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Cyanosis

[fā gàn]

Symptoms

Cyanosis refers to Deoxyhemoglobin The increase is a kind of expression that makes the skin and mucous membrane appear cyan and purple. It can also be called Cyanosis 。 This change often occurs in thin skin, less pigment and blood capillary Abundant parts, such as lips, fingers (toes) Nail bed Etc.

TCM disease name: Cyanosis
Alias: Cyanosis
Visiting department: Cardiac surgery

Common location: heart , lungs, lower limbs
Common causes: It is caused by the decrease of arterial oxygen saturation due to heart and lung diseases or the obstruction of peripheral circulation blood flow or both
common symptom: The skin and mucous membrane are cyan

catalog

▪ mixed cyanosis
three Etiology and clinical manifestations
four Key points of consultation
five Treatment and related health care methods

Occurrence mechanism

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The color of skin and mucosa changes with the color of blood flow. The red color of blood is due to red blood cell Contains hemoglobin 。 When hemoglobin Fully combine with oxygen to become Oxyhemoglobin Its color is bright red; When it emits oxygen, it becomes Deoxyhemoglobin The color turns dark red when the. Arteries and blood capillary The blood in it contains Oxyhemoglobin Many Deoxyhemoglobin It is less, so its color is bright red. Through the thin mucosa and translucent nails, the red color is still obvious.

The skin is thick and contains pigment, so it is red in white or reddish in light brown. veinal blood Due to inclusion Deoxyhemoglobin Many Oxyhemoglobin Less, so it is dark red. Through the skin, it appears cyan. Arm Previous One of the commonly called "blue veins" is vein. aniline 、 nitrobenzene and nitrite And other chemicals can make hemoglobin It becomes denatured hemoglobin, which itself is purple. Therefore, the capillaries and arteriole Hematogenous Oxyhemoglobin Decrease, while Deoxyhemoglobin When there is an increase or denatured hemoglobin Cyanosis 。

In blood Deoxyhemoglobin Increase Skin mucosa It is cyan. Usually in capillary blood Deoxyhemoglobin More than 50g/L can be formed Cyanosis 。 Cyanosis It can be divided into central, peripheral and Miscibility 。 In addition, drugs and chemicals poisoning lead to abnormalities in blood hemoglobin The appearance of derivatives can also form Cyanosis 。

classification

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central cyanosis

This kind of cyanosis is characterized by being systemic, involving the skin of the trunk and mucous membrane in addition to the limbs and face, but the skin of the affected part is warm. Cyanosis is mostly caused by heart and lung diseases Respiratory failure Ventilation and Ventilatory dysfunction , Lung Oxygenation Inadequate SaO2 reduction. Generally, it can be divided into: ① Pulmonary cyanosis : i.e. due to respiratory function Incomplete, lung Oxygenation Inadequate. Common in various serious Respiratory diseases , such as throat, trachea a bronchial tube Blocking pneumonia , blocking emphysema 、 Diffuse pulmonary interstitial fibrosis 、 Pulmonary congestion 、 pulmonary edema 、 Acute respiratory distress syndrome 、 pulmonary embolism 、 Primary pulmonary hypertension Etc; ② Heart nature mixed cyanosis : Due to abnormal channel diversion, part of veinal blood Failed Pulmonary circulation conduct Oxygenation The human circulatory arteries, such as Cardiac output 1/3, cyanosis can occur. Common in cyanotic type Congenital heart disease , such as Fallot tetralogy, Eisenmenger syndrome, etc.

peripheral cyanosis

Such cyanosis is often caused by peripheral circulatory blood flow disorders. It is characterized by cyanosis, which often occurs at the extremities and pendulous parts of the limbs. The skin of these parts is cold, but if massage or heating is given to warm the skin, cyanosis can subside. This feature can also be used as central cyanosis Identification point of. This type of cyanosis can be divided into: ① blood stasis peripheral cyanosis: common in Systemic circulation Congestion Diseases with slow peripheral blood flow, such as Right heart failure 、 Exudative pericarditis 、 Pericardial tamponade 、 Constrictive pericarditis 、 Thrombophlebitis 、 Superior vena cava obstruction syndrome 、 Varicose veins of lower limbs Etc; ② Ischemic peripheral cyanosis : often caused by Cardiac output Reduced disease and Local blood flow Obstructive diseases, such as severe shock, exposure to cold and neutralization Thromboangiitis obliterans Renault（ Raynaud ）Disease, acrocyanosis Cryoglobulinemia Etc.

mixed cyanosis

Central cyanosis and peripheral cyanosis coexist. Visible in heart failure Etc.

Etiology and clinical manifestations

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（1） In blood Deoxyhemoglobin increase

1． central cyanosis : Caused by heart and lung diseases Arterial oxygen saturation Caused by reduction. because Respiratory diseases Cyanosis caused by Pulmonary cyanosis , common in Airway obstruction 、 Severe pneumonia 、 Pulmonary congestion 、 pulmonary edema . Pleural effusion Spontaneous pneumothorax Etc. because Cardiovascular disease Cyanosis caused is called cardiac cyanosis, which is common in Tetralogy of Fallot Isocyanotic type Congenital heart disease 。 Its clinical feature is general cyanosis, except limbs End And face（ lips , nose tip, cheek Earlobe ）In addition, cyanosis can also be seen on the skin and mucosa of the trunk (including the tongue and oral mucosa), and the skin of the cyanotic part is warm, and cyanosis does not disappear after local warming or massage.

2. Peripheral cyanosis: due to the disturbance of peripheral circulation blood flow. See at Systemic circulation Congestion Peripheral tissue blood flow Inadequate perfusion 、 Local blood circulation disorder , such as Right heart failure , a large number of pericardial effusion , severe shock Thromboangiitis obliterans , cold stimulation, etc. Its clinical feature is that cyanosis often occurs at extremities and pendulous parts, such as extremities Earlobe , nose tip, etc., the skin of the cyanotic part is cool. If it is warmed or massaged to make it warm, the cyanosis can be alleviated or disappeared.

3． mixed cyanosis : Central cyanosis coexists with peripheral cyanosis, which is common in all Heart failure 。

（2） Exception hemoglobin Hematemia

1. Methemoglobinemia: may be caused by Primaquine Linen, nitrite Sulfonamides , nitrobenzene, aniline and other drugs or chemicals poisoning; It can also be caused by eating a lot of spoiled vegetables containing nitrite“ Enterogenic cyanosis ”。 Its clinical characteristics are sudden cyanosis, temporary and critical, Oxygen therapy Green and purple, drawn out veinal blood It is dark brown and cannot change to bright red when exposed to air, if intravenous injection Methylene blue 、 Sodium thiosulfate Or large dose vitamin C , can make Cyanosis Decline. There are very few Methemoglobinemia It is congenital. The patient has cyanosis since childhood, has a family history, and is in good health.

2. Hemoglobinemia sulfide: Methemoglobinemia Can be caused by Hemoglobinemia Sulfide However, the patient also has constipation or takes sulfide, which forms a large amount of hydrogen sulfide by precondition 。 The clinical characteristics of this kind of cyanosis are that it lasts for a long time, up to several months or more, and the patient's blood is blue brown.

Key points of consultation

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1. Occurrence of cyanosis: age of occurrence, onset time, possible inducement, and urgency of occurrence.

2. Characteristics and severity of cyanosis: pay attention to the location and scope of cyanosis, the degree of cyanosis, whether it is systemic or local; The temperature of the skin at the cyanotic part, whether the cyanosis can subside after massage or heating; Whether cyanosis is accompanied by dyspnea. Systemic cyanosis is found in cardiopulmonary diseases and abnormalities hemoglobin Hematemia ； However, severe cyanosis of cardiopulmonary disease is often accompanied by dyspnea and abnormality hemoglobin The patients with anemia generally have no dyspnea. red blood cell Cyanosis is obvious in the increased patients, while shock and anemia Cyanosis is not obvious.

3. Relevant medical history: whether there is a history of cardiorespiratory disease and other diseases related to cyanosis; Whether it occurs at birth and childhood Cyanosis ； Yes No family history ； Whether there is a history of ingestion of related drugs, chemicals, spoiled vegetables, and a history of overeating eggs or sulfides under persistent constipation.

4. Accompanying symptoms: acute cyanosis Consciousness obstacle Seen in some drugs or chemistry material acute poisoning , Shock, Acute pulmonary infection , Acute pulmonary edema Etc; Cyanotic companion Pestle finger (toe) seen in cyanotic type Congenital heart disease , some chronic Pulmonary diseases ； Cyanosis with dyspnea is found in severe heart and lung diseases pneumothorax , a large number of Pleural effusion etc.

Pestle finger and Cyanosis （ Heart failure Physical signs)

Treatment and related health care methods

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1. The cyan is only limited to the ends of the limbs Auricle , nose tip and other low temperature parts peripheral cyanosis It can be improved after keeping warm.

2. Infants with systemic cyanosis dyspnea Should be considered amniotic fluid Inhale, choke milk or vomit, and immediately use a straw to suck it Aspirate , and give oxygen. Suspicious pneumonia Patients were treated with antibiotics.

3． Immature child Systemic cyanosis, suspected Atelectasis and Respiratory distress syndrome Positive pressure oxygen should be given and further diagnosis should be made.

4. Cyanosis and dyspnea Or convulsions, etc intracranial hemorrhage And make corresponding treatment.

5. Systemic cyanosis with heart Positive signs Those with congenital heart malformations diaphragmatic hernia or Tracheoesophageal fistula And other departments.

Relevant health care methods include:

1. For Neonatal cyanosis , oxygen treatment should be given in time. Cyanosis indicates hypoxia in the body, which may cause damage to the brain, heart, kidney, lung and other important organs of the newborn, thus affecting his intelligence and Physical development 。

2. In the family, the oxygen generator can produce oxygen to meet the oxygen needs of newborns. But you must choose absolutely safe equipment, Oxygen generator There should be no side effects. The use of home oxygen generator is Neonatal hypoxia To save time and avoid irreversible damage to organ development and intellectual development due to prolonged hypoxia.

3. Keep warm and keep respiratory tract It is unobstructed to prevent milk and vomit from choking the air pipe.

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