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挫折的媽媽 留話於:2005/4/6 |
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內因性氣喘? |
小女今年10歲.在4個月大時曾經得過細支氣管炎,接近週歲時得過一次肺炎.之後常夜咳以致嘔吐,只好抱著她(直立的姿勢靠在我胸前)坐在沙發上才能一覺到天明.幼兒時期也常因夜咳求診,醫師告知只是"支氣管較敏感"而非氣喘.去年因為感冒,高燒不退且嚴重的咳嗽(不分白天黑夜),至大醫院照X光,醫師告知是"支氣管肺炎"(bronchopneumonia)而服用了一週的抗生素.之後又因為小女乘坐雲霄飛車過度興奮的大叫以致聲音沙啞才又至大醫院求診.但在無意間醫師聽診時聽到小女的支氣管收縮的聲音,而懷疑小女有氣喘.之後又連續兩個月(平均一個月一次)的嚴重夜咳皆以口服3日的類固醇,症狀才告緩解.醫師開單抽血檢驗小女的免疫球蛋白E,但數值不高(62).因此醫師判定小女的氣喘為"內因性氣喘".想請教醫師的是:
1. "內因性氣喘"的原因為何?為何小女過敏指數不高,卻有很明顯的過敏反應?(鼻涕倒流,上個月還得了一次過敏性皮膚炎,也是口服3日類固醇收場)
2. 雖有藥物控制(輔舒良和輔舒酮),但小女常常清喉嚨,好像喉嚨總是有痰.而有時只是大笑幾聲,就會咳嗽.發作的時候連吃飯也會咳嗽,高歌幾曲也會咳嗽,跟其他小朋友玩(跑跑跳跳)也會咳嗽.為什麼會這樣?
3. 發作期間,睡前也有口服支氣管擴張劑,輔舒良和輔舒酮也有使用,但夜裡還是會連續咳嗽咳不停,連坐著睡都咳,就算是喝溫開水,咳嗽藥水,用盡各種辦法,還是咳到半夜(半夜兩三點),非要吸一口"備勞喘"才能止住.我真的很擔心,小女的氣喘會不會愈來愈嚴重?
小女自小以來常為咳嗽所苦,而我也盡心盡力的照顧.只要醫生說什麼,我就配合什麼(環境控制,注重保暖,注意飲食-不食冰冷刺激食物,注重小女營養均衡,讓小女學游泳...)同事都開玩笑說我是"世界上最認真的媽媽".但小女再三的發作卻讓我有很深的挫折感.所以希望醫生能告訴我該怎麼做,才能讓小女的氣喘在將來有機會可以痊癒?不管有什麼方式,只要不會傷害到孩子的健康,我都願意嘗試,也決不放棄任何可以治癒的機會.
懇請醫師撥冗回覆上述問題,並提供氣喘兒照顧的建議.
感謝您! |
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葉子田 回應於:2005/4/9 |
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內因性氣喘 |
1. 氣喘可分為內因性、外因性及內外混合性。外因性氣喘(過敏性氣喘)主要因吸入外界過敏原所引起,受外界過敏原的重複刺激產生過敏反應而誘發氣喘,免疫球蛋白E(過敏性抗體)會升高,過敏皮膚測驗呈陽性,常和過敏體質有關且多具有家族過敏史。內因性氣喘原因不明,非因外界過敏原刺激所產生,可因感冒而發作,過敏抗體不會上升,過敏皮膚測驗常呈陰性且無家族過敏史。
2.,3. 咳嗽是氣喘常見的臨床表現,雖有用輔舒良和輔舒酮治療但症狀仍常發生,或許可請過敏專科醫生做藥物的調節。氣喘病患的臨床進程差異性極大,難斷定會不會愈來愈嚴重,但應適當的治療及控制。建議您帶女兒來小兒過敏科做評估。
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