非心源性胸痛

1、非 心 源 性 胸 痛Non-Cardiogenic Chest Pain 非心源性胸痛的病因Cause of Non-cardiogenic chest painpain胸壁疾病(disease of chest wall)：1)急性皮炎(acute dermatitis)2)皮下蜂窩織炎(subcutaneously dermatocellulitis)3)帶狀皰疹(herpes zoster)4)肌炎(myositis)5)肋軟骨炎(costal chondritis)6)肋間神經(jīng)炎(intercostal neuritis)7)肋骨骨折(fracture of rib)8)急性白血病(

2、acute leukemia)9)多發(fā)性骨髓瘤(multiple myeloma )等。 呼吸系統(tǒng)疾病(disease of respiratory system)：1)胸膜炎(pleurisy)2)胸膜腫瘤(pleural tumors)3)氣胸(pneumothorax)4)急性氣管-支氣管炎(acute trachea-bronchitis)5)肺炎(pneumonia)6)肺癌(lung cancer)等縱膈疾病(diseases of mediastinum)：1)縱隔膿腫(mediastinal abscess)2)縱隔腫瘤(mediastinal mass)3)縱隔氣腫(medi

3、astinal emphysema)消化系統(tǒng)疾病(disease of digestive system)：1)食管疾病(esophageal disease)2)肝膿腫（hepatapostema）3)肝癌（hepatic cancer)4)膽囊疾?。╣allbladder disease)等可導(dǎo)致胸痛的食管疾?。?1）胃食管反流病(Gastroesophageal reflux disease GERD) 2）食管裂孔疝(hiatus hernia) 3）食管憩室（esophageal diverticulum) 4）賁門失弛緩癥(cardiac achalasia) 5) 食管癌（car

4、cinoma of esophagus） 6）食管痙攣（esophageal spasm) 胃食管反流病包括NERD和RE，引起的胸痛多在進(jìn)食后1小時(shí)內(nèi)發(fā)生，疼痛程度不一定與病變的輕重程度一致。嚴(yán)重的疼痛與心絞痛類似。GERD的診斷除根據(jù)癥狀和體征外，輔助檢查包括食管pH和壓力檢測(cè)以及胃鏡檢查。LA Classification of RELundell et al. Gut. 1999;45:172-180.LA Grade D1 mucosal breaks bridging the tops of folds and involving 75% of the circumference1

5、 isolated mucosal breaks 5 mm longLA Grade BLA Grade C1 mucosal breaks bridging the tops of folds but involving 75% of the circumference1 isolated mucosal breaks 5 mm longLA Grade A食管裂孔疝：疼痛誘因與反流性食管炎類似，輕重與疝囊大小有關(guān)。食管憩室：憩室內(nèi)食物殘留引發(fā)炎癥或較大憩室牽拉食管可引起疼痛。賁門失弛緩癥：疼痛多位于胸骨后，發(fā)作有時(shí)酷似心絞痛，甚至舌下含硝酸甘油片可緩解。當(dāng)梗阻上段食管進(jìn)一步擴(kuò)張時(shí)疼痛反可減輕。食管癌：表現(xiàn)為吞咽食物時(shí)有胸骨后或劍突下疼痛，性質(zhì)可為燒灼樣、