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标题: 支气管炎 [打印本页]

作者: 大江 时间: 2019-4-9 00:03
标题: 支气管炎
支气管炎是肺部支气管（大中型呼吸道）的炎症。[1]症状包括咳嗽粘液，喘息，呼吸短促和胸部不适。[1]支气管炎分为两种类型：急性和慢性。[1]急性支气管炎也称为胸部感冒。[1]

急性支气管炎通常咳嗽持续三周左右。[4]在超过90％的病例中，病因是病毒感染。[4]当人们咳嗽或直接接触时，这些病毒可能通过空气传播。[1]风险因素包括接触烟草烟雾，灰尘和其他空气污染。[1]少数病例是由于高浓度的空气污染或细菌，如肺炎支原体或百日咳博德特氏菌。[4] [5]急性支气管炎的治疗通常包括休息，对乙酰氨基酚（对乙酰氨基酚）和NSAIDs以帮助发烧。[6] [7]

慢性支气管炎被定义为一种有效的咳嗽，每年持续三个月或更长时间至少两年。[8]大多数患有慢性支气管炎的人患有慢性阻塞性肺病（COPD）。[9]吸烟是最常见的原因，其他一些因素，如空气污染和遗传因素起着较小的作用。[10]治疗包括戒烟，接种疫苗，康复治疗，以及经常吸入支气管扩张剂和类固醇。[11]有些人可能会受益于长期氧疗或肺移植。[11]

急性支气管炎是最常见的疾病之一。[6] [12]大约5％的成年人受到影响，大约6％的儿童每年至少有一次发作。[2] [13] 2010年，COPD影响了3.29亿人，占全球人口的近5％。[3] 2013年，它造成290万人死亡，与1990年的240万人死亡有所不同。[14]

[attach]7146[/attach]
图A显示了肺和支气管的位置。图B是正常支气管的放大视图。图C是具有支气管炎的支气管的放大视图。

目录
1 急性支气管炎
1.1 原因
1.2 诊断
1.3 治疗方法
1.4 流行病学
2 慢性支气管炎
2.1 原因
2.2 诊断
2.3 治疗
2.4 流行病学
3 参考

急性支气管炎
主要文章：急性支气管炎

[attach]7147[/attach]
支气管炎
急性支气管炎，也称为胸部感冒，是肺部支气管的短期炎症。[1] [4]最常见的症状是咳嗽。[4]其他症状包括咳嗽粘液，喘息，呼吸短促，发烧和胸部不适。感染可能持续几天到十天。[1]咳嗽可能持续数周后，症状的总持续时间通常为三周左右。[1] [4]有些症状长达六周。[6]

原因
在超过90％的病例中，病因是病毒感染。[4]当人们咳嗽或直接接触时，这些病毒可能在空气中传播。风险因素包括接触烟草烟雾，灰尘和其他空气污染。[1]少数病例是由于高浓度的空气污染或细菌，如肺炎支原体或百日咳博德特氏菌。[4] [5]

诊断
诊断通常基于一个人的体征和症状。[15]痰液的颜色并不表明感染是病毒还是细菌。通常不需要确定基础生物。[4]其他类似症状的原因包括哮喘，肺炎，细支气管炎，支气管扩张和COPD。[4] [2]胸部X光可能有助于检测肺炎。[4]

支气管炎的另一个常见症状是咳嗽持续十天至三周。如果咳嗽持续一个月或一年，它可能会变成慢性支气管炎。此外，可能存在发烧。急性支气管炎通常由病毒感染引起。通常，这些感染是鼻病毒，副流感病毒或流感。为诊断急性支气管炎，通常不需要进行特殊检测。[16]

治疗
预防是指不吸烟和避免其他肺部刺激物。经常洗手也可能是保护性的。[17]急性支气管炎的治疗通常包括休息，对乙酰氨基酚（对乙酰氨基酚）和NSAIDs以帮助发烧。[6] [7]咳嗽药对其使用几乎没有支持，不建议6岁以下儿童使用。[4] [18]有初步证据表明沙丁胺醇可能对喘息患者有用;然而，它可能导致紧张和震颤。[4] [19]通常不应使用抗生素。[20]一个例外是急性支气管炎是由于百日咳引起的。初步证据支持蜂蜜和天竺葵有助于症状。[4]通常也建议大量休息和饮用足够的液体。[21]

流行病学
急性支气管炎是最常见的疾病之一。[6] [12]大约5％的成年人受到影响，大约6％的儿童每年至少有一次发作。[2] [13]它在冬天更常发生。[2]每年有超过1000万人在这种情况下去看医生，大约70％的人接受抗生素，而这些抗生素大多是不需要的。[6]有人努力减少急性支气管炎中抗生素的使用。[12]

慢性支气管炎
另见：慢性阻塞性肺病
慢性支气管炎被定义为一种有效的咳嗽，每年持续三个月或更长时间至少两年。[8]大多数患有慢性支气管炎的人也患有慢性阻塞性肺病（COPD）。[9]持久性细菌性支气管炎定义为慢性生产性咳嗽，支气管肺泡灌洗阳性，可用抗生素治疗。[22] [23]慢性支气管炎的症状可能包括喘息和呼吸短促，特别是在劳累和低氧饱和度时。[24]唤醒后不久咳嗽通常会更糟，所产生的痰液可能呈黄色或绿色，可能会出现斑点血迹。[25]

原因
大多数慢性支气管炎病例是由吸烟和其他形式的烟草引起的。[24] [26] [27]此外，长期吸入空气污染或刺激性烟雾或灰尘来自煤炭开采，谷物处理，纺织品制造，畜牧业，[28]和金属成型等职业中的危险暴露也可能是慢性支气管炎发展的危险因素。 [29] [30] [31]遗传因素也很少发挥作用。[32]持续性细菌性支气管炎通常由肺炎链球菌，非典型流感嗜血杆菌或粘膜炎莫拉氏菌引起[22] [23]。

诊断
患有阻塞性肺病如支气管炎的个体可能在肺功能检查中出现FEV1和FEV1 / FVC比值下降[33] [34] [35]。与其他常见的阻塞性疾病如哮喘或肺气肿不同，支气管炎很少导致高残余体积（在最大呼气努力后肺部残留的空气量）。[36]

治疗
有证据表明，慢性支气管炎中观察到的肺功能下降可能会因戒烟而减慢。[37]慢性支气管炎是对症治疗的，可以非药物方式或药物治疗药物治疗。包括支气管炎在内的COPD治疗的典型非药物学方法可能包括肺康复，肺减容手术和肺移植。[37]吸入皮质类固醇可能会降低呼吸道上皮的炎症和水肿[38]。喘息和呼吸急促可通过支气管扩张剂（如吸入性长效β2-肾上腺素能受体激动剂（如沙美特罗））和吸入抗胆碱能药（如异丙托溴铵）或减少支气管痉挛（由于平滑肌收缩引起的小支气管可逆性变窄）来治疗。噻托溴铵[39]粘液溶解剂可能对慢性支气管炎的急性加重有一个小的治疗效果。[40]补充氧气用于治疗低氧血症（血液中的氧气过少），并且已被证明可以降低慢性支气管炎患者的死亡率[25] [37]。补充氧气可导致呼吸驱动减少，导致血液中二氧化碳水平升高（高碳酸血症）和随后的呼吸性酸中毒。[41]儿童的长期细菌性支气管炎（持续超过4周）可能有助于抗生素治疗。[42]

流行病学
慢性支气管炎在一般人群中的患病率为3.4％至22％。 45岁以上的人，吸烟者，在空气污染严重的地区生活或工作的人，以及任何患有哮喘的人都患有慢性支气管炎的风险较高。[43]这种广泛的范围是由于慢性支气管炎的不同定义，可以根据症状和症状或疾病的临床诊断来诊断。慢性支气管炎往往比女性更容易影响男性。虽然慢性支气管炎的主要危险因素是吸烟，但仍有4％-22％的可能性从未吸烟者患上慢性支气管炎。这可能表明其他风险因素，如吸入燃料，粉尘，烟雾和遗传因素。[44]肥胖也与慢性支气管炎的风险增加有关。在2014年的美国，每100,000人中，慢性支气管炎的死亡率为0.2。[45]

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