两种雾化吸入方式诱发慢性阻塞性肺疾病咳嗽反射的临床观察

目的探讨治疗慢性阻塞性肺疾病（COPD）患者更好的雾化方法。方法采用随机分组自身对照研究的方法,将60例患者分为两组,A组：氧气驱动雾化吸入;B组：超声雾化吸入。每天雾化吸入2次,每次15min,连续观察7d。动态记录两组在雾化过程中咳嗽反射发生次数及发生率。结果 A组吸入过程中咳嗽发生率为3.33%,B组吸入过程中咳嗽发生率为30.00%,差异具有统计学意义（P〈0.05）。结论 COPD患者进行雾化吸入治疗,选择氧气驱动雾化吸入,能有效降低患者的不适咳嗽反射,改善通气功能。     

A new tool to assess and monitor the burden of chronic cough on quality of life: Chronic Cough Impact Questionnaire

INTRODUCTION: Chronic cough, one of the most frequent causes for a patient to consult a medical practitioner, limits the course of normal activities in everyday life of the patient affected (work, physical activities, social relations, night sleep). By now, there are few validated questionnaires for the evaluation of the impact of this symptom in the patient's quality of life (QoL). For this reason, we created a new questionnaire for the assessment of QoL in patients affected by chronic cough (Chronic Cough Impact Questionnaire, CCIQ). MATERIALS AND METHODS: In the development procedure of CCIQ an initial questionnaire of 40 items was compiled and given to a first pool of 170 patients, each coming to our attention because of chronic cough; then the 25 most significant items were detected and converted into questions evaluating the answers on a Likert scale of five steps. Consequently, this final questionnaire underwent a validation procedure to assess its construct validity, internal consistency, reliability, and responsiveness. 95 patients (44.2% F, 55.8% M) were evaluated (age 53.69 +/- 11.7 years). RESULTS: Following a statistical analysis, CCIQ showed a four-dimensional structure and good levels of internal consistency for the extracted factors: sleep/concentration (79.98), relationship (86.98), daily life impact (69.04), and mood (65.41). In stable conditions CCIQ showed a good reliability, ranged between 0.67 and 0.88. Responsiveness to clinical changes was accomplished. DISCUSSION: These results provide evidence that CCIQ has specificity enough for being a valid tool for detecting the relative burden of cough on subjective well-being, and for obtaining a global evaluation both of chronic cough impact and of treatments for it, taking into account the patient's point of view. The CCIQ was easily and quickly filled in by the patients while waiting, and it was accepted by the patients.     

Gabapentin for Chronic Refractory Cancer Cough

Vagal sensory neuropathy or vagal hypersensitivity has been implicated in the pathophysiology of chronic cough. Earlier reports have shown gabapentin to be effective in sensory laryngeal neuropathy and symptom conditions that have a proven neural origin. We present a case report of a patient with chronic refractory cough due to a soft tissue mass in the lung that caused compression of the mediastinal structures. The patient was successfully treated with gabapentin with reduction in the cough intensity, duration, and frequency.     

A Case of Chronic Cough Caused by Achalasia Misconceived as Gastroesophageal Reflux Disease

Cough is one of the most common symptoms that causes patients to seek outpatient medical care. If cough persists longer than 8 weeks, common causes of chronic cough, such as upper airway cough syndrome, asthma, and gastroesophageal reflux disease (GERD), should be considered. Although not a common cause of chronic cough, achalasia may cause symptoms very similar to reflux that can lead to its misdiagnosis as GERD. In this report, a 40-year-old woman presenting with chronic cough was initially diagnosed with GERD; however, her symptoms were refractory to conventional GERD treatment. Finally, she was diagnosed with achalasia. Her cough improved completely after pneumatic dilatation. Achalasia is a rare disease accompanied by dysphagia or regurgitation. If cough presumably due to GERD does not respond to treatment, or if the cause of chronic cough is uncertain, physicians should suspect achalasia.     

孟鲁司特联合布地奈德雾化吸入用于肺炎支原体感染后慢性咳嗽患儿的效果观察

目的 探讨孟鲁司特联合布地奈德雾化吸入对肺炎支原体感染后慢性咳嗽患儿降钙素原及炎性因子水平的影响。方法选择2016年1月~2018年6月我院收治的肺炎支原体感染后慢性咳嗽患儿106例,按随机数表法分为两组,各53例。对照组给予布地奈德雾化吸入治疗,观察组在此基础上给予孟鲁司特治疗。比较两组治疗后临床疗效、降钙素原水平及炎性因子水平。结果 治疗2个月后,观察组总有效率为94.34%,高于对照组的79.25%,差异有统计学意义（P＜0.05）;治疗2个月后,观察组患儿PCT为（0.45±0.28）μg/L,白介素6（IL-6）为（16.12±5.87） pg/ml,C反应蛋白（CRP）为（7.86±1.59） mg/L。低于对照组（0.68±0.33） μg/L、（29.62±6.05） pg/ml、（12.31±3.25） mg/L,差异有统计学意义（P＜0.05）。结论 孟鲁司特联合布地奈德雾化吸入治疗肺炎支原体感染后慢性咳嗽,可提高临床疗效,降低降钙素原及炎性因子水平。     

以症状为基础的程序化治疗方案对亚急性、慢性咳嗽的临床有效性研究

目的 探讨以临床症状为基础的程序化治疗方案对亚急性、慢性咳嗽患者的有效性。方法 将56例亚急性、慢性咳嗽患者随机分为试验组和对照组各28例。试验组采用以临床指南制定《以症状为基础的亚急性、慢性程序化治疗方案评估表》进行临床症状评估后,针对指向病因进行治疗,对照组给予经验治疗,以“咳嗽症状积分表”对两组患者的临床疗效进行评估,比较两组咳嗽症状评分、临床有效性评价、安全性评价。结果 治疗后,试验组夜间和全日咳嗽症状积分中位数均低于对照组（P＜0.05）。治疗2周后,试验组有效率为89.29%,高于对照组的52.17%,差异有统计学意义（P＜0.05）。结论 以症状为基础程序化治疗对于亚急性、慢性咳嗽的临床疗效优于简单的经验性治疗。     

A Comparison of Cough Assistance Techniques in Patients with Respiratory Muscle Weakness

PurposeTo assess the ability of a mechanical in-exsufflator (MI-E), either alone or in combination with manual thrust, to augment cough in patients with neuromuscular disease (NMD) and respiratory muscle dysfunction.ResultsAll 40 enrolled participants (37 males, three females; average age, 20.9±7.2 years) completed the study. The mean (standard deviation) PCFs in the unassisted, manually assisted following an MIC maneuver, MI-E-assisted, and manual thrust plus MI-E-assisted conditions were 95.7 (40.5), 155.9 (53.1), 177.2 (33.9), and 202.4 (46.6) L/min, respectively. All three interventions significantly improved PCF. However, manual assistance following an MIC maneuver was significantly less effective than MI-E alone. Manual thrust plus MI-E was significantly more effective than both of these interventions.ConclusionIn patients with NMD and respiratory muscle dysfunction, MI-E alone was more effective than manual assistance following an MIC maneuver. However, MI-E used in conjunction with manual thrust improved PCF even further.     

六君子汤加减对脾气虚弱证喉源性咳嗽的疗效分析

目的 观察脾气虚弱证喉源性咳嗽应用六君子汤加减治疗的效果。方法 选择2017年5月~2018年5月我院收治92例喉源性咳嗽患者,随机分为对照组和中药组,各46例。对照组予以常规西药治疗,中药组在对照组基础上应用六君子汤加减治疗。比较两组治疗前后的中医症候积分、治疗效果和不良反应发生率。结果 治疗后,中药组中医证候积分低于对照组[（4.01±1.01）分vs（8.22±2.01）分],差异有统计学意义（P＜0.05）;中药组的治疗总有效率高于对照组（95.65% vs 80.43%）,差异有统计学意义（P＜0.05）;中药组和对照组的不良反应发生率比较,差异无统计学意义（P＞0.05）。结论 应用六君子汤加减治疗脾气虚弱证喉源性咳嗽,可促进患者症状的恢复,提高治疗效果,且不增加药物不良反应。