過度換氣症候群

過度換氣症候群
過度換氣症候群
类型	过度换气
分类和外部资源
醫學專科	精神医学、神經學、胸腔醫學
ICD-10	R06.4 or F45.33
ICD-9-CM	306.1
DiseasesDB	31118
eMedicine	emerg/270
	[编辑此条目的维基数据]

過度換氣症候群（hyperventilation syndrome，HVS）又称通气过度综合征^[1]、高通气综合征^[2]，是由于通气过度，超过生理代谢所需而引起的综合征，具有与焦虑相关（情绪紧张、癔病发作等）的呼吸困难及呼吸急促，并伴有全身很多躯体和精神神经表现的临床症状^[3]。

過度換氣症候群有许多历史异名：“慢性過度換氣症候群”chronic hyperventilation syndrome、CHVS）、“失能性過度換氣症候群”（dysfunctional breathing hyperventilation syndrome）、“隐秘搐搦”（cryptotetany^[4]）、“痉挛素质”（spasmophilia^[5]）、“潜伏搐搦”（latent tetany）、“中枢神经元过度兴奋综合征”（central neuronal hyper excitability syndrome）等等。

症状

過度換氣症候群表现为精神紧张、焦虑、恐惧、害怕死亡，呼吸困难、胸闷窒息感、胸部不适或胸痛、呼吸深或快，心慌或心悸、心动过速，头昏、视物模糊，四肢末梢、面部及口周麻木、发紧与针刺感；严重者手指、上肢强直，手足搐搦，意识模糊，晕厥等。但查无相应的器质病因。

机制

過度換氣症候群的病理机制是二氧化碳排出过量导致呼吸性碱中毒，由過快或過深的呼吸所造成，導致身體排出過多的二氧化碳，引發呼吸性碱中毒，亦即血液pH值過高，影響了神经系统的正常放电生理过程，部分患者會感到在手、足、唇等部位感到麻痺或微微叮咬感、口齒不清、暈眩、胸痛、心跳加速。患者越緊張，呼吸越快，令症狀出現惡性循環，嚴重者更會昏厥。

該症狀可由生理或心理造成，患者誤以為自己缺氧，加快呼吸，但其動脈血中的氧化量仍然正常，只是二氧化碳含量過低，引致血管收縮，同时因為玻尔效应的影響，讓人體對重要器官的輸氧量減少。

診斷

过度换气综合症是暈眩症十分常見的誘因。 25%的暈眩症患者被診斷患有HVS。最佳診斷方法是讓患者快速呼吸兩分鐘。這樣會誘發症狀，以確定患者的症狀是由於呼吸過度導致的。這項檢查只能在患者沒有症狀的時候進行。

流行慢性病

每分鐘呼吸量是每分鐘由一個人的肺一分鐘吸入或呼出的空氣量。呼吸醫學資料（見下表）顯示病人的呼吸的空氣量是未患病人士的2-3倍。^{[來源請求]}

情况	每分鐘呼吸量（±標準差）	病人數量	參考文獻
呼吸正常	6 l/分鐘	無	醫學教科書: ^[6] ^[7] ^[8] ^[9]
哮喘	12 l/分鐘	101	^[10]
哮喘	15 l/分鐘	8	^[11]
哮喘	14.1 (±5.7) l/分鐘	39	^[12]
心臟病	14 (±4) l/分鐘	88	^[13]
心臟病	12.2 (±3.3) l/分鐘	132	^[14]
心臟病	16 (±2) l/分鐘	11	^[15]
心臟病	15 (±4) l/分鐘	22	^[16]
糖尿病	10-20 l/分鐘	28	^[17]
糖尿病	12-17 l/分鐘	26	^[18]
囊腫性纖維化	11-14 l/分鐘	6	^[19]
囊腫性纖維化	13 (±1.8) l/分鐘	10	^[20]
慢性阻塞性肺病(COPD)	12.2 (±1.9) l/分鐘	10	^[21]
肝硬化	11-18 l/分鐘	24	^[22]
過度換氣	14.9 (±0.6) l/分鐘	42	^[23]
癲癇	12.8 l/分鐘	12	^[24]

治疗

由于呼吸快速的原因很多，必须先排除器质病因后，才给予过度通气症状治疗。

罩袋治疗：利用口罩、面罩、纸袋、塑料袋等，使口鼻不透气重复呼吸，此时吸入气体中二氧化碳浓度提高而减轻症状；但是有些学者不建议使用^[25]。
调整呼吸节律与深度：腹式呼吸训练等^[26]。
药物治疗：抗焦虑药、β受体拮抗剂、选择性5-羟色胺再摄取抑制剂，严重者需要镇静催眠、补充钾盐、推注葡萄糖酸钙^[27]。

当症状缓解后，随诊可加强^[28]^[29]：

认知行为疗法
心理疗法
中医中药治疗

参考文献

^ 通气过度综合征. 术语在线. 全国科学技术名词审定委员会. （简体中文）
^ 高通气综合征. 术语在线. 全国科学技术名词审定委员会. （简体中文）
^ eMedicine - Hyperventilation Syndrome: Article by Edward Newton, MD. [29 November 2016]. （原始内容存档于2008-10-25）.
^ Seelig, MS; Berger, AR; Spielholz, N. Latent Tetany And Anxiety, Marginal Magnesium Deficit, And Normocalcemia (PDF). Dis Nerv Syst. August 1975, 36 (8): 461–5. （原始内容 (PDF)存档于2019-09-12）.
^ Spasmophilia in the Cardiological Outpatient Department: A Retrospective Study of 228 Sub-saharan Africans over 5 Years. ResearchGate. [2024-09-07]. （原始内容存档于2021-04-27）.
^ Ganong WF, Review of medical physiology, 15-th ed., 1995, Prentice Hall Int., London.
^ Guyton AC, Physiology of the human body, 6-th ed., 1984, Suanders College Publ., Philadelphia.
^ McArdle W.D., Katch F.I., Katch V.L., Essentials of exercise physiology (2-nd edition); Lippincott, Williams and Wilkins, London 2000.
^ Straub NC, Section V, The Respiratory System, in Physiology, eds. RM Berne & MN Levy, 4-th edition, Mosby, St. Louis, 1998.
^ McFadden ER & Lyons HA, Arterial-blood gases in asthma, The New Engl J of Med 1968 May 9, 278 (19): 1027-1032.
^ Johnson BD, Scanlon PD, Beck KC, Regulation of ventilatory capacity during exercise in asthmatics, J Appl Physiol. 1995 Sep; 79(3): 892-901.
^ Bowler SD, Green A, Mitchell CA, Buteyko breathing techniques in asthma: a blinded randomised controlled trial, Med J of Australia 1998; 169: 575-578.
^ Clark AL, Chua TP, Coats AJ, Anatomical dead space, ventilatory pattern, and exercise capacity in chronic heart failure, Br Heart J 1995 Oct; 74(4): 377-380.
^ Fanfulla F, Mortara , Maestri R, Pinna GD, Bruschi C, Cobelli F, Rampulla C, The development of hyperventilation in patients with chronic heart failure and Cheyne-Stokes respiration, Chest 1998; 114; p. 1083-1090.
^ Johnson BD, Beck KC, Olson LJ, O'Malley KA, Allison TG, Squires RW, Gau GT, Ventilatory constraints during exercise in patients with chronic heart failure, Chest 2000 Feb; 117(2): 321-332.
^ Dimopoulou I, Tsintzas OK, Alivizatos PA, Tzelepis GE, Pattern of breathing during progressive exercise in chronic heart failure, Int J Cardiol. 2001 Dec; 81(2-3): 117-121.
^ Tantucci C, Scionti L, Bottini P, Dottorini ML, Puxeddu E, Casucci G, Sorbini CA, Influence of autonomic neuropathy of different severities on the hypercapnic drive to breathing in diabetic patients, Chest. 1997 Jul; 112(1): 145-153.
^ Bottini P, Dottorini ML, M. Cordoni MC, Casucci G, Tantucci C, Sleep-disordered breathing in nonobese diabetic subjects with autonomic neuropathy, Eur Respir J 2003; 22: p. 654–660.
^ Tepper RS, Skatrud B, Dempsey JA, Ventilation and oxygenation changes during sleep in cystic fibrosis, Chest 1983; 84; p. 388-393.
^ Bell SC, Saunders MJ, Elborn JS, Shale DJ, Resting energy expenditure and oxygen cost of breathing in patients with cystic fibrosis, Thorax 1996 Feb; 51(2): 126-131.
^ Sinderby C, Spahija J, Beck J, Kaminski D, Yan S, Comtois N, Sliwinski P, Diaphragm activation during exercise in chronic obstructive pulmonary disease, Am J Respir Crit Care Med 2001 Jun; 163(7): 1637-1641.
^ Epstein SK, Zilberberg MD; Facoby C, Ciubotaru RL, Kaplan LM, Response to symptom-limited exercise in patients with the hepatopulmonary syndrome, Chest 1998; 114; p. 736-741.
^ Kahaly GJ, Nieswandt J, Wagner S, Schlegel J, Mohr-Kahaly S, Hommel G, Ineffective cardiorespiratory function in hyperthyroidism, J Clin Endocrinol Metab 1998 Nov; 83(11): 4075-4078.
^ Esquivel E, Chaussain M, Plouin P, Ponsot G, Arthuis M, Physical exercise and voluntary hyperventilation in childhood absence epilepsy, Electroencephalogr Clin Neurophysiol 1991 Aug; 79(2): 127-132.
^ Bergeron, J. David; Le Baudour, Chris. Chapter 9: Caring for Medical Emergencies. First Responder 8. New Jersey: Pearson Prentice Hall. 2009: 262. ISBN 978-0-13-614059-7.
^ Jones, M; Harvey, A; Marston, L; O'Connell, NE. Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults (review) (PDF). The Cochrane Database of Systematic Reviews. May 31, 2013, 5 (5): CD009041 [2024-09-07]. PMID 23728685. doi:10.1002/14651858.cd009041.pub2. （原始内容存档 (PDF)于2024-03-23）.
^ Hyperventilation Syndrome Medication. Medscape. [31 December 2013].
^ 呼吸病学（第3版）, 第3版, 978-7-117-31906-5
^ 中国心理卫生协会临床心理卫生手册. 内科分册, 第1版, 978-7-117-13017-2

外部連結

[1] 通气过度综合征. 术语在线. 全国科学技术名词审定委员会. （简体中文）

[2] 高通气综合征. 术语在线. 全国科学技术名词审定委员会. （简体中文）

[Edward_Newton-3] Medicine - Hyperventilation Syndrome: Article by Edward Newton, MD. [29 November 2016]. （原始内容存档于2008-10-25）.

[4] Seelig, MS; Berger, AR; Spielholz, N. Latent Tetany And Anxiety, Marginal Magnesium Deficit, And Normocalcemia (PDF). Dis Nerv Syst. August 1975, 36 (8): 461–5. （原始内容 (PDF)存档于2019-09-12）.

[5] Spasmophilia in the Cardiological Outpatient Department: A Retrospective Study of 228 Sub-saharan Africans over 5 Years. ResearchGate. [2024-09-07]. （原始内容存档于2021-04-27）.

[Ganong-6] Ganong WF, Review of medical physiology, 15-th ed., 1995, Prentice Hall Int., London.

[Guyton-7] Guyton AC, Physiology of the human body, 6-th ed., 1984, Suanders College Publ., Philadelphia.

[McArdle-8] McArdle W.D., Katch F.I., Katch V.L., Essentials of exercise physiology (2-nd edition); Lippincott, Williams and Wilkins, London 2000.

[Straub-9] Straub NC, Section V, The Respiratory System, in Physiology, eds. RM Berne & MN Levy, 4-th edition, Mosby, St. Louis, 1998.

[McFadden-10] McFadden ER & Lyons HA, Arterial-blood gases in asthma, The New Engl J of Med 1968 May 9, 278 (19): 1027-1032.

[JohnsonBD1-11] Johnson BD, Scanlon PD, Beck KC, Regulation of ventilatory capacity during exercise in asthmatics, J Appl Physiol. 1995 Sep; 79(3): 892-901.

[Bowler-12] Bowler SD, Green A, Mitchell CA, Buteyko breathing techniques in asthma: a blinded randomised controlled trial, Med J of Australia 1998; 169: 575-578.

[Clark-13] Clark AL, Chua TP, Coats AJ, Anatomical dead space, ventilatory pattern, and exercise capacity in chronic heart failure, Br Heart J 1995 Oct; 74(4): 377-380.

[Fanfulla-14] Fanfulla F, Mortara , Maestri R, Pinna GD, Bruschi C, Cobelli F, Rampulla C, The development of hyperventilation in patients with chronic heart failure and Cheyne-Stokes respiration, Chest 1998; 114; p. 1083-1090.

[JohnsonBD2-15] Johnson BD, Beck KC, Olson LJ, O'Malley KA, Allison TG, Squires RW, Gau GT, Ventilatory constraints during exercise in patients with chronic heart failure, Chest 2000 Feb; 117(2): 321-332.

[Dimopoulou-16] Dimopoulou I, Tsintzas OK, Alivizatos PA, Tzelepis GE, Pattern of breathing during progressive exercise in chronic heart failure, Int J Cardiol. 2001 Dec; 81(2-3): 117-121.

[Tantucci-17] Tantucci C, Scionti L, Bottini P, Dottorini ML, Puxeddu E, Casucci G, Sorbini CA, Influence of autonomic neuropathy of different severities on the hypercapnic drive to breathing in diabetic patients, Chest. 1997 Jul; 112(1): 145-153.

[Bottini-18] Bottini P, Dottorini ML, M. Cordoni MC, Casucci G, Tantucci C, Sleep-disordered breathing in nonobese diabetic subjects with autonomic neuropathy, Eur Respir J 2003; 22: p. 654–660.

[Tepper-19] Tepper RS, Skatrud B, Dempsey JA, Ventilation and oxygenation changes during sleep in cystic fibrosis, Chest 1983; 84; p. 388-393.

[Bell-20] Bell SC, Saunders MJ, Elborn JS, Shale DJ, Resting energy expenditure and oxygen cost of breathing in patients with cystic fibrosis, Thorax 1996 Feb; 51(2): 126-131.

[Sinderby-21] Sinderby C, Spahija J, Beck J, Kaminski D, Yan S, Comtois N, Sliwinski P, Diaphragm activation during exercise in chronic obstructive pulmonary disease, Am J Respir Crit Care Med 2001 Jun; 163(7): 1637-1641.

[Epstein-22] Epstein SK, Zilberberg MD; Facoby C, Ciubotaru RL, Kaplan LM, Response to symptom-limited exercise in patients with the hepatopulmonary syndrome, Chest 1998; 114; p. 736-741.

[Kahaly-23] Kahaly GJ, Nieswandt J, Wagner S, Schlegel J, Mohr-Kahaly S, Hommel G, Ineffective cardiorespiratory function in hyperthyroidism, J Clin Endocrinol Metab 1998 Nov; 83(11): 4075-4078.

[Esquivel-24] Esquivel E, Chaussain M, Plouin P, Ponsot G, Arthuis M, Physical exercise and voluntary hyperventilation in childhood absence epilepsy, Electroencephalogr Clin Neurophysiol 1991 Aug; 79(2): 127-132.

[25] Bergeron, J. David; Le Baudour, Chris. Chapter 9: Caring for Medical Emergencies. First Responder 8. New Jersey: Pearson Prentice Hall. 2009: 262. ISBN 978-0-13-614059-7.

[26] Jones, M; Harvey, A; Marston, L; O'Connell, NE. Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults (review) (PDF). The Cochrane Database of Systematic Reviews. May 31, 2013, 5 (5): CD009041 [2024-09-07]. PMID 23728685. doi:10.1002/14651858.cd009041.pub2. （原始内容存档 (PDF)于2024-03-23）.

[27] Hyperventilation Syndrome Medication. Medscape. [31 December 2013].

[28] 呼吸病学（第3版）, 第3版, 978-7-117-31906-5

[29] 中国心理卫生协会临床心理卫生手册. 内科分册, 第1版, 978-7-117-13017-2

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過度換氣症候群

症状

机制

診斷

流行慢性病

治疗

参考文献

外部連結

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