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郭红荣:咳嗽是隐疾信号久治不愈要警惕

2017-08-09 04:03:36   中国青年网

一位65岁的王老伯反复咳嗽三月余,在社区及门诊多次就诊,肺部CT没有发现明显异常,予以抗感染、止咳等处理,病情总是没有缓解,慕名来市三医院光谷院区呼吸科找郭红荣主任就诊。郭红荣主任通过仔细阅读CT片,建议王老伯做纤支镜检查,结果发现患者右上支气管腔内见一新事物,病理证实为鳞癌。通过综合评估患者系肺癌早期,立即转外科手术治疗,目前术后患者恢复良好。

郭红荣主任说,纤支镜检查是呼吸科非常成熟的常规检查手段,医生将一根带有探头细而柔软的管道从患者的鼻子或口腔进入气管直至各支气管段口进行检查和治疗,患者是在麻醉下进行检查的,过程并不可怕。对于一些长期迁延不愈的咳嗽患者,为探究病因进行纤支镜检查是必不可少的。

咳嗽是表相“真凶”或藏在别处

上个月,郭红荣主任接诊了一名中年患者刘先生,他说自己咳嗽有好几年了,就是干咳,没什么痰。这几年他没少去医院看病,医生诊断为慢性咽喉炎,试了各种抗感染、止咳的方法,就是反反复复不见好转。

郭主任仔细询问病史,问出了一句“有时候吃完饭后咳得特别厉害”,经过初步检查后,郭主任初步判断刘先生可能患有“胃食管反流”。郭主任安排消化内科医生参与会诊,进行胃镜检查,果然确诊为“胃食管反流病”。郭红荣介绍说,胃和食管之间有一个“闸门”,正常情况下,这个“闸门”只允许食管里的食物进入胃,不允许胃里的食物反流回食管。但有些人“闸门”出了故障会变松,如果吃得比较多,或是吃了一些不容易消化的食物,胃里的食物就会反流进食管,从而刺激咽喉部引起长期反复咳嗽。

但也有一部分胃食管反流患者并不会出现“吃饭后咳嗽加重”这样典型症状,不典型的症状还可能包括:频繁的清嗓子、反复发作的哮喘、治不好的慢性鼻炎、咽部异物感等,这时也应该考虑胃食管反流性咳嗽的可能。

当然,还有一些其他病因也会引起咳嗽,比如鼻窦炎、心脏病、部分口服的降压药等,同时部分患者的咳嗽跟心理因素有关。因此,出现咳嗽这一症状时,千万不要忽视,及时就医确病因,尽早得到合适的治疗。

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