摘要
目的通过比较正常人和慢性咳嗽患者冷刺激食道前后咳嗽敏感性、肺功能的变化来探讨冷刺激与咳嗽的关系。方法对慢性咳嗽患者按慢性咳嗽病因诊断程序进行病因诊断,分为胃食管反流性咳嗽组(GERC组)和非胃食管反流性咳嗽组(非GERC组),同时入选正常人作为对照。首先对所有受试者检测肺通气功能、气道阻力和辣椒素咳嗽敏感性,间隔24 h后,受试者取坐位,记录10 min内的咳嗽次数,再经鼻饲管灌注0℃生理盐水300 ml,持续15 min。记录刺激过程中和刺激结束后10 min内的咳嗽次数,刺激结束40 min后所有受试者需再次检测肺通气功能、气道阻力和咳嗽敏感性。比较冷刺激前后咳嗽次数、咳嗽敏感性、肺通气功能和气道阻力的变化。咳嗽敏感性检测采用辣椒素定量吸入激发试验,结果以诱发≥5次咳嗽的最低激发浓度的对数值(Lg C5)表示。结果纳入试验的慢性咳嗽患者共17例,其中GERC 8例,非GERC 9例,同时纳入正常人9例。三组受试者在年龄、性别、咳嗽病程上没有显著差异。冷刺激食道前GERC、非GERC和正常受试者的10 min咳嗽次数分别为4.5(0~20)、7(0~35)、0(0~2),刺激食道后10 min的咳嗽次数分别为9(0~25)、11(0~70)、0(0~5),刺激前后比较均无显著变化(P>0.05)。冷刺激食道前GERC、非GERC和正常受试者的咳嗽敏感性(Lg C5)分别为1.34(0.29~3.00)、3.00(1.19~3.00)、3.00(3.00~3.00),刺激食道后咳嗽敏感性分别为1.50(0.59~3.00)、3.00(0.59~3.00)、3.00(2.70~3.0),刺激前后比较均无显著变化(P>0.05)。冷刺激食道后慢性咳嗽患者呼吸阻抗Zrs较刺激前显著增高[3.75±0.91(cm H_2O)·L^(-1)·S^(-1)vs.3.46±0.78(cm H_2O)·L^(-1)·S^(-1),P<0.05],以GERC患者冷刺激后呼吸阻抗增高为主[3.94±1.04(cm H_2O)·L^(-1)·S^(-1)vs.3.44±0.83(cm H_2O)·L^(-1)·S^(-1),P<0.05]。冷刺激食道前后GERC、非GERC和正常受试者的其它气道阻力指标和肺通气功能指标均无显著变化(P>0.05)。结论冷刺激食道可以增高GERC患者的呼吸阻抗,但对咳嗽敏感性和肺通气功能无明显影响。
Objective It is considered traditionally that drinking cold water may cause or increase cough. The effect of esophageal cold instillation on cough reflex sensitivity and lung function was assessed in patients with chronic cough and healthy subjects. Methods A total of 17 patients with chronic cough were enrolled in present study,including 8 patients with gastroesophageal reflux cough（ GERC）,9 patients without gastroesophageal reflux（ NGERC）,and 9 healthy subjects as control. Esophageal instillation was performed in all subjects with 0 ℃ normal saline（ 300 ml,15 min） through a nasal feeding tube. Airway resistance,lung ventilation functions and cough reflex sensitivity were measured 24 h before and 40 min after cold instillation.The cough numbers was recorded for 10 min before and after perfusion. The cough reflex sensitivity was measured by capsaicin challenge test and expressed as logarithm values of the concentration inducing 5 or more coughs. Results The frequency of cough in GERC,NGERC and healthy subjects was 4.5（ 0-20）,7（ 0-35）,0（ 0-2） before cold instillation and 9（ 0-25）,11（ 0-70）,0（ 0-5） after instillation,which showed no difference in before and after instillation（ P〉0.05）. The cough reflex sensitivity in GERC,NGERC and healthy subjects was1.34（ 0.29-3.00）,3.00（ 1. 19-3. 00）,3. 00（ 3. 00-3. 00） before cold instillation and 1. 50（ 0. 29-3. 00）,3. 00（ 0.59-3.00）,3. 00（ 2. 70-3. 00） after instillation,which revealed no significant difference（ P〉0. 05）.Esophageal cold water instillation increased the Zrs（ total resistance of the respiratory system） in patients with chronic cough[3.75±0.91（ cmH 2O） ·L^-1·S^-1vs. 3.46±0.78（ cmH 2O） ·L^-1·S^-1,P〉0.05],especially in patients with GERC[3.94± 1. 04（ cmH 2O） ·L^-1·S^-1vs. 3. 44 ± 0. 83（ cmH 2O） ·L^-1·S^-1,P〈0.05]. The other airway resistance and lung ventilation function showed no significant difference in before and after cold instillation（ P〉0.05）. Conclusion cold stimulation on esophagus increases total resistance of the respiratory tract in patients with chronic cough,especially in patients with GERC,but no changes were observed either in the cough sensitivity or lung ventilation function.
出处
《中华肺部疾病杂志（电子版）》
CAS
2016年第2期154-158,共5页
Chinese Journal of Lung Diseases(Electronic Edition)
基金
国家科技支撑计划基金项目(2012BAI05B01)
关键词
咳嗽
食道冷刺激
咳嗽敏感性
气道阻力
Cough
Intra-esophageal cold stimulation
Cough reflex sensitivity
Airway resistance
