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1、上海医学20034f-*-26A第些搜·论著·慢性咳嗽的临床诊断和治疗谭申生沈策容朝晖张云娇A乙月【摘要】目的分析慢性咳嗽的病因分布和特异性治疗的疗效。方法对41例胸片正常的慢性咳嗽患者(咳嗽持续3周以上，除外吸烟及服用血管紧张素转换酶抑制剂者)进行前瞻性研究。根据临床表现、实验室检查及特异性治疗有显效或咳嗽消失进行诊断。结果所有慢性咳嗽患者均诊断明确。31例(75.6%)患者为单个病因，10例((24.4%)为2个以t病因。常见的致病因素:鼻后滴流综合征(PNDS)22例(41.5%)，哮喘12例(22.6%),胃食道反
2、流病(GERD)9例(17.0%)，支气管扩张(BRO)3例(5.7%)感染后咳嗽4例(7.5%)0特异性治疗咳嗽消失时间:PNDS(17.115.0)d.哮喘(23.9士4.3)d,GERD(59.0士10.5)d,BRO(27-3士3.1)do结论PNDS,哮喘和GERD为慢性咳嗽最常见的3种病因，占总病种数的81.2%。特异性治疗效果好，故明确病因是治疗的关键。【关健词I慢性咳嗽;葬后滴流综合症;哮喘;骨食管反流病ClinicaldiagnosisandtreatmentofchroniccoughTANShensh
3、eng,SHENa，RONGZhanhui,etal.DepnrirneotfPul-rv,ShanghaiSixthPeople'sHospital,ShanghaiJiaotungUniversity,Shanghai200233,China[AbstractObjectiveToanalysethecausativefactorsandspecifictherapyofchroniccoughMethodsProspectivestudyasperformedin41nonsmokingpatientswhocomp
4、lainedofcoughfor}>3weekswithnormalchestradiographs(excludethosetakingcapotenorally).Thepresentandpasthistories,physicalexamination,chestX-ray,chestHRCTscans,cytologicandbacteriologicexaminationsofsputum,bloodeosinophihccount,measurementofserumIgEandantibodiesofmyc
5、oplasmapneumonieandchlamydia,serumantibodiesofrespiratorytractvirus(influenzavirus,adenovirus,respiratorysyncytialvirus),lungfunctionandesophagealbariumexaminationwereperformed.Thefollowinginvestigationsweremadeaccordingtodemand:peakexpiratoryflowmonitoring,sinusC
6、Tscans,fiberopticbronchoscopy,rhinoscopy.Thefinaldiagnosiswasmadebyclinicalfeatures,resultsofclinicalinvestigationandtheresponsetospecifictherapy.ResultsThecausativefactorsofchroniccoughwereverifiedinallpa-tients,coughingduetosinglecausativefactorin31patients(75.6
7、%)andmultiplefactorsin10patients(24.4%).Thecausativefactorsincludedpostnasaldrippingsyndrome(PNDS;22patients,41.5%),bronchialasthma(12patients,22.6%).gastree-sophageatrefluxdiseaseGERD(9patients,17.0'%),brouchiectasis(3patients,5.7%)andpostinfectiouscoughing(4pati
8、ents,7.5%).Thetimefordisappearanceofcoughwas(17.115.0)dforPNDS,(23.914.3)dforasthma,(59.0110.5)dand(27.313.1)dforGERDandbronchiectasis,respectively.Conc
