每日一题_2023.09.08

A 34-year-old man presented to the emergency department with a 10-day history of shortness of breath that worsened when he bent forward or laid supine and abated when he sat upright. His respiratory rate was 36 breath per minute, and his oxygen saturation was 98% when sitting upright and 88% when supine in room air. On physical examination, the lungs were clear and accessory inspiratory muscles were engaged. When the patient laid supine, the abdominal wall paradoxically moved inward during inspiration (left) and outward during expiration (right). Which of the following is not a test used to confirm the cause of the patient’s dyspnea?

一名34岁男性因呼吸短促10日到急诊科就诊，前屈或仰卧时呼吸短促加重，直立坐立时呼吸短促减轻。患者的呼吸频率为36次/分，直立坐姿时的氧饱和度为98%，仰卧时的氧饱和度为88%。体格检查时，肺透明，辅助吸气肌交战。当患者平卧时，吸气时腹壁矛盾地向内移动(左)，呼气时腹壁矛盾地向外移动(右)。下列哪一项不是用来确认病人呼吸困难原因的试验?

A. Chest radiography 胸片

B. Measurement of inspiratory pressures 吸气压力的测量

C. Polysomnography 多导睡眠描记术

D. Pulmonary function tests 肺功能检查

E. Ultrasonography of the diaphragm 膈肌超声检查

答案解析：

除多导睡眠描记术外，上述所有检查均可用于识别双侧膈肌麻痹——当患者在呼吸过程中出现反常腹部运动时，应考虑这一诊断。在该病例中，吸气和呼气期间获得的胸片显示两侧膈肌运动不足。肺量测定还发现，当患者从直立位移动到仰卧位时，用力肺活量减少50%以上。膈肌麻痹的潜在原因包括影响神经系统、肌肉本身或神经肌肉接头的过程。该患者的颈椎磁共振成像显示C3至C6椎管狭窄并伴有骨髓炎。患者开始接受夜间持续气道正压通气，并被转诊接受进一步评估。

正确答案：C