慢性咳嗽病因诊断与治疗.pptVIP

慢性咳嗽病因诊断和治疗 广州市第一人民医院呼吸内科 曾 军 副主任医师 什么是慢性咳嗽? 咳嗽反射途径 咳嗽会引起哪些机体不适及并发症？ 定义 慢性咳嗽是指咳嗽症状持续 3周以上，经常规治疗效果不佳且病因未明者。 胸片正常 咳嗽并发症 urinary incontinence fecal incontinence frequent retching dizziness sweating broken ribs. 案例 A 44-year-old man presented with cough of three weeks duration. He was otherwise healthy and did not smoke cigarettes. The cough had begun with a cold but persisted after other cold symptoms had resolved. On questioning, he acknowledged a sensation of postnasal drip. A chest x-ray showed no abnormality. A course of brompheniramine maleate, 6 mg twice a day, and sustained-release pseudoephedrine sulfate, 120 mg twice a day, was initiated. One week later, the patient reported that the treatment had brought partial relief but that he still coughed and cleared his throat frequently. Four-view sinus x-rays subsequently showed evidence of chronic sinusitis. A five-day course of oxymetazoline nasal spray and doxycycline, 100 mg a day, were added to his medical regimen. Within two weeks, he reported marked improvement. By three weeks, the cough was gone entirely. After four weeks, all medications were discontinued. 慢性咳嗽的病因分析 慢性咳嗽不同疾病的临床表现 Common causes Postnasal drip Asthma Gastroesophageal reflux Transient airway hyperresponsiveness (e.g., after viral upper respiratory infection) Medication-related (ACE inhibitors, beta blockers) Chronic bronchitis Smoking and other environmental irritants Rare Causes of Chronic Cough Tracheobronchial collapse Lung cancer Tuberculosis Other lung infection Occupational environment-induced cough Bronchiectasis Sarcoidosis Rare Causes of Chronic Cough Left ventricular failure Interstitial lung disease Metastatic breast carcinomatosis Hyperthyroidism Carcinoid tumor Retained suture Hodgkins disease Zenkers diverticulum Etiology: 0 to 18 months 支气管异物 支气管异物 Etiology: 18 months to 6 years 1.