慢性咳嗽的临床诊断与治疗  

Clinical and Etiological Diagnosis and Treatment of Chronic Cough

作　　者：楚辉[1] 张杰[1] 林隆[1] 

机构地区：[1]首都医科大学附属北京天坛医院呼吸内科

出　　处：《首都医科大学学报》2006年第1期52-55,共4页Journal of Capital Medical University

摘　　要：目的探讨慢性咳嗽的病因分布和诊断,评价特异性治疗的疗效。方法采用Irwin的慢性咳嗽解剖学诊断流程,并补充痰细胞分类检查,对125例慢性咳嗽的病因进行分析,并针对慢性咳嗽的病因给予特异性治疗。无痰者采用5%高渗盐水雾化吸入诱导痰的产生。所有患者均符合咳嗽时间大于3周,胸片阴性,年龄大于14岁,不吸烟或戒烟4周以上的入选标准。结果125例慢性咳嗽患者中确诊114例,确诊率91.2%。其中咳嗽变异性哮喘(CVA)29例,占23.2%;鼻后滴漏综合征(FNDS)28例,占22.4%;感染后咳嗽(PIC)23例,占18.4%;胃食管反流性咳嗽(GER)16例,占12.8%;血管紧张素转换酶抑制剂(ACEI)类药物诱导的药源性咳嗽15例,占12%;嗜酸粒细胞性支气管炎(EB)3例,占2.4%。114例确诊患者经特异性治疗后,107例(93.9%)得到临床控制,7例(6.1%)咳嗽部分缓解。结论慢性咳嗽的解剖学诊断流程及诱导痰细胞分类学检查是诊断慢性咳嗽的重要手段。CVA、FNDS、PIC、GER、ACEI类药物诱导的药源性咳嗽、EB等是慢性咳嗽的主要病因,针对咳嗽病因的特异性治疗效果良好。Objective To investigate the causes of chronic cough in Chinese patients with chronic cough and assess the efficacy of specific therapy. Methods Adopting a diagnostic protocol distribution of cough receptors designed by Irwin, and additional cytological assay of sputum, we made etiological diagnoses of the chronic cough and treated the patients with specific therapy. We got the sputum of the patients who could not expectorate by a way of inhaling 5% hypertonic saline. The patients who complained of cough 3 weeks or longer, age≥14, nonsmoking or had given up smoking ≥4 weeks and with normal chest X ray were enrolled into our study in the time period of July 2004 to February 2005. Results Definite diagnosis was made in 114 out of the 125 patients with chronic cough. The causes included cough variant asthma, 29/125, 23.2%, postnasal drip syndrome, 28/125,22.4%, post infectious cough, 23/125, 18.4%, gastroesophageal reflux, 16/125, 12.8%, cough induced by angiotension-converting enzyme inhibitor, 15/125, 12%, eosinophilic bronchitis, 3/125, 2.4 %. The causes of chronic cough in 11 patients （ 11/125, 8.8 % ） had not been diagnosed. After treatment with specific therapy based on diagnosis, cough disappeared in 107 patients （93.9%） and alleviated in 7 patients （6.1% ）. Conclusion The diagnostic protocol based on the anatomy and distribution of cough receptors designed by Irwin, as well as cytological assay of sputum are the important methods in the diagnosis of chronic cough. Cough variant asthma, postnasal drip syndrome, post infectious cough, cough induced by angiotension converting enzyme inhibitor, gastroesophageal reflux, and eosinophilic bronchitis are the most common causes of chronic cough. And specific therapy based on diagnosis is effective.

关 键 词：慢性咳嗽 病因 诊断 治疗 

分 类 号：R441.5[医药卫生—诊断学]