呼吸(xi)系(xi)統(tong)疾病是(shi)兒(er)童(tong)常見(jian)病，主要有上呼吸(xi)道感(gan)染(感(gan)冒、發燒)、喉(hou)炎(yan)、氣管(guan)炎(yan)、肺炎(yan)、哮喘等。兒(er)童(tong)易發生呼吸(xi)系(xi)統(tong)疾病除了抵抗力弱以外，家(jia)庭護理不(bu)周、居住環境不(bu)佳、生活習慣不(bu)好也是(shi)主要誘(you)因(yin)。

五洲(zhou)兒(er)科(ke)對常見(jian)兒(er)童呼(hu)吸系統疾(ji)病(bing)提(ti)供診療(liao)服(fu)務，提(ti)倡(chang)適當使用(yong)藥物、合理(li)應用(yong)抗(kang)生素(su)并拒絕(jue)過度醫療(liao)等綠(lv)色的醫療(liao)方式，針對兒(er)童呼(hu)吸系統疾(ji)病(bing)根源，指導家長改(gai)善(shan)孩(hai)子(zi)的生活方式，通過必(bi)要的治療(liao)結合行為醫學實現孩(hai)子(zi)身體的痊愈(yu)。

常識(shi)分享：呼吸道疾(ji)病常見的癥狀與體征

【癥狀】

呼吸系(xi)統的(de)咳(ke)嗽、咳(ke)痰(tan)、咯血、氣急、哮(xiao)鳴、胸痛等癥(zheng)狀，雖為一般肺部所(suo)共有(you). 但仍各有(you)一定(ding)的(de)特點，可(ke)能為診斷提供參考。

1、咳(ke)(ke)(ke)嗽(sou)。急(ji)性(xing)(xing)發(fa)(fa)作(zuo)(zuo)的(de)興奮(fen)性(xing)(xing)干咳(ke)(ke)(ke)常為(wei)上(shang)呼吸道炎引起，若伴有發(fa)(fa)熱、聲嘶，常提示急(ji)疾細菌性(xing)(xing)咽、喉、氣(qi)(qi)(qi)管(guan)、支(zhi)氣(qi)(qi)(qi)管(guan)炎。慢性(xing)(xing)支(zhi)氣(qi)(qi)(qi)管(guan)炎，咳(ke)(ke)(ke)嗽(sou)多在寒冷天發(fa)(fa)作(zuo)(zuo)，氣(qi)(qi)(qi)候(hou)轉暖時(shi)緩解。改(gai)變時(shi)咳(ke)(ke)(ke)痰加劇，常見于肺(fei)膿腫、支(zhi)氣(qi)(qi)(qi)管(guan)擴(kuo)張。支(zhi)氣(qi)(qi)(qi)管(guan)癌初(chu)期出現(xian)(xian)干咳(ke)(ke)(ke)，當腫瘤增大阻塞(sai)氣(qi)(qi)(qi)道，出現(xian)(xian)高音調的(de)阻塞(sai)性(xing)(xing)咳(ke)(ke)(ke)嗽(sou)。陣發(fa)(fa)性(xing)(xing)咳(ke)(ke)(ke)嗽(sou)可(ke)為(wei)支(zhi)氣(qi)(qi)(qi)管(guan)哮喘的(de)一種(zhong)表現(xian)(xian)，晚(wan)間陣發(fa)(fa)性(xing)(xing)咳(ke)(ke)(ke)嗽(sou)可(ke)見于左心衰竭的(de)患(huan)者。

2、咳痰(tan)(tan)(tan)。痰(tan)(tan)(tan)的(de)性(xing)質(zhi)(漿液、粘液、粘液膿性(xing)、膿性(xing))、量、氣(qi)味(wei)，對診斷有(you)一定幫助。慢支咳白色泡沫(mo)或(huo)粘液痰(tan)(tan)(tan)。支氣(qi)管擴張(zhang)、肺(fei)膿腫的(de)痰(tan)(tan)(tan)呈有(you)色膿性(xing)，且(qie)量多，伴厭氧菌感染(ran)時，膿痰(tan)(tan)(tan)有(you)惡臭。肺(fei)水腫時，咳粉紅色稀薄泡沫(mo)痰(tan)(tan)(tan)。肺(fei)阿米(mi)巴(ba)病呈咖啡色，且(qie)出現(xian)體溫升高，可(ke)能與(yu)支氣(qi)管引(yin)流不暢(chang)有(you)關。

3、咯血(xue)(xue)。咯血(xue)(xue)可以從痰中帶血(xue)(xue)到整口(kou)鮮紅血(xue)(xue)。肺(fei)結核、支氣(qi)管肺(fei)癌以痰血(xue)(xue)或少量咯血(xue)(xue)為多(duo)見;支氣(qi)管擴張的細支氣(qi)管動(dong)脈形成小動(dong)脈瘤(體循環)或肺(fei)結核空洞壁動(dong)脈瘤破裂可引(yin)起反復、大(da)量咯血(xue)(xue)，24h達300ml以上。此外咯血(xue)(xue)應(ying)與口(kou)鼻喉和上消化道出血(xue)(xue)相鑒別。

4、呼(hu)吸(xi)困(kun)難。按其發作(zuo)(zuo)快慢(man)分為急(ji)性(xing)(xing)(xing)(xing)(xing)、慢(man)性(xing)(xing)(xing)(xing)(xing)和(he)反復發作(zuo)(zuo)性(xing)(xing)(xing)(xing)(xing)。急(ji)性(xing)(xing)(xing)(xing)(xing)氣(qi)(qi)(qi)(qi)急(ji)伴(ban)(ban)胸(xiong)痛常(chang)提示肺炎、氣(qi)(qi)(qi)(qi)胸(xiong)、胸(xiong)腔積液，應注(zhu)意肺梗塞(sai)(sai)，左心衰(shuai)竭(jie)患(huan)者常(chang)出(chu)現(xian)夜間陣發性(xing)(xing)(xing)(xing)(xing)端坐呼(hu)吸(xi)困(kun)難。慢(man)性(xing)(xing)(xing)(xing)(xing)進行性(xing)(xing)(xing)(xing)(xing)氣(qi)(qi)(qi)(qi)急(ji)見于慢(man)性(xing)(xing)(xing)(xing)(xing)阻塞(sai)(sai)性(xing)(xing)(xing)(xing)(xing)肺病、彌散性(xing)(xing)(xing)(xing)(xing)肺間質纖維化疾病。支(zhi)氣(qi)(qi)(qi)(qi)管(guan)(guan)哮喘(chuan)發作(zuo)(zuo)時(shi)，出(chu)現(xian)呼(hu)氣(qi)(qi)(qi)(qi)性(xing)(xing)(xing)(xing)(xing)呼(hu)吸(xi)困(kun)難，且伴(ban)(ban)哮鳴音(yin)，緩解(jie)時(shi)可消失，下次發作(zuo)(zuo)時(shi)又復出(chu)現(xian)。呼(hu)吸(xi)困(kun)難可分吸(xi)氣(qi)(qi)(qi)(qi)性(xing)(xing)(xing)(xing)(xing)、呼(hu)氣(qi)(qi)(qi)(qi)性(xing)(xing)(xing)(xing)(xing)和(he)混合性(xing)(xing)(xing)(xing)(xing)三種。如喉(hou)頭水腫、喉(hou)氣(qi)(qi)(qi)(qi)管(guan)(guan)炎癥、腫瘤或異物引(yin)起(qi)上氣(qi)(qi)(qi)(qi)道狹窄，出(chu)現(xian)吸(xi)氣(qi)(qi)(qi)(qi)性(xing)(xing)(xing)(xing)(xing)喘(chuan)鳴音(yin);哮喘(chuan)或喘(chuan)息性(xing)(xing)(xing)(xing)(xing)支(zhi)氣(qi)(qi)(qi)(qi)管(guan)(guan)炎引(yin)起(qi)下呼(hu)吸(xi)道廣泛(fan)支(zhi)氣(qi)(qi)(qi)(qi)管(guan)(guan)痙攣，則引(yin)起(qi)呼(hu)氣(qi)(qi)(qi)(qi)性(xing)(xing)(xing)(xing)(xing)哮鳴音(yin)。

5、胸(xiong)痛(tong)(tong)(tong)(tong)(tong)。肺和(he)臟層(ceng)胸(xiong)膜對(dui)痛(tong)(tong)(tong)(tong)(tong)覺不敏感，肺炎、肺結核、肺梗塞、肺膿腫(zhong)等病(bing)變累及壁(bi)層(ceng)胸(xiong)膜時(shi)，方(fang)發生胸(xiong)痛(tong)(tong)(tong)(tong)(tong)。胸(xiong)痛(tong)(tong)(tong)(tong)(tong)伴高熱，考慮肺炎。肺癌侵及胸(xiong)壁(bi)層(ceng)胸(xiong)膜或骨，出現隱痛(tong)(tong)(tong)(tong)(tong)，持續加劇，乃至刀(dao)割樣痛(tong)(tong)(tong)(tong)(tong)。亦(yi)應注意與非呼吸系(xi)疾(ji)病(bing)引起的(de)胸(xiong)痛(tong)(tong)(tong)(tong)(tong)相(xiang)鑒(jian)別，如心絞痛(tong)(tong)(tong)(tong)(tong)、縱(zong)隔(ge)、食(shi)管、膈和(he)腹腔(qiang)疾(ji)患所致(zhi)的(de)胸(xiong)痛(tong)(tong)(tong)(tong)(tong)。

【體征】

由于病(bing)變的(de)(de)(de)性質(zhi)、范圍(wei)不同，胸前疾(ji)病(bing)的(de)(de)(de)體征(zheng)(zheng)可完全正常(chang)(chang)或出現(xian)明顯異(yi)常(chang)(chang)。氣(qi)管(guan)支氣(qi)管(guan)病(bing)變以干濕啰音為主;肺(fei)(fei)部(bu)炎(yan)變有(you)呼吸音性質(zhi)、音調和(he)強度的(de)(de)(de)改變，如(ru)大片炎(yan)變呈實變體征(zheng)(zheng);胸腔(qiang)積液、氣(qi)胸、或肺(fei)(fei)不張可出現(xian)相應(ying)的(de)(de)(de)體征(zheng)(zheng)，可伴有(you)氣(qi)管(guan)的(de)(de)(de)移位。胸前疾(ji)患可伴有(you)肺(fei)(fei)外的(de)(de)(de)表現(xian)，常(chang)(chang)見的(de)(de)(de)有(you)支氣(qi)管(guan)-肺(fei)(fei)和(he)胸膜化膿疾(ji)病(bing)變的(de)(de)(de)杵狀指(趾);某些(xie)支氣(qi)管(guan)肺(fei)(fei)癌(ai)所致的(de)(de)(de)肺(fei)(fei)性骨關節(jie)病(bing)、杵狀指，還有(you)因異(yi)位內分(fen)泌(mi)癥群等(deng)副癌(ai)綜合征(zheng)(zheng)。