慢性咳嗽的诊断与治疗2011巡讲ppt课件.pptVIP

* * 通常指非常见胸肺部疾病引起的慢性咳嗽，一般要求符合如下条件： （1）干咳作为唯一症状，或主要症状； （2）咳嗽持续3周或以上； （3）胸部影像学检查除外肺内明显病变； （4）能除外吸烟相关性咳嗽； （5）非血管紧张素转换酶抑制剂ACEI诱发者，如未用ACEI类药物或已停用4周以上仍咳嗽者； （6）无近期上呼吸道感染，或治疗8周以上仍咳嗽者。 符合上述条件CPC诊断成立。 * 慢性咳嗽的常见原因咳嗽变异型哮喘(CVA),上呼吸道综合征(UACS),嗜酸粒细胞性支气管炎(EB),胃食管反流性咳嗽(GERC).这些原因占了呼吸内科内科门诊慢性咳嗽比例的70%～95%.慢性咳嗽其它病因其它病因较少见,但涉及面广,如慢性支气管炎,支气管扩张,支气管内膜结核,变应性咳嗽(AC),心理性咳嗽等. * * A successful, systematic, anatomic, diagnostic protocol for evaluating patients with chronic cough was presented in 1981. To determine whether it was still valid, we prospectively evaluated, over a 22-month interval, 102 consecutive and unselected immunocompetent patients complaining of cough an average of 53 +/- 97 months (range, 3 wk to 50 yr). Utilizing the anatomic, diagnostic protocol modified to include prolonged esophageal pH monitoring (EPM), the causes of cough were determined in 101 of 102 (99%) patients, leading to specific therapy that was successful in 98%. Cough was due to one condition in 73%, two in 23%, and three in 3%. Postnasal drip syndrome was a cause 41% of the time, asthma 24%, gastroesophageal reflux (GER) 21%, chronic bronchitis 5%, bronchiectasis 4%, and miscellaneous conditions 5%. Cough was the sole presenting manifestation of asthma and GER 28 and 43% of the time, respectively. While history, physical examination, methacholine inhalational challenge (MIC), and EPM yielded the most frequent true positive results, MIC was falsely positive 22% of the time in predicting that asthma was the cause of cough. Laboratory testing was particularly useful in ruling out suspected possibilities. We conclude that the anatomic diagnostic protocol is still valid and that it has well-defined strengths and limitations. * * 诊断：常规抗感冒、抗感染治疗无效，支气管扩张剂治疗可以有效缓解咳嗽症状，此点可作为诊断和鉴别诊断的依据。肺通气功能和气道高反应性检查是诊断CVA的关键方法。 CVA治疗原则与哮喘治疗相同。大多数患者吸人小剂量糖皮质激素加β激动剂即可，很少需要口服糖皮质激素治疗。治疗时间不少于6~8周。 * * 4.治疗：依据导致PNDs的基础疾