79例慢性咳嗽病因分析及诊治

Analysis of 79 Cases with Chronic Cough

目的分析79例慢性咳嗽的病因及治疗。方法根据中华医学会呼吸分会制定的《咳嗽的诊断与治疗指南》中慢性咳嗽的定义及诊断流程,对79例慢性咳嗽患者询问病史,查体,行胸部X线及CT、肺功能、支气管舒张试验、胃镜检查、副鼻窦拍片、痰细胞学分类及心脏彩超等检查。结果79例中咳嗽变异性哮喘51例(占64.56%);鼻后滴漏综合征10例(占12.70%);胃食管反流病11例(占13.92%);慢性心功能不全6例(占7.60%);药物性咳嗽6例(占6.30%);感染性咳嗽2例(占2.50%);贲门失弛缓症3例(占3.79%);嗜酸细胞性支气管炎2例(占2.50%);病因未明的2例(占0.01%)。单一病因66例(占83.54%),两种以上病因13例(占16.46%)。经针对性治疗,75例(占94.90%)患者咳嗽完全缓解,4例(占5.10%)症状有所改善。结论慢性咳嗽主要病因是咳嗽变异性哮喘,其次是鼻后滴漏综合征和胃食管反流病,同时不能忽视慢性心功能不全和ACEI类药物,病因明确后,经针对性治疗,大多数患者症状缓解,充分说明了慢性咳嗽病因诊断的重要性。

Objective To analyze the causes and the therapy of chronic cough. Methods Totally 79 patients with chronic cough were diagnosed according to the diagnostic routine based on the guideline on diagnosis and treatment of chronic cough established by Chinese Medical Association,which included medical history,medical examination,X-ray or CT of paranasal sinus or chest,lung function,bronchodilatation, gastmscope, sputum cytology classification, and heat color uhrasonography. The pathogeny and curative effect of chionic cough were detemined in the light of objective sign, examination results,and response to specific therapy. Results The chronic cough due to a single cause was con- firmed in 66 patients（83.54%）,and due to multiple causes in 13 patients（16.46%）. Among all the patients,cough variable asthma（CVA） was found in 51patients（64.56%）,postnasal drip syndrome（PNDs） in 10 patients（12.70%）,gastmesopha-geal reflux（GERC） in 11 patients（13.92%）, chronic cardiac insufficiency （ CCI ） in 6 patients （ 7.60% ）, drug （ ACEI and ASP ） induced coughin 6 patients （ 6.30% ）, post-infection cough （ PIC ）in 2 patients （ 2.50% ）, ac halasia of cardia in 3 patients （ 3.79% ）, eosinop hilic bronchitis （ EB ） in 2 patients （ 2.50% ）, unidentifiedcough in 4 patients（5.10%）. Conclusion The main cause cough of chronic cough is CVA,the next is PNDs and GERC. CCI and ACEI,however,are also considerable. The suffering of most patients could be greatly alleviated through definite diagnosis and specific treatment.