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1、慢性咳嗽病因診斷和治療廣州市第一人民醫(yī)院呼吸內(nèi)科曾軍副主任醫(yī)師什么是慢性咳嗽?咳嗽反射途徑咳嗽會(huì)引起哪些機(jī)體不適及并發(fā)癥？定義慢性咳嗽是指咳嗽癥狀持續(xù)3周以上，經(jīng)常規(guī)治療效果不佳且病因未明者。胸片正?？人圆l(fā)癥urinaryincontinencefecalincontinencefrequentretchingdizzinesssweatingbrokenribs.案例A44-year-oldmanpresentedwithcoughofthreeweeks'duration.Hewasotherwisehealthyanddidnotsmokecig
2、arettes.Thecoughhadbegunwithacoldbutpersistedafterothercoldsymptomshadresolved.Onquestioning,heacknowledgedasensationofpostnasaldrip.Achestx-rayshowednoabnormality.Acourseofbrompheniraminemaleate,6mgtwiceaday,andsustained-releasepseudoephedrinesulfate,120mgtwiceaday,wasinitiated.
3、Oneweeklater,thepatientreportedthatthetreatmenthadbroughtpartialreliefbutthathestillcoughedandclearedhisthroatfrequently.Four-viewsinusx-rayssubsequentlyshowedevidenceofchronicsinusitis.Afive-daycourseofoxymetazolinenasalsprayanddoxycycline,100mgaday,wereaddedtohismedicalregimen.
4、Withintwoweeks,hereportedmarkedimprovement.Bythreeweeks,thecoughwasgoneentirely.Afterfourweeks,allmedicationswerediscontinued.慢性咳嗽的病因分析慢性咳嗽不同疾病的臨床表現(xiàn)CommoncausesPostnasaldripAsthmaGastroesophagealrefluxTransientairwayhyperresponsiveness(e.g.,afterviralupperrespiratoryinfection)Med
5、ication-related(ACEinhibitors,betablockers)ChronicbronchitisSmokingandotherenvironmentalirritantsRareCausesofChronicCoughTracheobronchialcollapseLungcancerTuberculosisOtherlunginfectionOccupationalenvironment-inducedcoughBronchiectasisSarcoidosisRareCausesofChronicCoughLeftventri
6、cularfailureInterstitiallungdiseaseMetastaticbreastcarcinomatosisHyperthyroidismCarcinoidtumorRetainedsutureHodgkin'sdiseaseZenker'sdiverticulumEtiology:0to18months支氣管異物支氣管異物Etiology:18monthsto6years1.5to6YearsEtiology:Adolescents6to16YearsEtiology:Adults后鼻滴流癥就是鼻腔有較多分泌物,咽后感有分泌物往下
7、并常有清喉。體查可見咽后粘模表面粗糙呈鵝卵石樣改變。鼻后滴流是最常見的慢性咳嗽原因。后鼻滴流癥X線或鼻竇CT可見鼻竇炎。治療可用抗組胺藥和縮血管藥，也可加鼻腔激素噴劑。治療開始五天可用血管收縮劑，不要超過5天。治療鼻后滴流引起的慢性咳嗽需數(shù)周到幾個(gè)月時(shí)間。如伴有鼻竇炎則需用抗生素治療。后鼻滴流癥過敏性鼻炎和慢性鼻竇炎：過敏性鼻炎引起慢性咳嗽主要通過后鼻滴流對(duì)抗組胺藥與鼻腔激素反應(yīng)好。如果伴有慢性鼻竇炎應(yīng)使用能覆蓋厭氧菌的廣譜抗生素至少三周同時(shí)加用鼻腔激素及血管收縮劑。在抗生素使用同時(shí)，短時(shí)間口服強(qiáng)的松（40mg/日×5天）鼻竇炎的診斷敏感性不高，懷疑有慢
8、性鼻竇炎時(shí)應(yīng)做CT掃描來確診。Insomecases,nospecificcau
