慢性咳嗽病因診斷及其治療培訓(xùn)課件

1、慢性咳嗽病因診斷及其治療慢性咳嗽病因診斷及其治療什么是慢性咳嗽?咳嗽反射途徑咳嗽會引起哪些機體不適及并發(fā)癥？2慢性咳嗽病因診斷及其治療什么是慢性咳嗽?2慢性咳嗽病因診斷及其治療 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。 胸片正常3慢性咳嗽病因診斷及其治療 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4慢性咳嗽病因診斷及其治療4慢性咳嗽病因診斷及其治療5慢性咳嗽病因診斷及其治療5慢性咳嗽病因診斷及其治療咳嗽并發(fā)癥 urinary incontinence fecal incontinence frequent retching dizziness swe

2、ating broken ribs.6慢性咳嗽病因診斷及其治療咳嗽并發(fā)癥 urinary incontinence 6慢案例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

3、 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.7慢性咳嗽病因診斷及其治療案例A 44-year-old man presented One week later, the patient reported that the treatmen

4、t 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.8慢性咳嗽病因診斷及其治療One week later, the patient reA five-day course of oxymetazoline nasal spray and doxycycline, 100 mg a day, were added to hi

5、s medical regimen. Within two weeks, he reported marked improvement. By three weeks, the cough was gone entirely. After four weeks, all medications were discontinued.9慢性咳嗽病因診斷及其治療A five-day course of oxymetazo慢性咳嗽的病因分析慢性咳嗽不同疾病的臨床表現(xiàn)10慢性咳嗽病因診斷及其治療慢性咳嗽的病因分析10慢性咳嗽病因診斷及其治療Common causes Postnasal drip Ast

6、hma 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 11慢性咳嗽病因診斷及其治療Common causes 11慢性咳嗽病因診斷及其治療Rare Causes of Chronic Cough Trac

7、heobronchial collapse Lung cancer Tuberculosis Other lung infection Occupational environment-induced cough Bronchiectasis Sarcoidosis 12慢性咳嗽病因診斷及其治療Rare Causes of Chronic Cough Rare Causes of Chronic CoughLeft ventricular failure Interstitial lung disease Metastatic breast carcinomatosis Hyperthyroi

8、dism Carcinoid tumor Retained suture Hodgkins disease Zenkers diverticulum13慢性咳嗽病因診斷及其治療Rare Causes of Chronic CoughLeEtiology: 0 to 18 months14慢性咳嗽病因診斷及其治療Etiology: 0 to 18 months14慢性咳嗽15慢性咳嗽病因診斷及其治療15慢性咳嗽病因診斷及其治療支氣管異物16慢性咳嗽病因診斷及其治療支氣管異物16慢性咳嗽病因診斷及其治療支氣管異物17慢性咳嗽病因診斷及其治療支氣管異物17慢性咳嗽病因診斷及其治療Etiology:

9、18 months to 6 years18慢性咳嗽病因診斷及其治療Etiology: 18 months to 6 years1.5 to 6 Years Etiology: Adolescents19慢性咳嗽病因診斷及其治療1.5 to 6 Years Etiology: Adole6 to 16 Years Etiology: Adults20慢性咳嗽病因診斷及其治療6 to 16 Years Etiology: Adults21慢性咳嗽病因診斷及其治療21慢性咳嗽病因診斷及其治療22慢性咳嗽病因診斷及其治療22慢性咳嗽病因診斷及其治療23慢性咳嗽病因診斷及其治療23慢性咳嗽病因診斷及其

10、治療后鼻滴流癥 就是鼻腔有較多分泌物, 咽后感有分泌物往下并常有清喉。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。24慢性咳嗽病因診斷及其治療后鼻滴流癥24慢性咳嗽病因診斷及其治療后鼻滴流癥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)周到幾個月時間。如伴有鼻竇炎則需用抗生素治療。25慢性咳嗽病因診斷及其治療后鼻滴流癥25慢性咳嗽病因診斷及其治療 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 對抗組胺藥與鼻腔激素反應(yīng)好。如果伴有慢性鼻竇炎

11、應(yīng)使用能覆蓋厭氧菌的廣譜抗生素至少三周同時加用鼻腔激素及血管收縮劑。在抗生素使用同時，短時間口服強的松（40mg/日5天）鼻竇炎的診斷敏感性不高，懷疑有慢性鼻竇炎時應(yīng)做CT掃描來確診。26慢性咳嗽病因診斷及其治療 后鼻滴流癥26慢性咳嗽病因診斷及其治療27慢性咳嗽病因診斷及其治療27慢性咳嗽病因診斷及其治療In some cases, no specific cause can be found for PND. When no correctable disease is present, attention is usually directed to thinning secretion

12、s so they can pass more easily. This is particularly true for the elderly, who often have inadequate fluid intake. These patients should drink eight glasses of water a day, eliminate caffeine, and avoid diuretics (fluid pills) if possible. 28慢性咳嗽病因診斷及其治療28慢性咳嗽病因診斷及其治療過敏性鼻炎與哮喘的關(guān)系 一、 哮喘（預(yù)期危險因素） : 23年隨

13、訪（前瞻性研究） 被隨訪者狀況 總?cè)藬?shù)* 新發(fā)哮喘人數(shù) % P值 過敏性鼻炎 162 17 10 Patient is a smoker -Purulent sputum -Patient taking an ACEI-High risk for TB exposure Wheezing - Possible diagnosisCongenital malformations Tobacco-induced bronchitis Pneumonia, bronchitis ACE inhibitor-induced cough Tuberculosis Asthma 58慢性咳嗽病因診斷及其治

14、療Clues to Common Causes of CougClues to Common Causes of Cough by History Nocturnal wheezing -Cough is worse at work -Cough following URI or exposure to allergen Sensation of postnasal drip -Facial pain, tooth pain -Heartburn or sour taste in mouth History of weight loss- Asthma, congestive heart fa

15、ilure Occupational environment cause Postnasal drip Postnasal drip, asthma Sinusitis Gastroesophageal reflux disease Cancer, tuberculosis 59慢性咳嗽病因診斷及其治療Clues to Common Causes of Coug總結(jié)慢性咳嗽是呼吸科門診最常見就診的癥狀引起慢性咳嗽的病因有多種，但最常見的疾病有三種，分別是后鼻滴溜綜合征、哮喘、胃食道返流綜合征。經(jīng)驗治療是鑒別和治療慢性咳嗽的主要手段60慢性咳嗽病因診斷及其治療總結(jié)慢性咳嗽是呼吸科門診最常見就診的

16、癥狀60慢性咳嗽病因診斷Diagnostic Protocol InitialEvaluation History Remove irritant Physical Exam Treat post nasal drip,sinusitis, etc Chest Xray 61慢性咳嗽病因診斷及其治療Diagnostic Protocol Initial61Treat/further evaluation Bronchoscopy Evaluate anatomy Remove foreign body Collect specimen for cultures, pathology Pulmonary FunctionTesting Spirometry -Treat asthma MIC Treat -asthma 62慢性咳嗽病因診斷及其治療Treat/further evaluation 62慢性咳GERDTesting pH probe - Treat GERD Upper GI series -Treat any anatomic abnorm