安徽医科大学第一附属医院MBBS课程教案
课程 时间 地点 班级 课题 学时 课型 任课教师 教材 诊断学（双语版），吕卓人，雷寒主编，科学出版社，第1版，2006，北京 教具 PPT（多媒体课件） 1. Understand the definition of the dyspnea. 教学2. Master the mechanism and clinical features of dyspnea. 目标 3. Understand the etiology of dyspnea. 1.Definition of the dyspnea. 2.Mechanism and clinical feature of dyspnea, pay special attention to cardiac dyspnea. 教学重点难点Solutions: 及其解决Combining with clinic.Using examples, pictures to explain. Through the 方案 preparation before class, teaching in class and review after class to deepen the understanding of the contents. 参考“TEXTBOOK OF DIAGNOSTICS” (双语版) 科学出版社 资料 课后 作业 教学Summarize after class. 后记 1
安徽医科大学教案续页
教学过程 教学方法、手段 及时间分配 Present the concept of dyspnea by introducing respiratory physiology Total time for course: ------The full process of respiration. 2 hours 教学内容 DYSPNEA Definition Dyspnea is defined as an awareness of difficulty in breathing. It is therefore a symptom, usually described by the patient as “shortness of breath,” whether the sensation is due to actual difficulty in breathing or is essentially an awareness of hyperventilation. Etiology The most frequent causes of dyspnea are cardiorespiratory disease. The other is toxic, neuropsychogenic, hematologic, the increase of abdominal pressure (massive ascites, pregnancy etc). Mechanism and clinical feature 1. Respiratory dyspnea: Respiratory dyspnea is caused by abnormal ventilation and gas exchange, reduction in ventilatory capacity, hypercapnia and hypoxemia resulting from respiratory disease. (1) Inspiratory dyspnea (2) Expiratory dyspnea (3) Mixed dyspnea 2. Cardiac dyspnea Cardiac dyspnea is usually attributable to pulmonary vascular congestion resulting from the left and/or right heart failure. Left-sided heart failure leads to impaired gas exchange. Right-sided heart failure causes stasis systemic circulation. Symptoms of congestive heart failure can cause orthopnea and paroxysmal nocturnal dyspnea when elevated-filling pressure is present. Paroxysma nocturnal dyspnea is a specific symptom. 3. Toxic dyspnea. In the metabolic acidosis (uremia and diabetic ketosis), the acid metabolites stimulate the respiratory center, causing deep and regular respiration with snoring. 5min 10min 20min Apply a large number of clinical cases and pictures,which may make the students further understand the contents. 2
4. Neuro-Psychogenic dyspnea. Dyspnea may occur in the patients suffering from cerebro vascular diseases (intra cranial hemorrhage, elevated intracerebral pressure). The respiratory center loses the blood supply or is compressed. The respiration becomes deep, slow and irregular. 5. Hematologic dyspnea In severe anemia, sulfhemoglobinemia, methaemoglobinemia or carbon monoxide poisoning the decrease of oxygen-carrying capacity and oxygen content develop abnormal respiration and increased heart rate. 15min Accompanying symptoms Paroxysmal dyspnea with wheezing. 1. Dyspnea with chest pain. 2. Dyspnea with fever. 3. Dyspnea with coma 4. Dyspnea with cough and purulent sputum- 5. Dyspnea with large amount of foamy sputum Apply clinical cases to interpret the contents. 10min Key points to be asked in diagnosis 1.Occurrence of dyspnea 2.Inducement: inhaled any special smell? 3.Expression: Dyspnea in inhalation or in exhalation? Or in both? 4.Way of Dyspnea Occurrence: acute or progressive? 5.Connection with body position and movement 6.Difference in daytime and at night 7. Is there history of drug, poison or foreign substance intake? Is there history of cranial trauma Is there history of cardiac, pulmonary or nephridial disease Is there history of hyper-sensibility, toxication or dysautonomia disease etc. Ask two students to do role play(to take medical history of dyspnea) Case analysis （A case of dyspnea） 5min 10min CYANOSIS Definition Increased quantity of reduced hemoglobin/deoxyhemoglobin or present abnormal hemoglobin derivatives
5min 3
5min Mechanism of Cyanosis 1.Absolute increase of amount of reduced hemoglobin in blood, > 50g/L (capillary) 2.Nonfunctional hemoglobin such as methemoglobinor or sulfhemoglobin is present in blood. 5min Clinical Classification Central Type——caused by decreased SaO2 Peripheral Type——due to poor peripheral circulation and increased oxygen consumption in peripheral tissue. Mixed Type——caused by both the above factors 15min Cyanosis due to abnormal Hb derivatives 1.Methemoglobinemia：>30g/L in blood Intake or exposure to some drugs or chemicals, such as sulfa drugs, nitrite salt. “enterogenic cyanosis ” 2.Sulfhemoglobinemia Sulfhemoglobin >5g/L Caused by some drugs or chemicals,Spectroscope is helpful to diagnose Differentiation of central as opposed to peripheral 1.Skin temperature 2.If Cyanosis disappeares after massageing or warming? 3.If cyanosis aggravates after movement? 5min Accompanied symptoms of cyanosis. Clinical features Central Type——Warm skin, systemic cyanosis, with cardiac or pulmonary dysfunction disease, often has symptoms of palpitations, cough ,etc. Peripheral Type——In the distal limb and drooping parts, with low skin temperature. Cyanosis disappeares after massageing or warming. Usually accompanied with systemic venous congestion or peripheral arterial occlusion and spasm. Mixed type——Both the above. 1.Cyanosis + Dyspnea Disorders of respiratory or cardiovascular system 2.Cyanosis with mild or no dyspnea Methemoglobinemia Sulfhemoglobinemia: Spectroscopy helpful 3.Cyanosis + clubbing Severe, long duration 4
5min The interrogation points 1.particularly the onset (cyanosis present since birth is usually due to congenital heart disease) 2.possible exposure to drugs or chemicals that may produce abnormal types of hemoglobin Case analysis
5min Through the case analysis, students can further understand the differentiation of central as opposed to peripheral cyanosis. 5
因篇幅问题不能全部显示，请点此查看更多更全内容