本文選題：喉疾病 + 咽疾病�。� 參考：《第四軍醫(yī)大學(xué)》2011年碩士論文

【摘要】：以咽異物感、頻繁清嗓、慢性咳嗽、發(fā)音易倦、吞咽困難等主訴就診的患者在耳鼻喉科門診中占有很大比重,醫(yī)生在排除慢性扁桃體炎、莖突綜合征、咽喉部腫瘤以及全身性疾病后,往往診斷為慢性咽炎(chronic pharyngitis),并給予相應(yīng)治療,但很多時(shí)候,患者經(jīng)藥物治療后達(dá)不到滿意療效,或病情反復(fù)不能根治,長(zhǎng)期的用藥治療但又效果不佳,常常給患者帶來心理負(fù)擔(dān)和經(jīng)濟(jì)壓力,有些時(shí)候藥物副作用還可能引發(fā)患者機(jī)體功能損害。 隨醫(yī)療水平的不斷發(fā)展,診療技術(shù)的不斷完善,人們逐漸認(rèn)識(shí)到一種反流性疾病,即喉咽反流(laryngopharyngeal reflux,LPR),其在發(fā)病機(jī)制、發(fā)病條件、反流模式、臨床表現(xiàn)、診療方法等諸多方面都與胃食管反流(gastroesophageal reflux,GER)有著很大不同。國外已有眾多相關(guān)臨床研究,發(fā)現(xiàn)喉咽反流的發(fā)病率并不低,在咽異感癥狀、發(fā)音問題、睡眠呼吸功能障礙等患者中都存在喉咽反流相關(guān)問題,也是諸如任克間隙水腫、喉狹窄、喉接觸性肉芽腫、喉癌等多種疾病的致病因素,已成為國際研究熱點(diǎn)問題。但相比之下,國人對(duì)喉咽反流的認(rèn)識(shí)尚不足,再加上其缺少便捷、可靠的診斷方法,也沒有統(tǒng)一的診斷標(biāo)準(zhǔn),臨床上常常造成診斷延誤或誤診、漏診,從而導(dǎo)致咽異感癥的治療失敗。近來,有學(xué)者提出喉部痰液/唾液胃蛋白酶檢測(cè)可做為一種高效、無創(chuàng)、客觀的喉咽反流檢出方法,但國內(nèi)鮮有此類研究。 因此,本臨床實(shí)驗(yàn)通過研究喉部痰液胃蛋白酶檢測(cè)方法以判斷其對(duì)喉咽反流的診斷及療效判定的價(jià)值,通過反流癥狀指數(shù)量表與反流檢查計(jì)分量表臨床應(yīng)用研究以評(píng)價(jià)其對(duì)喉咽反流初篩的意義,從而為喉咽反流與慢性咽炎臨床鑒別診斷奠定理論基礎(chǔ)。本實(shí)驗(yàn)選取2010年6月至2010年9月以咽干、咽喉部異物感、頻繁清嗓、慢性咳嗽、發(fā)音易倦等癥狀就診的123例門診患者,進(jìn)行3個(gè)月質(zhì)子泵抑制劑(PPI)診斷性治療。其中36例患者治療前后評(píng)估反流癥狀指數(shù)(The reflux symptom index,RSI)和反流檢查計(jì)分(The reflux finding score,RFS),并檢測(cè)喉部痰液胃蛋白酶質(zhì)量濃度,診斷性治療有效者計(jì)入咽喉反流組(15例),其余計(jì)入慢性咽喉炎組(21例),分析兩組指標(biāo)的差異和痰液胃蛋白酶檢測(cè)的診斷價(jià)值。123例患者按診斷性治療有效分為喉咽反流組(29例)和慢性咽炎組(94例),對(duì)初診時(shí)所填RSI量表和RFS量表各評(píng)分項(xiàng)目進(jìn)行統(tǒng)計(jì)學(xué)分析,比較兩組差異。通過實(shí)驗(yàn)可以得出以下結(jié)論: 1.喉部痰液胃蛋白酶質(zhì)量濃度檢測(cè)可以作為一項(xiàng)客觀、有效的指標(biāo)用于喉咽反流的診斷和療效判定。 2.診斷性治療,結(jié)合治療前后RSI量表和RFS量表評(píng)分對(duì)比,是目前喉咽反流切實(shí)有效的診斷方法,適用于各級(jí)醫(yī)院。
[Abstract]:Patients with foreign body sensation in the pharynx, frequent throat clearing, chronic cough, weariness of pronunciation, dysphagia and so on occupied a large proportion in the otolaryngology outpatient clinic. The doctor was ruling out chronic tonsillitis, styloid process syndrome, etc. Pharynx and larynx tumors and systemic diseases are often diagnosed as chronic pharyngitis and treated accordingly. However, in many cases, the patients can not get satisfactory results after drug treatment, or their condition is repeatedly unable to be cured. Long-term drug treatment but not good results, often bring psychological burden and economic pressure to patients, sometimes side effects may also lead to the patient's body function damage. With the development of medical treatment and the improvement of diagnosis and treatment technology, people have come to realize a kind of reflux disease, that is, laryngopharyngeal reflux LPRP, which is involved in pathogenesis, condition, reflux mode and clinical manifestation. The methods of diagnosis and treatment are very different from gastroesophageal reflux (GER). There have been many related clinical studies abroad, and it has been found that the incidence of laryngopharyngeal reflux is not low. There are problems related to larynx reflux in patients such as pharynx symptoms, pronunciation problems, sleep apnea dysfunction and so on, such as Renke space edema. The causes of laryngeal stricture, laryngeal contact granuloma and laryngeal cancer have become a hot topic in international research. However, in contrast, people in China still do not know enough about laryngopharyngeal reflux, coupled with the lack of convenient and reliable diagnostic methods and the lack of a unified diagnostic standard. In clinical practice, the diagnosis is often delayed or misdiagnosed, and the diagnosis is missed. This leads to the failure of the treatment of pharynx allelopathy. Recently, some scholars have suggested that the detection of pepsin in sputum and saliva can be used as an effective, non-invasive and objective method for detecting laryngopharyngeal reflux, but there are few such studies in China. Therefore, in this clinical experiment, the method of detecting pepsin in sputum of larynx was studied to determine the value of pepsin in the diagnosis and curative effect of laryngopharyngeal reflux. The clinical application of the reflux symptom index scale and the reflux score scale was studied to evaluate the significance of the reflux screening in order to lay a theoretical foundation for the clinical differential diagnosis of laryngopharyngeal reflux and chronic pharyngitis. From June 2010 to September 2010, 123 outpatients with symptoms such as pharyngeal dry, foreign body sensation in throat, frequent throat clearing, chronic cough, and weariness of pronunciation were treated with proton pump inhibitor PPI for 3 months. The reflux symptom index (reflux symptom) and the reflux finding score were evaluated before and after treatment in 36 patients, and the pepsin concentration in the sputum of larynx was measured. 15 cases of laryngeal reflux group and 21 cases of chronic pharyngitis group were included in the effective diagnostic treatment. The difference between the two groups and the diagnostic value of pepsin detection in sputum were analyzed. 123 patients were divided into two groups according to the effective diagnostic treatment of laryngopharynx. 29 cases of reflux group (n = 29) and 94 cases of chronic pharyngitis group (n = 94). The scores of RSI scale and RFS scale were analyzed statistically. The differences between the two groups were compared. The following conclusions can be drawn from the experiment: 1. The determination of pepsin concentration in sputum of larynx can be used as an objective and effective index to diagnose and evaluate the curative effect of laryngopharyngeal reflux. 2. Diagnostic therapy, combined with RSI scale and RFS scale before and after treatment, is a practical and effective diagnostic method for laryngopharynx reflux, which is suitable for hospitals at all levels.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R766

【引證文獻(xiàn)】

相關(guān)博士學(xué)位論文 前1條

1 宋芊;慢性咳嗽證候特征與“溫潤(rùn)辛金培本”法應(yīng)用研究[D];北京中醫(yī)藥大學(xué);2013年

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本文編號(hào)：1919692