咳痰

姜淑香@秋日雛菊

痰是氣管、支氣管的分泌物或肺泡內(nèi)的滲出物，并不包括口、鼻、咽喉的黏液?？忍凳呛粑纼?nèi)的病理分泌物借助于支氣管粘膜上皮細(xì)胞的纖毛運(yùn)動(dòng)、支氣管平滑肌的收縮及咳嗽時(shí)的氣流沖動(dòng)，將呼吸道內(nèi)的分泌物從口腔排除的動(dòng)作。簡(jiǎn)單而言是：咳嗽伴有痰液時(shí)稱(chēng)為咳痰, 也叫濕性咳嗽，相對(duì)的是干性咳嗽(俗稱(chēng)干咳, 指無(wú)痰或痰量甚少的咳嗽)?？忍党Ｒ?jiàn)于肺炎、慢性咽炎、慢性支氣管炎、支氣管擴(kuò)張、肺膿腫與空洞型肺結(jié)核等疾病。 咳嗽(cough)是促使痰液或氣道異物排出的一種保護(hù)性生理反射，有利于排除誤入呼吸道的異物、清除呼吸道的分泌物和有害因子。來(lái)自呼吸道黏膜的刺激通過(guò)迷走神經(jīng)、舌咽神經(jīng)和三叉神經(jīng)的感覺(jué)纖維傳入至延髓咳嗽中樞，由喉下神經(jīng)、膈神經(jīng)和脊神經(jīng)傳出，將沖動(dòng)傳到咽肌、聲門(mén)、膈肌和其他呼吸肌引起咳嗽動(dòng)作。但頻繁或劇烈的咳嗽和咳多量或黏稠的痰則屬病態(tài)。過(guò)強(qiáng)烈或長(zhǎng)時(shí)間的咳嗽有時(shí)反而會(huì)造成患者呼吸、睡眠及生活上的嚴(yán)重干擾，引起呼吸道內(nèi)的感染擴(kuò)散、呼吸道出血、肺泡破裂及氣胸、胸內(nèi)壓改變而影響心血管功能。 一、辨痰知病因：了解觀察痰的量、色、氣味、性狀?？商崾驹\斷。一般來(lái)說(shuō)，痰液是氣道炎癥或感染的產(chǎn)物，但也可以是來(lái)自肺泡的分泌物。對(duì)患者痰液的評(píng)價(jià)主要是要了解痰液的性狀，并根據(jù)其性狀確定導(dǎo)致咳痰的病因。 （一）性狀1、黏液性痰：痰質(zhì)黏稠，無(wú)色透明或稍白，多見(jiàn)于支氣管炎、支氣管哮喘、肺炎球菌肺炎的初期。2、黏液膿性痰：痰液性狀介于黏液性痰和膿性痰之間，痰內(nèi)除黏液外有一部分膿，帶黃白色，富黏性;常見(jiàn)于支氣管炎，肺結(jié)核，肺內(nèi)炎癥等。這是由于肺組織在炎癥過(guò)程中形成膿液，同時(shí)又有大量黏液分泌物相混而成。3、膿性痰：痰呈膿性，為黃色或綠色，質(zhì)黏稠，有的帶有臭味，常見(jiàn)于化膿性支氣管炎，支氣管擴(kuò)張，肺膿腫，膿胸或肝，脊椎，縱隔膿腫潰穿肺部造成的支氣管瘺等，帶臭味的膿性痰，常提示厭氧菌感染。4、漿液性痰泡沫狀痰：痰液稀薄而多泡沫，常見(jiàn)于肺水腫，是由于肺瘀血或肺毛細(xì)血管道透性增高，毛細(xì)血管內(nèi)液體滲入肺泡所致。5、血性痰：痰內(nèi)帶有血液，血液多少不一，少者為血絲狀痰，多者可為粉紅色，棕褐色。常見(jiàn)肺癌，肺結(jié)核，肺梗死，支氣管擴(kuò)張等。根據(jù)痰液的一些癥狀，我們可以判斷患者發(fā)生的咳痰是正常的咳痰現(xiàn)象，還是不正常的咳痰現(xiàn)象，還有就是如果發(fā)生了不正常的咳痰，我們也可以及早發(fā)現(xiàn)身體出現(xiàn)的問(wèn)題，及時(shí)的去檢查，這也是發(fā)現(xiàn)疾病的一個(gè)方法。 （二）痰量痰量多的疾病有肺水腫，肺膿腫，支氣管擴(kuò)張，肺泡細(xì)胞癌，膿胸或肚膿腫形成支氣管瘺等。檢查痰量一般以24h為準(zhǔn)，痰量增多反映支氣管和肺的炎癥進(jìn)展；痰不能順利排出，臨床上雖表現(xiàn)為痰量減少，實(shí)際上病情仍在發(fā)展，中毒癥狀也會(huì)加重。 （三）氣味一般的痰無(wú)臭味，放置時(shí)間長(zhǎng)時(shí)由于痰內(nèi)細(xì)菌的分解作用產(chǎn)生臭味，厭氧菌感染時(shí)，痰有惡臭，見(jiàn)于肺于疽、肺膿腫、支氣管擴(kuò)張，支氣管肺癌的晚期。 （四）顏色無(wú)色透明或灰白色黏液痰見(jiàn)于正常人、支氣管黏膜輕度炎癥。黃色或綠色黏痰提示呼吸道存在化膿性感染，綠色痰常因含膽汁，變性血紅蛋白或綠膿素所致，見(jiàn)于黃疸，吸收緩慢的肺炎球菌肺炎，肺部綠膿桿菌感染，血性痰見(jiàn)于肺癌，肺結(jié)核，支氣管擴(kuò)張，鐵銹色痰，見(jiàn)于肺炎球菌肺炎。粉紅色或血性泡沫痰見(jiàn)急性肺水腫。紅褐色或巧克力色痰，見(jiàn)于阿米巴肝膿腫潰穿入肺內(nèi)引起的肺阿米巴病。果醬樣痰見(jiàn)于肺吸蟲(chóng)病，灰色或黑色痰，見(jiàn)于各種塵肺，如煤塵肺等。棕色痰，見(jiàn)于肺梗死，肺含鐵血黃色沉著癥。 （五）伴隨癥狀咳痰伴高熱者應(yīng)考慮肺炎，肺膿腫?？忍蛋樾赝凑邞?yīng)注意肺部病變波及胸膜者如肺炎，肺癌，肺梗死等?？忍嫡唛L(zhǎng)期接觸有害粉塵史時(shí)應(yīng)考慮相應(yīng)的塵肺?？确奂t色泡沫痰伴呼吸困難者應(yīng)注意急性肺水腫，40歲以上男性，有長(zhǎng)期吸煙史，咳血性痰應(yīng)警惕肺癌的可能。 青島環(huán)語(yǔ)翻譯公司業(yè)務(wù)聯(lián)系電話：15588617120 聯(lián)系人：姜淑香QQ郵箱：634363114@qq.com微信：qq634363114 ExpectorationSputum is the excretions of the trachea and bronchus or the exudates in the alveoli, which doesn’t include mucus from the mouth, noise and throat. The production of sputum is a action of the pathological secretions in the respiratory tract to expel the secretions from mouth with the help of the ciliary movement of epithelial cells of bronchial mucosa, the contraction of the bronchial smooth muscle, and the impulse of airflow during coughing. In short, cough accompanied by sputum is known as expectoration, also called wet cough, relative to dry pharynx (which is commonly known as dry cough, refers to the cough without sputum or very little sputum). Coughing of phlegm is often seen in diseases such as pneumonia, chronic pharyngitis, chronic bronchitis, bronchiectasis, lung abscess and hollow-type tuberculosis. Cough is a protective physiological reflect to expel sputum or foreign body from the airway, and is conducive to the elimination of foreign bodies into the respiratory tarct, the removal of secretions and harmful factors. Coughing movement is induced by the stimulation from the respiratory mucosa, the impulse which is transmitted to medulla oblongata cough center by sensory fibers of the vagus, glossopharyngeal, and trigeminal nerves, and which is transmitted out from the inferior laryngeal nerve, phrenic nerve and spinal nerve, then which is transmitted to the pharyngeal muscles, glottis, diaphragm, and other respiratory muscles. But it is pathological of a frequent or violent cough and a large or sticky sputum. And the intensive or prolonged cough will sometimes cause a serious interference in the patient’s breath, sleep and live, resulting in the spread of infection in the respiratory tract, respiratory bleeding, alveolar rupture and pneumothorax, and intrathoracic pressure change, which affect cardiovascular function. Differentiation of pathogenic factors by sputum: to understand and observe sputum quantity, color, odor and character can often prompt diagnosis. In general, sputum is the product of inflammation or infection of the airways, but it can also be the secretions from the alveoli. So the evaluation for patients’ sputum is mainly focused on understanding of the characteristics of sputum and according to its characteristics to determine the cause of expectoration. Character:1.mucous sputum is manifested by sticky sputum with colorless and transparent, or slightly white color, and is often seen in the early stage of bronchitis, bronchial asthma, pneumococcal pneumonia. 2.mucous purulent sputum is manifested in the character of sputum between mucous sputum and purulent sputum, and in addition to mucus, there is a part of pus in sputum, with yellowish white and viscos. It is often seen in bronchitis, tuberculosis, lung inflammation and so on. That is because the lung tissue forms pus in the process of inflammation, and at this time the pus will be mixed with a lot of mucus secretions. 3.purulent sputum is manifested with pus in sputum with yellow or green color, and cheesy pus in strong stinking smell, and it is often seen in suppurative bronchitis, bronchiectasis, lung abscess, empyema or bronchial fistula in the lung caused by ulcerous pus from liver, spine, and mediastina. Pus in sputum with stinking smell indicates anaerobe infection. 4.serous sputum foamy sputum is manifested by thin and pale sputum full of bubble, and is often seen in pulmonary edema, because of lung blood stasis, increased pulmonary capillary permeability, and the liquid in the capillary infiltrating into alveoli. 5.bloody sputum is manifested with more or less blood in sputum, less blood for filamentous sputum, more one in pink and brown color, and is often seen in lung cancer, tuberculosis, lung infarction, bronchiectasis and so on. According to some symptoms of sputum, we can judge whether the patient’s expectoration is normal or abnormal. In addition, if abnormal expectoration occurs, we can find the problems of the body as early as possible and check in time, which is also a way to find the disease. Sputum volume:Diseases with high sputum volume include pulmonary edema, lung abscess, bronchiectasis, alveolar cell carcinoma, empyema or abdominal abscess forming bronchial fistula. The sputum volume is generally measured at 24 hours, and the increased sputum volume reflects the progressive inflammation of bronchus and lung. Sputum can’t be discharged smoothly, although the performance of sputum volume is reduced clinically, in fact, the disease is still developing, and poisoning symptoms will also be aggravated. Odor:In general, sputum doesn’t have a foul smell, but when it is placed for a long time, the foul smell is generated due to the decomposition of bacteria in sputum. When infected by Anaerobic bacteria, sputum has a foul odor, seen in the anthrax, lung abscess, bronchiectasis, and advanced bronchial lung cancer. Color:Mucous sputum with colorless and transparent or off-white color is often seen in a normal person or the mild inflammation of bronchus mucous membrane; yellow or green color of mucous sputum indicates the suppurative infection occurred in the respiratory tract; green sputum often contain bile, caused by denatured hemoglobin or pyocyanin, and is often seen in jaundice, slow absorption of pneumococcal pneumonia, and pulmonary infection with pseudomonas aeruginosa; bloody sputum is often seen in lung cancer, tuberculosis, bronchiectasis; rusty sputum is seen in pneumococcal pneumonia; pink or bloody foaming sputum is seen in acute pulmonary edema; reddish-brown or chocolate sputum is seen in amoeba pulmonary disease caused by invasion of the lung caused by an amoeba liver abscess; jam-like sputum is seen in paragonimiasis; gray or black sputum, in various pneumoconiosis, such as coal pneumoconiosis, etc; and brown sputum is seen in pulmonary infarction, pulmonary hemosiderosis. Accompanying symptoms:Expectoration with high fever should be considered pneumonia, lung abscess. Expectoration with chest pain should pay attention to lung lesions and pleura, such as pneumonia, lung cancer, pulmonary infarction, etc. Pneumoconiosis should be considered in patients who produce phlegm with a long history of exposure to harmful dust. Acute pulmonary edema should be noted in patients who cough pink frothy sputum with dyspnea. Male patients over 40 years old with a long history of smoking who is cough bloody sputum should be aware of the possibility of lung cancer. Qingdao Global language translation CompanyBusiness Call: 15588617120Contact person: Jiang ShuxiangQQ E-mail: 634363114@qq.comWeChat:qq634363114