儿童紫绀的病因及评估
- Author
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Section Editor
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
- Translators
- 卢慧玲, 副主任医师，副教授
卢慧玲, 副主任医师，副教授
- 华中科技大学同济医学院附属同济医院儿科
引言
本专题将讨论儿童紫绀的鉴别诊断和处理方法。
背景
紫绀是指毛细血管床血液中还原型血红蛋白浓度增加时皮肤和黏膜出现的蓝紫色改变，多种疾病可引起紫绀，其中很多甚至可危及生命[1]。紫绀最常见于嘴唇、甲床、耳垂、黏膜和其他皮肤较薄的部位。不同的光照条件和肤色可增强或减弱紫绀。危及儿童生命的紫绀大多由呼吸系统疾病引起。
定义
紫绀有两种发生机制：全身动脉血氧饱度下降和以及组织氧摄氧增加。根据这两种发生机制可将紫绀分为两种类型：中心型紫绀和周围型紫绀。此外，一些皮肤问题也可导致类似于紫绀的皮肤蓝色改变，但其毛细血管床血液中的还原型血红蛋白含量并未增加。 (参见下文‘皮肤问题’)
中心型紫绀 — 当全身动脉血中还原型血红蛋白(hemoglobin, Hb)含量超过5g/dL(3.1mmol/L)(血氧饱和度≤85%)时，则会出现中心型紫绀[2]。有一点应注意，若患者有严重贫血[Hb<5g/dL(3.1mmol/L)]，则仅凭肉眼观察无法发现紫绀。
周围型紫绀 — 周围型紫绀患者的全身动脉血氧饱和度正常。然而，组织摄氧增加会导致全身动静脉血氧差增大和静脉侧毛细血管内还原型血红蛋白浓度增加。摄氧增加是由毛细血管内血流缓慢引起的。其原因包括血管舒缩功能不稳定、寒冷环境中血管收缩、静脉梗阻、静脉压增大、红细胞增多症和低心输出量。
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