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高通气综合征?还是惊恐障碍?

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中华结核和呼吸杂志 2001年第9期24卷 516-517页

作者：韩江娜 R Schepers K Stegen O van den Bergh kp van de woestijne 中国协和医科大学北京协和医院呼吸科北京100730 Laboratory of Pneumology UZ Gasthuisberg department of Psychology KU Leuven

高通气综合征是由于通气过度超过生理代谢所需而引起的一组征候群,其特征是临床症状可以用过度通气激发试验诱发出来[1].传统的观念认为,焦虑和应激反应等心因性因素诱发了超生理代谢需要的过度通气,而临床症状都可以用过度通气和呼吸... 详细信息

高通气综合征是由于通气过度超过生理代谢所需而引起的一组征候群,其特征是临床症状可以用过度通气激发试验诱发出来[1].传统的观念认为,焦虑和应激反应等心因性因素诱发了超生理代谢需要的过度通气,而临床症状都可以用过度通气和呼吸性碱中毒来解释.高通气综合征的临床症状累及多器官系统,常见的有气短、憋气、胸部不适或胸痛、呼吸深或快、心慌或心悸、头晕、四肢麻木、精神紧张、焦虑、恐惧等.这些所谓的心身症状不伴有相应的器质性病因,症状的发生与呼吸控制系统异常(很可能是下丘脑、大脑边缘系统、大脑皮层的高位神经调节异常)、自主呼吸调节丧失稳定性有关.当患者的呼吸受到刺激时,呼吸调节功能发生一过性紊乱,出现过度通气.

关键词：高通气综合征惊恐障碍诊断重叠性

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少年儿童非器质性呼吸困难34例分析

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中华儿科杂志 2004年第4期42卷 280-283页

作者：韩江娜朱元珏李舜伟雒冬梅尹小文陈育智 O van den Bergh kp van de woestijne 中国医学科学院协和医科大学北京协和医院呼吸科呼吸心理生理实验室 100730 首都儿科研究所哮喘防治教育中心比利时鲁文大学心理系鲁文大学医学院呼吸系

目的　总结分析 1996～ 2 0 0 2年间在北京协和医院诊断的 34例少年儿童非器质性呼吸困难病例。方法　非器质性呼吸困难的临床诊断标准 :有突出的呼吸困难 ,经过询问病史、体格检查和相关的实验室检查 ,没有心肺或其他器质性病因。结果... 详细信息

目的　总结分析 1996～ 2 0 0 2年间在北京协和医院诊断的 34例少年儿童非器质性呼吸困难病例。方法　非器质性呼吸困难的临床诊断标准 :有突出的呼吸困难 ,经过询问病史、体格检查和相关的实验室检查 ,没有心肺或其他器质性病因。结果　少年儿童非器质性呼吸困难最小发病年龄 8岁 ,13～ 16岁为高峰发病年龄 ,17岁以后发病人数明显减少。大多数为慢性病程 ,伴症状急性发作。表现为呼吸困难 ,伴随明显的过度通气、低碳酸血症的症状。少年儿童患者焦虑不明显 ,与成人形成鲜明对比。多数患儿有明显的心因性诱因 ,中学阶段学习压力大为最重要的诱因。 13例患儿接受腹式呼吸训练治疗 2～ 3个月后复查 ,呼吸困难和伴随症状得到明显改善。结论　少年儿童非器质性呼吸困难呈慢性过程 ,需要引起足够的重视 ,提高医师警觉性是正确诊断处理的关键。

关键词：少年儿童非器质性呼吸困难腹式呼吸训练诊断治疗

Medically unexplained dyspnea:psychophysiological characteristics and role of breathing therapy

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Chinese Medical Journal 2004年第1期117卷 6-13页

作者：韩江娜朱元珏李舜伟雒冬梅胡征 van Diest I de Peuter S van de woestijne kp van den Bergh O Laboratory of Respiratory Psychophysiology Department of PneumologyPeking Union Medical College HospitalChinese Academy of Medical Sciences department of Psychology University of Leuven department of Pneumology UZ Gasthuisberg

Background Medically unexplained dyspnea occurs commonly in medical settings and remains poorly understood. This study was conducted to investigate the psychophysiological characteristics of medically unexplained dyspnea and the efficacy of breathing retraining for these patients. Methods A group of patients with medically unexplained dyspnea were compared to patients with a variety of organic lung diseases and healthy subjects. In another group of patients,the influence of breathing therapy on complaints,anxiety, and breath-holding was evaluated for an average of 1.5 years. Results Patients with medically unexplained dyspnea reported more intense dyspnea than patients with a variety of organic lung diseases. Additionally,they were anxious and presented a broad range of symptoms in daily life and under challenge,for instance voluntary hyperventilation. More than one third of them qualified for panic disorder. They had shorter breath-holding time at rest,less increase in breath-holding time and higher chances of showing a “paradoxical” decrease of breath-holding time after hyperventilation. A combination of PaO2,forced expiratory volume in one second (FEV_1),and anxiety measures distinguished them from organic dyspnea. Breathing retraining profoundly improved their symptoms and decreased the level of state and trait anxiety. Moreover,they better tolerated the voluntary hyperventilation and the symptoms induced were also markedly decreased after therapy. Breath-holding time was prolonged and PetCO2 in a representative group of patients increased. Conclusions Patients with medically unexplained dyspnea appear to have the feature of a “psychosomatic” patient: an anxious patient with a wide variety of symptoms of different organ systems that do not have an organic basis. They can be distinguished from organic dyspnea using a small set of physiological and psychological measures. Breathing retraining turns out to be an effective therapy for those “difficult to

关键词： dyspnea·somatization·anxiety·hyperventilation·breathing therapy