慢性咽喉炎病因分析
体会
该研究者认为慢性咽喉炎中胃酸反流为主要致病因素(去除全身性病因和鼻部疾病),故在临床表现和喉部体征符合诊断后,推荐选择质子泵抑制剂治疗,在试验性治疗两周后症状改善者,可以继续治疗8周,治疗期间每4周检查肝功1次。质子泵抑制剂治疗慢性咽喉炎尚需注意以下几点:①少食多餐,每餐进食不要过饱,以减轻胃部负荷,对部分胃动力差的患者也起到保护作用;②头肩部高位睡眠,防止夜间胃酸反流;③保存心情愉快,防止因心情不畅导致胃蠕动减弱。希望对各位临床医师临床治疗起到借鉴作用。
[参考文献]
[1] Vaezimf,Hicks DM,Abelson TI,et al.Laryngeal signs and symptoms and gastroesophageal reflux disease: a critical assessment of cause and effectassociation [J]. Clin Gastroenterol Hepatol, 2003,1(5):333-344.
[2] 张艳红,杜友红,陈鲜芳,等.质子泵抑制剂诊断性治疗返流性咽喉炎76例[J].中国耳鼻咽喉颅底外科杂志,2010(4):285-286.
[3] Lipan MJ, Reidenberg JS,Laitman JT. Anatomy of Reflux:A Growing Health Problem Affecting Structures of the Head and Neck[J].The anatomical record, 2006,289(6):261-270.
[4] 折管伸彦,刘汝美.喉咽反流病:GERD的耳鼻喉表现[J].日本医学介绍,2002,23(2): 51-52.
[5] Gill GA, Johnston N, Buda A, et al. Laryngeal epithelial defenses against laryngopharyngeal reflux: investigations of E-cadherin, carbonic anhydrase isoenzyme Ⅲ and pepsin[J].Annotol Rhinol Laryngeal,2006,114(12):913-921.
[6] Koufman JA, Aviv JE, Casiano RR, et al.Laryngopharyngeal reflux: position statement of the committee on speech,voice,and swallowing disorders of the American Academy of Otolaryngology –Head and Neck Surgery[J].Otolaryngol Head Neck Surg,2002,127(1):32-35.
[7] Kiljander TO. The role of proton pump inhibition in the management of gastroesophageal reflux disease-related asthma and chronic cough[J]. Am J Med , 2003, 115(3): 65-71.
(收稿日期:2015-06-05)