慢性咳嗽的临床诊断和治疗VIP免费

上海医学20034f-*-26A第些搜·论著·慢性咳嗽的临床诊断和治疗谭申生沈策容朝晖张云娇A乙月【摘要】目的分析慢性咳嗽的病因分布和特异性治疗的疗效。方法对41例胸片正常的慢性咳嗽患者(咳嗽持续3周以上，除外吸烟及服用血管紧张素转换酶抑制剂者)进行前瞻性研究。根据临床表现、实验室检查及特异性治疗有显效或咳嗽消失进行诊断。结果所有慢性咳嗽患者均诊断明确。31例(75.6%)患者为单个病因，10例(24.4%)为2个以t病因。常见的致病因素:鼻后滴流综合征(PNDS)22例(41.5%)，哮喘12例(22.6%),胃食道反流病(GERD)9例(17.0%)，支气管扩张(BRO)3例(5.7%)感染后咳嗽4例(7.5%)0特异性治疗咳嗽消失时间:PNDS(17.115.0)d.哮喘(23.9士4.3)d,GERD(59.0士10.5)d,BRO(27-3士3.1)do结论PNDS,哮喘和GERD为慢性咳嗽最常见的3种病因，占总病种数的81.2%。特异性治疗效果好，故明确病因是治疗的关键。【关健词I慢性咳嗽;葬后滴流综合症;哮喘;骨食管反流病ClinicaldiagnosisandPul-rv,ShanghaitreatmentofchroniccoughTANShensheng,SHENa，RONGZhanhui,etal.DepnrirneotfSixthPeople'sHospital,ShanghaiJiaotungUniversity,Shanghai200233,[AbstractObjectiveToanalysethecausativefactorsandspecifictherapyofchroniccoughChinaMethodsProspectivestudyasperformedin41nonsmokingpatientswhocomplainedofcoughfor}>3weekswithnormalchestradiographs(excludethosetakingcapotenorally).Thepresentandpasthistories,physicalexamination,chestX-ray,chestHRCTscans,cytologicandbacteriologicexaminationsofsputum,bloodeosinophihccount,measurementofserumIgEandantibodiesofmycoplasmapneumonieandchlamydia,serumantibodiesofrespiratorytractvirus(influenzavirus,adenovirus,respiratorysyncytialvirus),lungfunctionandesophagealbariumexaminationwereperformed.Thefollowinginvestigationsweremadeaccordingtodemand:peakexpiratoryflowmonitoring,sinusCTscans,fiberopticbronchoscopy,rhinoscopy.Thefinaldiagnosiswasmadebyclinicalfeatures,resultsofclinicalinvestigationandtheresponsetospecifictherapy.ResultsThecausativefactorsofchroniccoughwereverifiedinallpa-tients,coughingduetosinglecausativefactorin31patients(75.6%)andmultiplefactorsin10patients(24.4%).Thecausativefactorsincludedpostnasaldrippingsyndrome(PNDS;22patients,41.5%),bronchialasthma(12patients,22.6%).gastre-sophageatrefluxdiseaseGERD(9patients,17.0'%),brouchiectasis(3patients,5.7%)andpostinfectiouscoughing(4patients,7.5%).Thetimefordisappearanceofcoughwas(17.115.0)dforPNDS,(23.914.3)dforasthma,(59.0110.5)dand(27.313.1)dforGERDandbronchiectasis,respectively.ConclusionPNDS,asthmaandGERDarethethree.mostcommoncausesofchroniccoughwhichareresponsiblefor81.2%ofthecases.Determinationofthecausativefactorsofcoughisthekeypointinthemanagement.(ShanghaiMed3,2003,26:745-747)[Keywords]Chroniccough;Pwtnasaldripsyndrome;Asthma;Gastrossophagealreflux慢性持续咳嗽是呼吸科门诊常见的就诊原因，在美国，不吸烟人群中成人慢性咳嗽发生率为14%一2396"'。本研究对41例不吸烟，未服用血管紧张素转换酶(ACEI)类药物且胸片正常的慢性咳嗽患者进行临床研究。应用神经解剖诊断原则分析咳嗽反射的产生及传导途径，作出初步诊断，给予特异性治疗并观察疗效，根据治疗效果分析慢性咳嗽的病因分布[27对象与方法作者单位:200233上海交通大学附属第六人民Ik院，上海市第六人民医院肺内科一、研究对象随机选择2002年3月一7月本院门诊及住院的41例患者，咳嗽持续3周以上，年龄18岁以上，X线胸片正常，除外吸烟或服用ACEI药物者。其中男16例(39.0%)，女25例(61.0%)。年龄18-78岁，平均为(40.2士18.9)岁;病程(连续咳嗽时间)1-480个月，平均为(37.4士104.9)个月;随访时间2-6个月。二、诊断方法所有患者询问过去史和现病史，进行体格检医生在线ShanghaiOreJ,2003,V.I.26,N..10查IX线...