老年人慢性咳嗽的病因构成和临床分析

目的 对老年慢性咳嗽患者采取经验性治疗联合病因诊断流程要求,分析老年人慢性咳嗽的病因及诊治效果. 方法 按照我国咳嗽指南,对52例老年慢性咳嗽患者,采取经验性治疗,效果不明确者,再采取病因诊断流程,包括肺功能、支气管舒张试验或支气管激发试验、诱导痰细胞学检查、鼻窦CT、24 h食管pH值监测等检查,进行病因判断和临床治疗. 结果 52例老年慢性咳嗽患者,明确病因76例次.老年人慢性咳嗽病因依次为咳嗽变异性哮喘(CVA)23例次(30.3％),上气道咳嗽综合征(UACS) 16例次(21.1％),胃食管反流性咳嗽(GERC)12例次(15.8％),药源性咳嗽(DC)9例次(11.8％),脑血管疾病7例次(9.2％),肺间质纤维化、嗜酸粒细胞性支气管炎(EB)、变应性咳嗽(AC)、左心功能不全各1例次(各占1.3％),病因未明4例次(5.3％).单一病因31例(59.6％),二重病因11例(21.2％)、三重病因5例(9.6％)、四重病因1例(1.9％). 结论 CVA、UACS、GERC和DC是最常见的老年人慢性咳嗽的病因,遵循我国咳嗽指南,根据常见病因采取经验性治疗与病因诊断相结合,可较好适合我国基层医院的诊疗需求.

The etiological and clinical features of chronic cough in the elderly

Objective To analyze the etiological and clinical features of chronic cough in the elderly.Methods Fifty-two elderly patients with chronic cough were treated according to experience.The patients received the measurement of pulmonary function when they showed no efficacy,bronchodilation test,induced sputum cytology,CT of sinus and 24 h esophagus pH monitoring.Results Fifty-two elderly patients with chronic cough were diagnosed with clear cause for 76 times,which contained 23 cases of cough variant asthma(CVA),16 cases of upper airway cough syndrome(UACS),12 cases of gastroesophageal reflux cough(GERC),9 cases of drug-induced cough(DC),7 cases of cerebrovascular diseases,and 1 case of Interstitial pulmonary fibrosis,eosinophils bronchitis,allergic cough(AC),left heart insufficiency and psychogenic cough,respectively,and 4 cases with unclear cause.Out of the patients,31 cases presented with a single cause,11 with double causes,5 cases with triple causes and 1 case with four causes.Conclusions CVA,UACS,GERC and DC are the main causes of chronic cough in the elderly.According to experience combined with etiological diagnosis process,the patients could acquire right diagnosis.