气胸组(n=33)、肺栓塞组(n=67)及CAD(慢性阻塞性肺疾病/哮喘/膈肌功能障碍)组(n=74);比较各组CLAUS所见,以及BLUE与CLAUS方案诊断急性呼吸困难病因的准确性。结果CLAUS显示,心源性肺水肿组肺超声表现多呈BB及B-C模式,肺炎组多为A-B、A-C、B-A、B-B、B-C及C-C模式,气胸组、肺栓塞组及CAD组均以A-A模式最多。5组肺超声表现、前胸壁胸膜特征、有无左/右心功能不全及有无下腔静脉内径异常差异均有统计学意义(P均<0.05)。BLUE与CLAUS方案诊断急性呼吸困难病因的准确率分别为86.91%(883/1016)及94.49%(960/1016),后者高于前者(χ^(2)=34.587,P<0.05)。结论CLAUS方案可有效诊断急性呼吸困难病因,其准确率高于BLUE方案。

Fearful imagery induces hyperventilation and dyspnea in medically unexplained dyspnea

Background Medically unexplained dyspnea refers to a condition characterized by a sensation of dyspnea and is typically applied to patients presenting with anxiety and hyperventilation without underlying cardiopulmonary pathology. We were interested to know how anxiety triggers hyperventilation and elicits subjective symptoms in those patients. Using an imagery paradigm, we investigated the role of fearful imagery in provoking hyperventilation and in eliciting symptoms, specifically dyspnea. Methods Forty patients with medically unexplained dyspnea and 40 normal subjects matched for age and gender were exposed to scripts and asked to imagine both fearful and restful scenarios, while end-tidal PCO2 （PetCO2） and breathing frequency were recorded and subjective symptoms evaluated. The subject who had PetCO2 falling more than 5 mmHg from baseline and persisting at this low level for more than 15 seconds in the imagination was regarded as a hyperventilation responder. Results In patients with medically unexplained dyspnea, imagination of fearful scenarios, being blocked in an elevator in particular, induced anxious feelings, and provoked a significant fall in PetCO2 （P〈0.05）. Breathing frequency tended to increase. Eighteen out of 40 patients were identified as hyperventilation responders compared to 5 out of 40 normal subjects （P〈0.01）. The patients reported symptoms of dyspnea, palpitation or fast heart beat in the same fearful script imagery. Additionally, PetCO2 fall was significantly correlated with the intensity of dyspnea and palpitation experienced during the mental imagery on one hand, and with anxiety symptoms on the other. Conclusions Fearful imagery provokes hyperventilation and induces subjective symptoms of dyspnea and palpitation in patients with medically unexplained dyspnea.

老年急性脑卒中患者经鼻高流量氧疗后呼吸困难信念现状及相关影响因素分析

目的 探讨老年急性脑卒中(CVA)患者经鼻高流量氧疗后(HFNC)呼吸困难信念现状及影响因素。方法 回顾性选取2022年1月-2023年1月首都医科大学附属北京天坛医院收治的136例老年CVA经HFNC患者作为研究对象,采用呼吸困难信念问卷(BBQ)进行呼吸困难信念评分,得分率=分值/满分×100%,将得分率<满分的60%设为低呼吸困难信念组,得分率≥满分的60%设为高呼吸困难信念组。比较2组文化程度、性别、领悟社会支持量表(PSSS)、住院时间、日常生活活动能力(ADL)、 24项自我效能感量表(SEES)差异,并通过二元Logistic回归分析高呼吸困难信念的影响因素。结果 研究共纳入136例老年CVA经HFNC患者,其中低呼吸困难信念组87例,高呼吸困难信念组49例;低呼吸困难信念组年龄、肺部感染控制、昏迷、吞咽功能、咳嗽反射、 SEES评分、 PSSS评分、 ADL、是否规律体育锻炼、 HFNC设置温度、发病后救治时间评估值与高呼吸困难信念组差异均有统计学意义(P<0.05);二元Logistic分析结果显示,年龄>75岁(OR=1.719,P=0.004)、吞咽功能越差(OR=1.735,P=0.006)、咳嗽反射越差(OR=1.898,P=0.0004)、 SEES评分低(OR=1.785,P=0.002)、 PSSS评分低(OR=1.599,P=0.006)、不规律体育锻炼(OR=1.634,P=0.003)、 HFNC设置温度≥37℃(OR=1.621,P=0.006)均为影响老年CVA患者HFNC后呼吸困难信念的独立危险因素(P<0.05);构建老年CVA患者HFNC后高呼吸困难信念的风险预测模型,以模型新生成概率值为依据,绘制预测模型ROC曲线,得到AUC=0.769 0(95%CI为0.681~0.759)>0.75;Hosmer-Lemeshow检验评价模型校准能力(χ^(2)=3.543,P=0.896>0.05)。结论 老年CVA患者经HFNC后呼吸困难信念总体处于较低水平,临床工作者应早期识别患者经HFNC后呼吸困难的动机,纠正他们对呼吸困难的灾害性认识,制定针对性干预措施,促进患者心理调适和疾病康复。

ADO在慢性阻塞性肺疾病患者近期预后评估中的价值

目的探讨呼吸困难指数气流受限程度指数(dyspnea index air flow restriction degree,ADO)在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者近期预后评估中的价值。方法选取新疆医科大学第二附属医院呼吸内科自2021年3月—2023年3月的COPD患者120例,并依照患者最终转归情况将其分为存活组(n=95)与死亡组(n=25)。观察2组患者的基础病情况及患者性别、年龄、第1秒用力呼气容积(first second forced expiratory volume,FEV1)占预计值的百分比和ADO指数等相关指标。比较ADO指数不同分数患者病死率。比较ADO指数预测180 d死亡的受试者工作特征(receiver operating characteristic,ROC)曲线面积。结果2组患者的高血压、冠心病、心律失常、糖尿病、慢性肝病、慢性肾病、亚临床甲减发生情况对比,差异无统计学意义(P>0.05)。死亡组患者的FEV1占预计值的百分比、FEV1占预计值的百分比评分、呼吸困难分[英国医学研究委员会(the Medical Research Council,MRC)]评分以及ADO指数均高于存活组患者(P<0.05)。ADO指数<5分者的死亡率高于ADO指数≥5分者(P<0.05)。ADO指数预测180 d死亡的ROC曲线面积为0.851(95%CI:0.767~0.928,P<0.001),ADO指数为5.5时,约登指数最大,为0.565。结论ADO可有效反映COPD病情严重程度,对于患者而言可准确反映其病情进展情况,帮助其获得良好的疾病治疗效果,对于患者近期预后而言也具有积极意义,临床应用效果良好。

王玉教授应用经方治疗咳喘病的临床经验及学术思想初探

王玉教授临床工作50余年,将中医经典理论与临床实践相结合,在治疗呼吸系统疾病方面造诣深厚,见解独到。王玉教授在治疗咳喘疾病时首辨寒热虚实,根据寒热真假,虚实夹杂的不同阶段进行治疗;注重经典,善用《伤寒论》经方,治疗咳喘病主张分经辨治;认为咳喘病位在肺,与五脏失调密切相关,治疗时注重调和五脏;重视科研,将临床与科研紧密结合,研制出多项治疗咳喘疾病的院内制剂及气雾剂;作为专家指导国家、省市级课题,临床及科研相互贯通,硕果累累。通过对王玉教授经验和学术思想的总结,以期为临床辨治拓展思路和方法。

COPD病人一氧化碳弥散量与运动耐力、呼吸困难及通气效率的相关性研究

目的 探讨COPD病人一氧化碳弥散量(DLCO)与运动耐力、呼吸困难、通气效率的相关性。方法 入选60例稳定期COPD病人,根据单位肺泡容积的弥散量(DLCO/V_(A))将病人分为正常DLCO组和低DLCO组,收集2组静态肺功能、心肺运动试验(CPET)参数,并采用呼吸困难量表(mMRC)对呼吸困难进行评分。采用相关分析以及多重线性回归分析DLCO与运动耐力、呼吸困难、通气效率的相关性。结果 低DLCO组的一氧化碳弥散量占预计值百分比[(DLCO/V_(A))/pred]、最大功率负荷(Peak Load)、峰值摄氧量占预计值的百分比(Peak VO_(2)/pred)、每公斤体质量峰值摄氧量(Peak VO_(2)/kg)均低于正常DLCO组,无氧阈时CO_(2)通气当量(EQCO_(2)@AT)、mMRC评分均高于正常DLCO组,差异有统计学意义(P<0.01)。相关性分析显示,(DLCO/V_(A))/pred与Peak Load、Peak VO_(2)/pred、Peak VO_(2)/kg呈正相关,与EQCO2@AT、mMRC评分呈负相关(P<0.05)。多重线性回归分析结果显示,(DLCO/V_(A))/pred是预测COPD病人呼吸困难、运动耐力以及通气效率的独立预测因子(P<0.05)。结论 DLCO与COPD病人的呼吸困难、运动耐力、通气效率独立相关。