咳痰

姜淑香@秋日雏菊

痰是气管、支气管的分泌物或肺泡内的渗出物，并不包括口、鼻、咽喉的黏液。咳痰是呼吸道内的病理分泌物借助于支气管粘膜上皮细胞的纤毛运动、支气管平滑肌的收缩及咳嗽时的气流冲动，将呼吸道内的分泌物从口腔排除的动作。简单而言是：咳嗽伴有痰液时称为咳痰, 也叫湿性咳嗽，相对的是干性咳嗽(俗称干咳, 指无痰或痰量甚少的咳嗽)。咳痰常见于肺炎、慢性咽炎、慢性支气管炎、支气管扩张、肺脓肿与空洞型肺结核等疾病。 咳嗽(cough)是促使痰液或气道异物排出的一种保护性生理反射，有利于排除误入呼吸道的异物、清除呼吸道的分泌物和有害因子。来自呼吸道黏膜的刺激通过迷走神经、舌咽神经和三叉神经的感觉纤维传入至延髓咳嗽中枢，由喉下神经、膈神经和脊神经传出，将冲动传到咽肌、声门、膈肌和其他呼吸肌引起咳嗽动作。但频繁或剧烈的咳嗽和咳多量或黏稠的痰则属病态。过强烈或长时间的咳嗽有时反而会造成患者呼吸、睡眠及生活上的严重干扰，引起呼吸道内的感染扩散、呼吸道出血、肺泡破裂及气胸、胸内压改变而影响心血管功能。 一、辨痰知病因：了解观察痰的量、色、气味、性状常可提示诊断。一般来说，痰液是气道炎症或感染的产物，但也可以是来自肺泡的分泌物。对患者痰液的评价主要是要了解痰液的性状，并根据其性状确定导致咳痰的病因。 （一）性状1、黏液性痰：痰质黏稠，无色透明或稍白，多见于支气管炎、支气管哮喘、肺炎球菌肺炎的初期。2、黏液脓性痰：痰液性状介于黏液性痰和脓性痰之间，痰内除黏液外有一部分脓，带黄白色，富黏性;常见于支气管炎，肺结核，肺内炎症等。这是由于肺组织在炎症过程中形成脓液，同时又有大量黏液分泌物相混而成。3、脓性痰：痰呈脓性，为黄色或绿色，质黏稠，有的带有臭味，常见于化脓性支气管炎，支气管扩张，肺脓肿，脓胸或肝，脊椎，纵隔脓肿溃穿肺部造成的支气管瘘等，带臭味的脓性痰，常提示厌氧菌感染。4、浆液性痰泡沫状痰：痰液稀薄而多泡沫，常见于肺水肿，是由于肺瘀血或肺毛细血管道透性增高，毛细血管内液体渗入肺泡所致。5、血性痰：痰内带有血液，血液多少不一，少者为血丝状痰，多者可为粉红色，棕褐色。常见肺癌，肺结核，肺梗死，支气管扩张等。根据痰液的一些症状，我们可以判断患者发生的咳痰是正常的咳痰现象，还是不正常的咳痰现象，还有就是如果发生了不正常的咳痰，我们也可以及早发现身体出现的问题，及时的去检查，这也是发现疾病的一个方法。 （二）痰量痰量多的疾病有肺水肿，肺脓肿，支气管扩张，肺泡细胞癌，脓胸或肚脓肿形成支气管瘘等。检查痰量一般以24h为准，痰量增多反映支气管和肺的炎症进展；痰不能顺利排出，临床上虽表现为痰量减少，实际上病情仍在发展，中毒症状也会加重。 （三）气味一般的痰无臭味，放置时间长时由于痰内细菌的分解作用产生臭味，厌氧菌感染时，痰有恶臭，见于肺于疽、肺脓肿、支气管扩张，支气管肺癌的晚期。 （四）颜色无色透明或灰白色黏液痰见于正常人、支气管黏膜轻度炎症。黄色或绿色黏痰提示呼吸道存在化脓性感染，绿色痰常因含胆汁，变性血红蛋白或绿脓素所致，见于黄疸，吸收缓慢的肺炎球菌肺炎，肺部绿脓杆菌感染，血性痰见于肺癌，肺结核，支气管扩张，铁锈色痰，见于肺炎球菌肺炎。粉红色或血性泡沫痰见急性肺水肿。红褐色或巧克力色痰，见于阿米巴肝脓肿溃穿入肺内引起的肺阿米巴病。果酱样痰见于肺吸虫病，灰色或黑色痰，见于各种尘肺，如煤尘肺等。棕色痰，见于肺梗死，肺含铁血黄色沉着症。 （五）伴随症状咳痰伴高热者应考虑肺炎，肺脓肿。咳痰伴胸痛者应注意肺部病变波及胸膜者如肺炎，肺癌，肺梗死等。咳痰者长期接触有害粉尘史时应考虑相应的尘肺。咳粉红色泡沫痰伴呼吸困难者应注意急性肺水肿，40岁以上男性，有长期吸烟史，咳血性痰应警惕肺癌的可能。 青岛环语翻译公司业务联系电话：15588617120 联系人：姜淑香QQ邮箱：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