乾燥性鼻炎

乾燥性鼻炎

楊惟婷

 

乾燥性鼻炎(chronic rhinitis sicca)一般認為長期受外界的物理或化學物質的刺激所致,如長期粉塵的機械性刺激、空氣過熱或過乾的影響等,是一種常見的職業性、慢性鼻炎。

 

一、乾燥性鼻炎的病因

 

■乾燥性鼻炎多發生在氣候乾燥的冬、春季;

■高溫作業和在有大量粉塵環境中工作的人也容易發生乾燥性鼻炎;

■維生素(A、B2、C)缺乏可引起鼻黏膜改變,誘發乾燥性鼻炎;

■吸煙、飲酒及其他周身疾病,可使患者抵抗力減弱,易於發病。

 

二、乾燥性鼻炎的症状

 

■乾燥性鼻炎大多鼻內發乾,鼻腔分泌物減少,發癢、灼熱感,常誘使患者挖鼻,引起小量鼻出血,嗅覺一般不減退。

■鼻粘膜杯狀細胞減少或消失致鼻粘膜乾燥,但鼻粘膜和鼻甲骨均無萎縮,鼻分泌物也無臭味。因鼻、咽粘液腺體萎縮,鼻分泌減少之故,鼻涕過於粘稠,粘於粘膜上,不易擤出,有時帶血或血痂。

■鼻內有刺癢感或異物感,經常引起噴嚏,患者經常揉鼻、挖鼻,藉以減輕症状。

■粘膜乾燥,血管易於脆裂,輕微損傷,常導致出血,尤其粘膜糜爛、潰瘍或鼻中隔穿孔時,經常有血涕。

■急性鼻炎初期粘膜鮮紅充血,有粘液性分泌物。

■慢性鼻炎前鼻鏡檢查可見鼻粘膜深紅色,表面乾燥無光,鼻道有絲狀分泌物。

■鼻中隔前下區粘膜常糜爛,可有小片薄痂附著,去之常出血。

 

三、乾燥性鼻炎的併發症

 

當鼻炎未能得到及時治療,影響嗅覺粘膜時,就會出現嗅覺障礙,導致聞不著香臭等氣味。

 

當長期反覆發作的鼻竇炎未得到及時治療,炎症就會擴散至鄰近器官、組織,而併發如額骨骨髓炎、眶骨壁骨炎及骨膜炎、眶壁骨膜下膿腫、眶內蜂窩織炎、球後視神經炎、硬腦膜外膿腫、硬腦膜下膿腫、化膿性腦膜炎、腦膿腫、海綿竇血栓性靜脈炎等多種危重急症。

 

四、乾燥性鼻炎的防治方法

 

1、首先,增加室內濕度。

可用加濕器,或常用清水拖地,也可在室內養些植物。

2、其次,可每天做鼻部按摩。

用拇指、食指夾住鼻根兩側,用力向下拉,由上而下連拉12次。此法可促使鼻黏膜的血液循環,有利於鼻黏膜的正常分泌,保持鼻腔的濕潤。

3、感覺鼻腔乾燥時,可以將一杯開水放到口鼻處,讓蒸汽濕潤鼻腔,出門時還可戴上口罩。

4、飲食中忌食辛辣、燥熱、煎炸的刺激性食物之物,多吃些蔬菜、水果,保持大便通暢。

5、可定期滴、塗有潤澤鼻腔作用的藥劑,或感覺鼻腔乾燥時使用油劑滴鼻藥液,如復方薄荷油、鼻軟膏等。

6、適量服用魚肝油丸或維生素B2,對於預防鼻腔乾燥也有不錯的效果。

7、平時多補充一些維生素A、B2、C,有助於鼻黏膜上皮的恢復。

因為維生素B2能增強細胞功能,促進鼻黏膜纖毛的運動。

維生素C對毛細血管壁有保護作用。

8、應戒除煙酒。

 

五、乾燥性鼻炎的中醫治療

 

1、燥邪傷鼻症

■主症:鼻內乾燥、灼熱、異物感,有時鼻涕帶血。鼻粘膜乾燥,下鼻甲前端常有少許結痂,鼻中隔前下方乾紅,或有咽癢乾咳,口乾欲飲。舌質偏紅少苔,脈細略數。

■治法:清燥宣肺,養陰生津。

■治療乾燥性鼻炎方藥:清燥救肺湯(《醫門法律》霜桑葉、石膏、芝麻仁、人蔘、甘草、枇杷葉、阿膠、麥冬、杏仁)加減,方中人蔘改為沙參、鼻衄者加元參、白茅根、炒蒲黃,大便干者加郁李仁、火麻仁。

 

2、陰虛鼻竅失濡症

■主症:鼻內乾燥、刺癢。灼熱感,時有少量衄血,鼻粘膜乾燥,鼻中隔乾紅,有少許結痂,口燥咽乾,腰膝酸軟,舌紅少苔,脈細數。

■治療乾燥性鼻炎方藥:百合固金湯(《醫方集解》百合、生地、熟地、麥冬、當歸、白芍、川貝母、玄參、桔梗、甘草)。

 

3、氣虛鼻竅失養症

■主症:鼻內乾燥感、異物感、灼熱感、鼻涕帶血、鼻粘膜色淡少津,鼻中隔前方乾燥、糜爛、結痂。倦怠乏力、面色無華、納差、舌質淡、脈弱無力。

■治法:健脾益氣、升清潤燥。

■治療乾燥性鼻炎方藥:補中益氣湯(《脾胃論》黃芪、人蔘、白朮、當歸、升麻、柴胡、陳皮、甘草)加薩參、麥冬、百合等。

 

4、脾胃郁熱症

■主症:鼻內乾燥、鼻息氣熱。多見鼻衄、鼻粘膜干紅,鼻中隔前下方有少量結痂、糜爛,咽乾欲飲、大便乾、小便黃、舌質紅、苔黃而乾、脈滑數。

■治法:清解肺胃、生津潤燥。

■治療乾燥性鼻炎方藥:加味升葛湯(《醫學見能》升麻、葛根、白芍、甘草、連翹、銀花、天花粉、白芷、杏仁、枳殼、生地、黃芩、芒硝)。

 

六、乾燥性鼻炎的西醫護理

 

(一)去除病因。

如降塵、降溫、通風等改善環境條件,加強個人保護,如戴口罩、沖洗鼻腔等措施。

■對於乾燥性鼻炎,不要經常用手挖鼻,以免損傷鼻黏膜,每天應清洗鼻腔,將結痂浸軟,取出。

(二) 鼻腔可用油劑滴鼻藥液。如復方薄荷油、液體石蠟或鼻軟膏。

■應注意勿用血管收縮劑。

■可鼻內滴用生理鹽水、5%葡萄糖鹽水、液體石蠟、1%~3%碳酸氫鈉、稀釋甘油等,上述藥物可根據情況任選一種。一般認為5%葡萄糖生理鹽水效果較好,無刺激性,可以長期使用。

■此外,可以進行鼻腔沖洗,每天一次。

■為保護鼻黏膜,氣候乾燥時,出門時應戴口罩。

(三) 每天做鼻部摩擦或按摩鼻穴:用拇指沿鼻樑上下摩擦鼻翼數次,用食指旋轉按摩「迎香」穴數次,加強鼻部血液流通。

(四)內服維生素C,對毛細血管壁有保護作用,每日3次。

(五) 內服維生素A,有助於上皮的恢復,劑量為5000U,每日1次。

(七) 內服維生素B2,能促進細胞的正常新陳代謝,用量為10mg,每日3次。

(八) 內服魚肝油丸,2丸,每日3次。

 

七、消除秋燥引起的「火大」

 

「哈啾!哈啾!」,過敏的鼻子總是最先感受到秋天捎來的訊息。

有的人則會覺得口乾舌燥、喉嚨脹痛,很難受,猛灌水也沒用。

這些症狀是秋燥引起的,秋天氣候乾爽,燥氣導致身體缺水而上火,產生發炎、乾燥等不適。

 

中醫認為秋氣與人體的肺臟相通,若燥氣太強,容易引起上呼吸道疾病,如乾咳、喉嚨痛等,加上肺在五行中屬金,金剋木,肺氣強會傷屬木的肝,進而產生肝火、虛火,因此容易失眠、便秘或腹瀉。

此外肺也主皮毛,表現在皮膚上就是乾燥、緊繃、起疹子、泛紅。

 

(一)多吃「保濕」食物

 

1、解決身體「火大」引起的症狀,首要多吃滋陰潤燥的食物,增加體內的「保濕液」。有生津退火功效的杏仁、百合、銀耳、梨子、山藥、蘿蔔、豆腐是不錯選擇。

 

2、反之涼寒的食物要忌口,例如西瓜、香瓜等瓜果類,因為秋天漸漸陰長陽消,「秋瓜壞肚」,易損脾胃陽氣,造成腹瀉。

 

3、也要少吃辛辣食物,如蔥、薑、蒜、韭、椒等,以免加重乾燥症狀。

 

4、有些中藥則可以養滋潤肺,如西洋參、麥門冬、枸杞、茯苓、川貝母、玉竹等。一種避免「火大」的秘方是提氣的黃耆2錢、滋陰的麥冬3錢,再加補脾胃的沙蔘3錢,以500cc水煮沸後早晚飲用。

 

(二)體質虛寒的人,更應提早吃「溫熱」食補

 

而體質虛寒的人,更應提早養生,預防秋天寒氣入侵。尤其是「冷底」的過敏體質(深受氣喘、過敏性鼻炎、異位性皮膚炎所苦),為了避免過敏疾病發作,可從七夕(國曆八月)就開始就吃溫熱食物麻油雞,而且以人參、西洋參調氣,讓身體活絡,抵禦寒氣。

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