咳嗽性昏厥1例临床诊疗体会
摘要
目的:探讨咳嗽性昏厥的中西医病因病机,总结其诊治要点及防护措施。方法:对甘肃中医药大学附属医院老年病科收治的1例咳嗽性昏厥患者的临床资料进行回顾性分析。结果:患者因剧烈咳嗽时晕厥多次入院,发作前均有剧烈咳嗽,遂即摔倒。经24 h动态心电图、头颅磁共振血管成像(MRA)、心脏超声、颈部血管超声、胸部CT、动脉血气分析、NT-pro BNP、甲状腺功能全项等检查,排除心、脑、肺部等脏器的病变。中医诊断:厥证,气厥;痰热郁肺。西医诊断:慢性支气管炎并肺气肿、咳嗽性晕厥综合征、低氧血症。予以中西医结合治疗,西医予抗感染、镇咳化痰联合中医益气养阴、润肺止咳,后未再发生昏厥,随访2个月未再复发。结论:咳嗽性晕厥为一种良性综合征,诊断需排除诱发晕厥的各种器质性病变,治疗基础病,缓解咳嗽症状是关键,中西医结合系统治疗效果良好。
Objective: To explore the etiology and pathogenesis of Chinese and western medicine of tussive syncope and to summarize the main points of diagnosis and treatment and preventive measures. Method: The clinical data of 1 case of tussive syncope in the department of geriatrics in Affiliated Hospital to Gansu College of traditional Chinese medicine were retrospectively analyzed. Result: The patient was admitted to hospital due to severe cough, he had a violent cough before the attack, and fell. After the examinations of 24 hours of dynamic ECG, cranial magnetic resonance angiography(MRA), cardiac ultrasound, cervical vascular ultrasound, chest CT, arterial blood gas analysis, NT-pro BNP, and thyroid function examination, the diseases of the heart, brain, lungs and other organs were excluded. Traditional Chinese medicine diagnosis: syncope syndrome and phlegm heat obstructing the lung. Western medicine diagnosis: Chronic bronchitis and emphysema, cough syncope, syndrome hyoxemia. Combination of traditional Chinese and Western medicine treatment was given: Western medicine was used for anti infection, relieving cough and resolving phlegm combined with Chinese medicine of tonifying qi and yin and moistening lung to arrest cough. Syncope didn't occur, no recurrence was followed up for 2 months. Conclusion: Tussive syncope was a benign syndrome, the diagnosis it should exclude various organic lesions, relieving cough symptoms was the key in the treatment of this foundation disease, combination of traditional Chinese and Western medicine treatment had a good effect.
Objective: To explore the etiology and pathogenesis of Chinese and western medicine of tussive syncope and to summarize the main points of diagnosis and treatment and preventive measures. Method: The clinical data of 1 case of tussive syncope in the department of geriatrics in Affiliated Hospital to Gansu College of traditional Chinese medicine were retrospectively analyzed. Result: The patient was admitted to hospital due to severe cough, he had a violent cough before the attack, and fell. After the examinations of 24 hours of dynamic ECG, cranial magnetic resonance angiography(MRA), cardiac ultrasound, cervical vascular ultrasound, chest CT, arterial blood gas analysis, NT-pro BNP, and thyroid function examination, the diseases of the heart, brain, lungs and other organs were excluded. Traditional Chinese medicine diagnosis: syncope syndrome and phlegm heat obstructing the lung. Western medicine diagnosis: Chronic bronchitis and emphysema, cough syncope, syndrome hyoxemia. Combination of traditional Chinese and Western medicine treatment was given: Western medicine was used for anti infection, relieving cough and resolving phlegm combined with Chinese medicine of tonifying qi and yin and moistening lung to arrest cough. Syncope didn't occur, no recurrence was followed up for 2 months. Conclusion: Tussive syncope was a benign syndrome, the diagnosis it should exclude various organic lesions, relieving cough symptoms was the key in the treatment of this foundation disease, combination of traditional Chinese and Western medicine treatment had a good effect.
引文
[1]候会玲,聂秀红.咳嗽性晕厥的危险因素及治疗策略的探讨[J].临床肺科杂志,2009,14(2):175-176.
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[6]周俊荣.125例咳嗽变异性哮喘的临床治疗分析[J].中国现代医生,2009,47(14):137,158.
[7]侯会玲,赵洪芬,聂秀红.58例咳嗽变异型哮喘的临床分析[J].首都医科大学学报,2009,30(6):841-844.
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[9]潘艳辉.儿童哮喘误诊误治原因分析[J].中国现代医,2013,51(2):111-112.
[10]支艳,张文龙,马新英,等.滋阴清热法为主治疗慢性咳嗽临床研究[J].中医临床研究,2014,6(31):12-13.
[11]尹世敏,王磊,陈红,等.丹红注射液治疗后循环缺血性眩晕临床观察[J].中国医药,2012,7(12):1609.
[12]李智强,于伯泉.咳嗽性晕厥1例并文献复习[J].医学信息,2010,5(10):2846-2847.
[13]侯会玲,聂秀红.咳嗽性晕厥的危险因素及治疗策略的探讨:附6例报道[J].临床肺科科志,2009,14(2):175-176.
[14]许延忠,王联芬,许月红.咳嗽晕厥综合征[J].中国综合临床,2003,19(12):1059-1060.
[15]雷少军,王瑞雪.咳嗽晕厥综合征1例[J].中国煤炭工业医学杂志,2010,13(8):1260.
[16]徐德兵,吴凌云,孔庆军.咳嗽性晕厥1例临床分析并文献复习[J].临床肺科杂志,2014,19(6):1152-1153.
[17]张钊旺,余学庆.慢性咳嗽从脾论治[J].中医临床研究,2013,5(17):50-51.
[18]王佳兴,苗青,张艳萍.咳嗽性昏厥的临床思路与方法[J].新中医,2011,43(4):123-124.
[19]许延忠,王联芬.咳嗽晕厥综合征[J].中国综合临床,2003,19(12):1059-1060.
[20]臧镭镭.咳嗽的中医辨证治疗心得[J].中医临床研究,2012,4(17):69-70.
[2]刘昱言,刘轲.咳嗽性晕厥1例[J].临床合理用药杂志,2012,5(6A):58.
[3]王维治,王化冰.临床神经病学定位[M].北京:人民卫生出版社,2009:228.
[4]袁巨平,张青竹,李淑云.咳嗽-晕厥综合征10例临床分析[J].临床肺科杂志,2007,12(7):738-739.
[5]侯会玲,聂秀红.咳嗽性晕厥的危险因素及治疗策略的探讨[J].临床肺科杂志,2009,14(2):175.
[6]周俊荣.125例咳嗽变异性哮喘的临床治疗分析[J].中国现代医生,2009,47(14):137,158.
[7]侯会玲,赵洪芬,聂秀红.58例咳嗽变异型哮喘的临床分析[J].首都医科大学学报,2009,30(6):841-844.
[8]梁淑云,高晋鲜,郭春苗.老年肺结核误漏诊原因探讨[J].中国医药,2012,7(6):778-779.
[9]潘艳辉.儿童哮喘误诊误治原因分析[J].中国现代医,2013,51(2):111-112.
[10]支艳,张文龙,马新英,等.滋阴清热法为主治疗慢性咳嗽临床研究[J].中医临床研究,2014,6(31):12-13.
[11]尹世敏,王磊,陈红,等.丹红注射液治疗后循环缺血性眩晕临床观察[J].中国医药,2012,7(12):1609.
[12]李智强,于伯泉.咳嗽性晕厥1例并文献复习[J].医学信息,2010,5(10):2846-2847.
[13]侯会玲,聂秀红.咳嗽性晕厥的危险因素及治疗策略的探讨:附6例报道[J].临床肺科科志,2009,14(2):175-176.
[14]许延忠,王联芬,许月红.咳嗽晕厥综合征[J].中国综合临床,2003,19(12):1059-1060.
[15]雷少军,王瑞雪.咳嗽晕厥综合征1例[J].中国煤炭工业医学杂志,2010,13(8):1260.
[16]徐德兵,吴凌云,孔庆军.咳嗽性晕厥1例临床分析并文献复习[J].临床肺科杂志,2014,19(6):1152-1153.
[17]张钊旺,余学庆.慢性咳嗽从脾论治[J].中医临床研究,2013,5(17):50-51.
[18]王佳兴,苗青,张艳萍.咳嗽性昏厥的临床思路与方法[J].新中医,2011,43(4):123-124.
[19]许延忠,王联芬.咳嗽晕厥综合征[J].中国综合临床,2003,19(12):1059-1060.
[20]臧镭镭.咳嗽的中医辨证治疗心得[J].中医临床研究,2012,4(17):69-70.