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--> 00:02.049\n大家好，\n\n00:02.049 --> 00:03.874\n今天讲一个慢性咳嗽。\n\n00:06.902 --> 00:08.703\n我们讲呼吸道的一个解剖结构。\n\n00:15.159 --> 00:16.684\n那么一个是环状软骨，\n\n00:16.684 --> 00:20.959\n是上下界呼吸道的一个分辨的标志啊，\n\n00:20.959 --> 00:22.809\n这个大家在图上可以看到。\n\n00:24.903 --> 00:26.753\n这个是左主支气管支气管。\n\n00:27.611 --> 00:28.861\n这个是肺啊。\n\n00:34.930 --> 00:36.980\n接下来讲一下咳嗽发生的机制。\n\n00:39.236 --> 00:39.587\n那么。\n\n00:41.484 --> 00:42.784\n首先是一个感受器，\n\n00:42.933 --> 00:51.734\n喉及支气管横膈胸膜、食管快反应切声音的千张感受器，\n\n00:52.234 --> 00:54.083\n无睡觉的C纤维，\n\n00:54.083 --> 00:55.333\n它是作为感受器。\n\n00:56.373 --> 00:56.522\n那么，\n\n00:56.522 --> 00:57.272\n感受器呢，\n\n00:57.673 --> 00:58.647\n主要是什么？\n\n00:58.647 --> 01:03.548\n要炎症性、过敏性、物理性、化学性的一个物质，\n\n01:03.548 --> 01:05.773\n可能会引起接下来，\n\n01:06.123 --> 01:09.023\n通过一个传入神经啊，\n\n01:09.873 --> 01:18.023\n同侧的一个迷走神经、实叶神经、横膈神经能达到支气管粘膜的一个下层的腺体。\n\n01:19.439 --> 01:20.338\n进一步达到。\n\n01:21.759 --> 01:22.308\n咳嗽中枢，\n\n01:22.908 --> 01:24.259\n咳嗽中枢里面呢，\n\n01:24.259 --> 01:25.859\n传入神经纤维，\n\n01:25.859 --> 01:29.458\n在脊髓整合并传入咳嗽中枢。\n\n01:29.658 --> 01:30.259\n那么，\n\n01:30.259 --> 01:31.708\n接下来是一个传出神经，\n\n01:32.408 --> 01:34.058\n传出神经的一个是横膈，\n\n01:34.158 --> 01:35.708\n一个是脊髓神经，\n\n01:35.808 --> 01:36.833\n喉返神经，\n\n01:36.833 --> 01:39.308\n支气管束的一个迷走神经。\n\n01:39.408 --> 01:42.333\n那通过肌肉效应器啊，\n\n01:42.333 --> 01:44.208\n肌肉效应器作用于肌肉，\n\n01:44.359 --> 01:45.308\n呼吸肌，\n\n01:45.558 --> 01:47.408\n横膈喉。\n\n01:48.342 --> 01:48.842\n支气管。\n\n01:50.875 --> 01:52.275\n这是一个这样的一个流程。\n\n01:54.140 --> 01:56.341\n接下来讲一个咳嗽的一个分类。\n\n01:57.277 --> 01:57.577\n嗯。\n\n01:58.339 --> 01:59.739\n按照咳嗽时间呢，\n\n01:59.739 --> 02:01.639\n通常我们可以分为三类，\n\n02:01.889 --> 02:05.940\n一个急性的咳嗽小于三周。\n\n02:07.474 --> 02:10.425\n第二个亚急性咳嗽3到八周，\n\n02:10.774 --> 02:14.675\n第三个慢性咳嗽大于八周啊，\n\n02:14.675 --> 02:15.475\n这个概念呢，\n\n02:15.475 --> 02:20.074\n往往有些这个临床医生也可不能不一定很熟悉，\n\n02:20.225 --> 02:23.750\n我们基本上这个急性咳嗽比较常见的，\n\n02:23.750 --> 02:26.125\n但是我们一般是小于三周，\n\n02:26.125 --> 02:27.024\n不是两周啊。\n\n02:28.557 --> 02:28.707\n那么，\n\n02:28.707 --> 02:31.608\n讲一讲那个慢性咳嗽的定义啊。\n\n02:32.207 --> 02:35.957\n慢性咳嗽是指病程大于8周。\n\n02:36.957 --> 02:41.432\n而且是以咳嗽为唯一或主要的症状，\n\n02:41.432 --> 02:44.957\n胸部体格检查及X片呢，\n\n02:45.108 --> 02:47.582\n未见明显异常的临床症状。\n\n02:47.582 --> 02:48.658\n这是慢性咳嗽，\n\n02:48.658 --> 02:49.757\n其实慢性咳嗽啊，\n\n02:49.757 --> 02:50.807\n临床很常见。\n\n02:52.802 --> 02:55.102\n那么慢性咳嗽的常见疾病，\n\n02:55.203 --> 02:59.402\n第一个上气道咳嗽综合症。\n\n03:00.501 --> 03:01.826\n第二个咳嗽，\n\n03:01.826 --> 03:03.401\n变异性哮喘，\n\n03:03.550 --> 03:07.300\n第3个嗜酸粒细胞性支气管炎，\n\n03:07.600 --> 03:10.701\n第4个胃食管反流性咳嗽。\n\n03:13.507 --> 03:16.156\n那么其大家看一个表格里面啊，\n\n03:16.457 --> 03:18.807\n那个上气道咳嗽综合症，\n\n03:19.106 --> 03:24.307\n这个原来这个名称就叫鼻后滴流综合症。\n\n03:25.755 --> 03:29.304\n就是2005年的版本，\n\n03:29.404 --> 03:30.830\n09年版本就改成这样了，\n\n03:30.830 --> 03:33.304\n那从四个诊断上面大家看一看啊，\n\n03:33.455 --> 03:36.630\n这个其实咳嗽变异性哮喘啊，\n\n03:36.630 --> 03:39.304\n我们经常门诊上也碰到，\n\n03:39.304 --> 03:42.104\n那么还有一个胃食管反流也会。\n\n03:43.212 --> 03:43.761\n引起啊，\n\n03:43.761 --> 03:45.186\n胃食管反流性咳嗽，\n\n03:45.186 --> 03:47.662\n这个有往往有些人会忽视啊。\n\n03:52.337 --> 03:52.787\n那么，\n\n03:52.787 --> 03:54.938\n慢性咳嗽的常见疾病。\n\n03:56.240 --> 04:00.539\n大家看一看广州呼吸疾病研究所专科门诊啊，\n\n04:00.889 --> 04:02.414\n它这个里面啊，\n\n04:02.414 --> 04:03.339\n大家看一看啊，\n\n04:03.339 --> 04:08.089\n这个疾病最多的咳嗽病性哮喘27.9啊。\n\n04:09.727 --> 04:10.626\n这个病毒感染，\n\n04:10.626 --> 04:11.501\nEB病毒感染啊，\n\n04:11.501 --> 04:13.126\n包括胃食管反流十二，\n\n04:13.427 --> 04:15.826\n病因未明的也有十点五啊，\n\n04:15.977 --> 04:20.877\n那么我们现在主要讲一讲几个最最主要的一个疾病第一个。\n\n04:22.380 --> 04:26.029\n上气道咳嗽综合症USCS，\n\n04:26.230 --> 04:27.880\n那么它的定义是什么呢？\n\n04:28.230 --> 04:35.579\n它是鼻部疾病引起分泌物倒流至鼻后和咽喉等部位，\n\n04:35.779 --> 04:39.355\n直接或间接刺激咳嗽的感受器啊，\n\n04:39.355 --> 04:40.079\n刚刚讲过了，\n\n04:40.079 --> 04:43.130\n它是一个传入神经到传出神经啊，\n\n04:43.329 --> 04:50.230\n那么导致以咳嗽为主要表现的综合症被称为鼻后滴流综合症。\n\n04:50.230 --> 04:51.079\nPNDS啊，\n\n04:51.380 --> 04:52.329\n那么二零。\n\n04:52.640 --> 04:56.915\n06年的美国胸科医师协会ACCP制定的咳嗽指南呢，\n\n04:56.915 --> 05:01.839\n用UACS代替了PNDS有上气道咳嗽综合症，\n\n05:02.339 --> 05:07.339\n那么USS引起慢性咳嗽最常见的病因之一，\n\n05:07.390 --> 05:10.589\n它除了鼻部疾病外。\n\n05:11.460 --> 05:13.860\n还常与咽喉部的疾病有关，\n\n05:14.260 --> 05:20.860\n如变异性或变应性的咽炎、喉炎、咽喉部的新生物、慢性扁桃体炎等。\n\n05:25.108 --> 05:25.458\n那么，\n\n05:25.757 --> 05:32.808\n上气道咳嗽综合症USS的临床表现除了咳嗽咳痰之外，\n\n05:33.157 --> 05:35.708\n它可以表现为鼻塞。\n\n05:37.365 --> 05:38.615\n鼻腔分泌物增加，\n\n05:38.966 --> 05:40.265\n频繁的清嗓，\n\n05:40.765 --> 05:42.816\n咽喉粘液的附着，\n\n05:42.966 --> 05:44.265\n鼻后的滴流感。\n\n05:48.955 --> 05:49.506\n它的治疗，\n\n05:49.605 --> 05:52.756\n那非变异性鼻炎引起者呢，\n\n05:52.906 --> 05:57.555\n首选第一代的抗组胺药和减充血药。\n\n05:57.906 --> 05:59.555\n对变异性鼻炎呢，\n\n05:59.656 --> 06:02.756\n则推荐鼻腔吸入的糖皮质激素。\n\n06:03.505 --> 06:05.605\n和口服第二代抗组胺药。\n\n06:05.804 --> 06:08.554\n细菌性鼻鼻鼻窦炎时呢，\n\n06:08.654 --> 06:11.404\n应选择适当的抗生素。\n\n06:15.419 --> 06:20.669\n第二个讲一讲咳嗽变异性哮喘CVI啊，\n\n06:20.669 --> 06:22.319\n这个咳嗽变异性哮喘呢，\n\n06:22.769 --> 06:25.919\n这是其实也蛮常见的啊。\n\n06:26.019 --> 06:28.669\n我们现在这个国内呢，\n\n06:28.669 --> 06:31.269\n也是比较也是比较多见，\n\n06:31.269 --> 06:33.993\n特别是在呼吸科的门诊也是比较常见的。\n\n06:33.993 --> 06:35.419\n那么它的定义是什么呢？\n\n06:35.519 --> 06:37.569\n咳嗽变异性哮喘检测CV呢，\n\n06:37.569 --> 06:39.368\n是一种特殊类型的哮喘，\n\n06:39.419 --> 06:40.618\n它也是哮喘啊，\n\n06:40.618 --> 06:41.343\n大家记好，\n\n06:41.343 --> 06:41.993\n但是呢，\n\n06:41.993 --> 06:44.269\n它是以慢性咳嗽为。\n\n06:45.359 --> 06:46.933\n唯一的临床症状，\n\n06:46.933 --> 06:50.609\n也是慢性咳嗽的常见病因。\n\n06:51.755 --> 06:52.579\n咳嗽呢，\n\n06:52.579 --> 06:56.054\n是其主唯一或者主要的临床表现，\n\n06:56.605 --> 06:59.255\n它没有明显的一个喘息气促啊。\n\n06:59.255 --> 07:02.054\n他气喘明显症状体征呢。\n\n07:03.548 --> 07:04.497\n这个还是比较轻，\n\n07:04.497 --> 07:05.197\n但是呢，\n\n07:05.197 --> 07:07.548\n它有这个气道的高反应性，\n\n07:07.947 --> 07:09.298\n那在国内呢，\n\n07:09.398 --> 07:11.097\n这个咳嗽变异哮喘呢，\n\n07:11.148 --> 07:13.298\n是作为慢性咳嗽的所谓病因，\n\n07:13.347 --> 07:16.773\n它一般是占于慢性咳嗽的14%.62%，\n\n07:16.773 --> 07:18.648\n所以这个比例还是很高的。\n\n07:21.132 --> 07:24.183\n临床表现除慢性咳嗽外。\n\n07:25.483 --> 07:25.733\n那么，\n\n07:25.733 --> 07:26.808\n咳嗽变异哮喘呢，\n\n07:26.808 --> 07:33.282\n也存在于典型哮喘相似的一个嗜酸粒细胞性气道炎症和气道高反应性，\n\n07:33.632 --> 07:38.032\n但是它没有明显的喘息和呼吸困难等症状。\n\n07:38.683 --> 07:39.583\n哮部呢，\n\n07:39.583 --> 07:40.433\n肺部呢，\n\n07:40.983 --> 07:42.983\n有明没有明显的哮鸣，\n\n07:43.282 --> 07:45.782\n它主要表现为的是刺激性的干咳。\n\n07:46.415 --> 07:47.190\n通常的咳嗽呢，\n\n07:47.190 --> 07:47.765\n比较剧烈，\n\n07:47.765 --> 07:50.665\n夜间咳嗽为其主要特征。\n\n07:51.065 --> 07:57.815\n感冒、冷空气、灰尘、油烟等容易愈发或者加重咳嗽。\n\n08:02.343 --> 08:05.144\n咳嗽变异哮喘的一个诊断标准呢？\n\n08:06.029 --> 08:06.329\n第一点，\n\n08:06.329 --> 08:07.179\n慢性咳嗽。\n\n08:08.420 --> 08:12.019\n常伴有明显的夜间刺激性的咳嗽啊，\n\n08:12.019 --> 08:13.070\n一般以干咳为主。\n\n08:13.220 --> 08:14.019\n第二个呢，\n\n08:14.070 --> 08:16.369\n支气管的激发试验阳性，\n\n08:16.570 --> 08:21.470\n或者呼气呼气风流速一间变异率大于20%，\n\n08:21.570 --> 08:26.170\n或者支气管的舒张试舒张试验阳性。\n\n08:27.532 --> 08:27.981\n第三个呢，\n\n08:27.981 --> 08:31.481\n是支气管的舒张剂治疗有效。\n\n08:33.206 --> 08:33.656\n这个呢，\n\n08:33.656 --> 08:39.356\n一般是我们到那个呼吸科或者做一个肺功能的测试的时候呢，\n\n08:39.356 --> 08:40.856\n比较常见做这个别的。\n\n08:41.057 --> 08:46.406\n那么治疗咳嗽病哮喘的治疗原则与支气管哮喘的治疗原则是相同的。\n\n08:46.557 --> 08:48.081\n大多数的患者呢，\n\n08:48.081 --> 08:52.856\n他可以吸入小剂量的糖皮激素联合支气管的舒张剂。\n\n08:54.624 --> 08:57.323\n贝塔二受体激动剂或者氨茶碱等即可。\n\n08:57.994 --> 08:59.594\n或者用两者的复合制剂，\n\n08:59.594 --> 09:04.195\n如布地奈德、福特摩罗、氟替卡松沙、美特罗，\n\n09:04.244 --> 09:05.919\n必要时可短期口服。\n\n09:05.919 --> 09:06.794\n小剂量的。\n\n09:07.468 --> 09:07.992\n糖皮激素，\n\n09:07.992 --> 09:08.817\n比如说强基松，\n\n09:08.918 --> 09:10.343\n那么我们治疗时间呢，\n\n09:10.343 --> 09:12.192\n是大于等于八周啊。\n\n09:12.192 --> 09:16.168\n这个是讲的一个是咳嗽的一个变异性哮喘。\n\n09:17.721 --> 09:18.372\n接下来呢，\n\n09:18.372 --> 09:21.471\n我们讲一个嗜酸粒细胞性的支气管炎。\n\n09:22.366 --> 09:24.065\n那是简称EB，\n\n09:24.116 --> 09:25.291\n那么它的EB呢，\n\n09:25.291 --> 09:28.690\n占于慢性咳嗽病的也是比例比较高的，\n\n09:28.690 --> 09:29.366\n10%.30%，\n\n09:29.616 --> 09:30.940\n它的临床特点呢，\n\n09:30.940 --> 09:35.065\n是嗜酸性粒细胞性气道炎的炎症和慢性咳嗽。\n\n09:35.739 --> 09:36.515\n它但是呢，\n\n09:36.515 --> 09:39.640\n它没有气道高反应性支气管的扩张。\n\n09:40.814 --> 09:42.213\n治疗药无效啊，\n\n09:42.213 --> 09:46.213\n对糖皮素、糖皮质激素的治疗反应良好。\n\n09:46.814 --> 09:47.914\n临床表现呢，\n\n09:47.914 --> 09:52.414\n是主要表现为慢性刺激性咳嗽。\n\n09:53.450 --> 09:55.924\n常见的是唯一的临床症状，\n\n09:55.924 --> 09:59.299\n干咳或者咳少许的白色粘液痰。\n\n09:59.650 --> 10:01.900\n白天或者夜间咳嗽。\n\n10:02.000 --> 10:03.250\n那部分患者呢，\n\n10:03.349 --> 10:08.750\n对油烟、灰尘、异味或冷空气比较敏感，\n\n10:08.849 --> 10:11.200\n常为咳嗽的诱发因素。\n\n10:13.940 --> 10:14.140\n那么，\n\n10:14.140 --> 10:16.590\n嗜酸粒细胞性支气管炎的EB呢，\n\n10:16.590 --> 10:17.890\n它的一个诊断标准呢，\n\n10:18.390 --> 10:24.140\n是常常缺乏的特异性部分表现类似于咳嗽变异哮喘。\n\n10:24.289 --> 10:25.489\n那体格检查呢，\n\n10:25.489 --> 10:26.690\n无异常发现，\n\n10:26.989 --> 10:30.489\n诊断主要依靠诱导痰细胞学检查。\n\n10:30.840 --> 10:31.815\n具体标准如下，\n\n10:31.815 --> 10:32.190\n第一点，\n\n10:32.190 --> 10:32.989\n慢性咳嗽，\n\n10:33.039 --> 10:36.940\n它是多为刺激性干咳伴。\n\n10:37.948 --> 10:39.398\n或斑少许的粘痰，\n\n10:39.499 --> 10:41.924\n第二个X线胸片是正常的啊，\n\n10:41.924 --> 10:43.398\n这个要大家注意一下，\n\n10:43.398 --> 10:45.648\n肺通气功能是正常的。\n\n10:46.364 --> 10:48.664\n气道高反应性检查是阴性的，\n\n10:48.763 --> 10:51.364\n呼气风流速日渐变异的是正常的。\n\n10:51.513 --> 10:53.364\n主要是痰细胞学检查，\n\n10:53.414 --> 10:56.814\n嗜酸粒细胞百分比大于等于2%，\n\n10:57.064 --> 10:58.013\n排除其他。\n\n10:59.359 --> 11:01.159\n嗜酸粒细胞增多性的疾病。\n\n11:02.143 --> 11:02.544\n第二个呢，\n\n11:02.544 --> 11:05.468\n是口服或者吸入糖皮质激素呢，\n\n11:05.468 --> 11:06.294\n是有效的。\n\n11:06.843 --> 11:07.643\n那么治疗。\n\n11:09.546 --> 11:10.270\n治疗呢，\n\n11:10.270 --> 11:13.046\n是嗜三类细胞性的细支气管炎，\n\n11:13.395 --> 11:15.895\n对糖皮素激素治疗发育良好。\n\n11:16.245 --> 11:17.070\n治疗后呢，\n\n11:17.070 --> 11:19.895\n咳嗽很快消失或者明显减轻。\n\n11:20.195 --> 11:24.346\n所以通常采用是吸入性的一个糖皮质激素治疗，\n\n11:24.546 --> 11:30.445\n二丙酸贝洛米松或者等剂量的其他糖皮激素，\n\n11:30.546 --> 11:31.495\n一天两次，\n\n11:31.745 --> 11:34.395\n持续时间应大于四周啊。\n\n11:34.395 --> 11:36.395\n所以这个治疗呢，\n\n11:36.395 --> 11:37.495\n是跟这个。\n\n11:38.906 --> 11:42.080\n咳嗽变异哮喘是治疗是有点不一样的，\n\n11:42.080 --> 11:45.306\n西它是对糖皮质激素治疗较好的。\n\n11:45.505 --> 11:47.255\n那么接下来讲一个啊。\n\n11:50.291 --> 11:53.841\n胃食管反流性咳嗽GERC啊，\n\n11:54.341 --> 11:55.242\n这个往往呢，\n\n11:55.242 --> 11:56.992\n有可能很多人就不理解，\n\n11:56.992 --> 12:01.666\n这个胃食管反流梗怎么跟这个这个咳嗽关系的啊。\n\n12:01.666 --> 12:02.041\n那么，\n\n12:02.041 --> 12:03.817\n我们首先定义啊，\n\n12:03.817 --> 12:05.242\n胃食管反流性咳嗽呢，\n\n12:05.242 --> 12:08.892\n是胃酸和胃其他的胃内流反流进入食管，\n\n12:09.041 --> 12:11.992\n导致以咳嗽为突出表现的临床症状。\n\n12:12.708 --> 12:19.357\n典型的反流症状表现为烧心、胸骨后的烧灼感、反酸、嗳气等。\n\n12:19.757 --> 12:25.007\n部分胃食管反流引起的咳嗽伴有典型的反流症状，\n\n12:25.107 --> 12:29.458\n也有不少患者以咳嗽为唯一的症状。\n\n12:29.708 --> 12:31.357\n那么他的咳嗽呢，\n\n12:31.458 --> 12:33.507\n大多发生在夜间。\n\n12:35.051 --> 12:36.875\n日间或者直立位啊，\n\n12:36.875 --> 12:38.500\n从这图上大家看一看啊，\n\n12:38.801 --> 12:39.801\n直立位啊。\n\n12:42.916 --> 12:44.216\n它的诊断标准，\n\n12:44.617 --> 12:48.267\n一患者有明显的一个近视相关的咳嗽。\n\n12:49.056 --> 12:50.955\n比如说如餐后的咳嗽，\n\n12:51.005 --> 12:51.906\n进食咳嗽，\n\n12:51.906 --> 12:56.106\n第二个患者伴有典型的烧心反酸的一个反流症状。\n\n12:57.140 --> 12:57.541\n第三个，\n\n12:57.841 --> 12:59.940\n排除了刚刚几个，\n\n12:59.940 --> 13:03.390\n比如说咳嗽、变异性哮喘啊，\n\n13:03.390 --> 13:04.841\nUUACS的EB等疾病，\n\n13:05.041 --> 13:07.440\n或者按这些疾病的治疗，\n\n13:07.541 --> 13:08.841\n它效果不佳的。\n\n13:09.140 --> 13:12.866\n但是服用了标准剂量的质子泵，\n\n13:12.866 --> 13:14.716\n一次记入奥美拉唑20mg，\n\n13:14.716 --> 13:15.591\n一天两次，\n\n13:15.940 --> 13:17.791\n治疗时间大于等于8周，\n\n13:18.041 --> 13:19.341\n抗反酸。\n\n13:20.286 --> 13:21.387\n反流治疗后呢，\n\n13:21.387 --> 13:23.137\n咳嗽消失或者显著缓解，\n\n13:23.187 --> 13:27.286\n可以临床诊断为胃食管反流性咳嗽治疗，\n\n13:27.786 --> 13:29.786\n调整生活方式。\n\n13:33.596 --> 13:33.822\n那么，\n\n13:33.822 --> 13:34.846\n超重患者呢，\n\n13:34.846 --> 13:35.596\n应减肥，\n\n13:35.997 --> 13:38.396\n避免过饱或者睡前进食，\n\n13:38.396 --> 13:40.771\n避免进食酸性油腻食物，\n\n13:40.771 --> 13:45.296\n避免饮用咖啡类饮料和吸烟制酸药，\n\n13:45.447 --> 13:47.947\n常选用质子泵抑制剂。\n\n13:49.809 --> 13:50.359\n或者。\n\n13:51.544 --> 13:55.419\nHR受体拮抗剂以直质邦抑制剂效果为佳。\n\n13:55.619 --> 13:56.869\n那么第三个呢，\n\n13:56.869 --> 13:59.820\n错胃动力药如多潘立酮啊。\n\n14:00.169 --> 14:03.794\n那么少数内科治疗失败的严重反流患者呢，\n\n14:03.794 --> 14:05.919\n抗反流手术治疗可能有效。\n\n14:17.492 --> 14:20.841\n那么还有其他慢性咳嗽的病因及诊治？\n\n14:21.890 --> 14:24.590\n如气管支气管结核啊，\n\n14:24.590 --> 14:27.390\n这个气管支气管结核在国内并不罕见，\n\n14:27.640 --> 14:31.465\n那多数病合并肺内结核也有不少患者呢，\n\n14:31.465 --> 14:33.640\n仅表现为单纯性的支气管结核。\n\n14:33.739 --> 14:36.140\n它主要症状也是慢性咳嗽，\n\n14:36.190 --> 14:36.789\n但是呢，\n\n14:36.789 --> 14:40.940\n它可以伴有低热盗汗消瘦等结核的中毒症状。\n\n14:41.289 --> 14:44.039\n有些患者咳嗽是唯一的临床表现。\n\n14:44.239 --> 14:46.690\n对怀疑气管支气管结核的患者呢，\n\n14:46.690 --> 14:49.840\n应首先进行普通的痰涂片找抗酸杆菌。\n\n14:49.989 --> 14:52.039\n部分患者结合分支。\n\n14:52.161 --> 14:54.161\n杆菌的培养科阳性，\n\n14:54.161 --> 14:55.835\nCT特别提示呢，\n\n14:55.835 --> 14:57.161\n高分辨率提示呢，\n\n14:57.361 --> 15:01.760\n显示支气管病变正向较X胸片更为敏感，\n\n15:01.760 --> 15:04.760\n尤其能显示叶以下的支气管病变，\n\n15:05.161 --> 15:06.861\n可以间接提示诊断。\n\n15:07.010 --> 15:12.310\n支气管镜检是确诊支气管支气管结核的主要手段。\n\n15:13.046 --> 15:16.346\n镜下常规筛检和组织活检的阳性较高。\n\n15:16.497 --> 15:18.646\n第5种是血管紧张，\n\n15:18.646 --> 15:19.697\n是转化酶抑制剂。\n\n15:20.773 --> 15:21.822\n愈发的咳嗽，\n\n15:21.822 --> 15:23.547\nACEI利用了高血压，\n\n15:23.547 --> 15:24.372\nACEI出现的咳嗽，\n\n15:24.872 --> 15:25.872\n这种咳嗽呢，\n\n15:25.872 --> 15:28.848\n是是服用a CER降引起的常见的不良反应，\n\n15:28.848 --> 15:30.672\n发生率也是很高，\n\n15:30.672 --> 15:31.622\n10%.30%，\n\n15:31.872 --> 15:34.622\n它是占慢性咳嗽病因的。\n\n15:35.612 --> 15:36.013\n一到。\n\n15:37.963 --> 15:40.114\n三那么停用这个药物以后呢，\n\n15:40.114 --> 15:41.138\n咳嗽缓解可以缓解。\n\n15:41.138 --> 15:43.914\n通常一般停药四到四周之后呢，\n\n15:43.963 --> 15:46.013\n咳嗽消失或者明显减轻，\n\n15:46.213 --> 15:50.013\n可用于血管紧张素二受体拮抗剂代替ACEI药物。\n\n15:50.213 --> 15:50.989\n第六个呢，\n\n15:50.989 --> 15:52.164\n是支气管肺癌。\n\n15:52.364 --> 15:53.963\n那么支气管反初期症状呢，\n\n15:53.963 --> 15:56.614\n典型症状轻微而不典型，\n\n15:56.614 --> 15:57.513\n容易被忽视。\n\n15:57.664 --> 15:58.388\n咳嗽呢，\n\n15:58.388 --> 16:00.513\n常是为中心性肺癌的早期症状，\n\n16:00.814 --> 16:03.638\n早期X检查通常无异常，\n\n16:03.638 --> 16:05.138\n容易漏诊、误诊。\n\n16:05.138 --> 16:05.471\n因此，\n\n16:05.471 --> 16:06.914\n在详细性奋病史呢，\n\n16:07.064 --> 16:08.064\n对有长期。\n\n16:08.206 --> 16:09.656\n吸烟时出现刺激性咳嗽，\n\n16:09.807 --> 16:10.706\n痰中带血，\n\n16:10.706 --> 16:12.307\n痰中带血的大家注意啊，\n\n16:12.307 --> 16:17.531\n胸痛、消瘦等症状或源于咳嗽性质发生变改变的患者，\n\n16:17.531 --> 16:19.257\n应高度怀疑肺癌的可能，\n\n16:19.257 --> 16:22.757\n要进一步进行影像学的检查和支气管镜的检查。\n\n16:31.192 --> 16:33.143\n那么其他心理性咳嗽，\n\n16:33.143 --> 16:38.192\n心理性咳嗽是由于患者严重心理问题或有意清喉引起，\n\n16:38.393 --> 16:40.143\n典型表现就是日间咳嗽，\n\n16:40.192 --> 16:42.718\n专注于免疫事物或者夜间休息时呢，\n\n16:42.718 --> 16:43.543\n咳嗽消失了，\n\n16:43.643 --> 16:45.718\n常伴有焦虑的症状。\n\n16:45.718 --> 16:49.992\n心理性咳嗽的诊断是排除他其他性的一个诊断，\n\n16:50.043 --> 16:53.742\n只有排除其他可能的诊断后才能考虑这种诊断，\n\n16:53.893 --> 16:56.593\n那可辅以心理咨询和精神干预治疗，\n\n16:56.692 --> 16:58.393\n适当应用抗焦虑中。\n\n17:02.369 --> 17:02.568\n好，\n\n17:02.568 --> 17:03.169\n结束。\n\n","v0247cg10004d61iej2ljht06tftq080",1028,559,"2026-01-25 03:02:34","慢性咳嗽的原因、症状及治疗方法 - 专业指南  ","慢性咳嗽, 咳嗽原因, 咳嗽症状, 咳嗽治疗, 长期咳嗽, 咳嗽诊断, 咳嗽缓解  ","了解慢性咳嗽的常见原因、症状及有效治疗方法。本文提供专业建议，帮助您识别长期咳嗽的潜在问题并找到合适的解决方案。","2026-04-13 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